5 Things a Patient Should Be Asking about a Hospital's ...

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Even after the advent of hospital-wide quality metrics and public scoring (such as Leapfrog, US News and World Report's Best Hospitals, CMS's Five-Star Rating System) and physician review sites (such as HealthGrades and RateMD), surgical patients across the country still have almost no insight into one of the most important aspects of safe surgical care: a hospital's surgical instrument program. Regardless of how skilled the surgeon or how highly rated the nursing staff may be, without functional, available, and sterile surgical instrumentation, patients may be placing themselves in harm's way without even knowing it.

Here are 5 things a patient should ask about a hospital's surgical instrument program, but don't:

1) Are the Sterile Processing technicians in this hospital nationally certified?

As an entry-level position in most hospitals, the personnel who reprocess every instrument from cranial drills to minimally-invasive cauterizing clamps are often only required to have a GED to qualify for the role. Without a mandatory certification program for these technicians, there can be no assurance of the kind of necessary baseline knowledge (such as basic microbiology, regulatory standards, and documentation) required to ensure safe surgical instrumentation.

2) Is there a robust preventative maintenance and repair program in place for their surgical instruments?

Most patients never even consider that the scissors, clamps, and retractors being used on them have actually been used many times before, on many other people. But like any other tool, surgical instruments have a limited life-span, and must be maintained, repaired, and removed in accordance with strict manufacturer specifications. If they are not, any number of intra-operative instrument failures can occur.

3) Does this hospital have the proper tools and instrument models to allow for adequate inspection during reprocessing?

With the growing complexity of surgical instrumentation also comes the need for critical inspection tools, such as desktop magnification for micro-eye instrumentation and protein detection systems to pinpoint residual bio-burden prior to sterilization. The first generation of instruments known as laparoscopic graspers and Kerrison rongeurs can not be taken apart or flushed properly during the decontamination phase, so hospitals should be replacing them with advanced models that can be completely taken apart for reprocessing.

4) Is there sufficient instrument inventory to support this hospital's surgical volume?

Due to the competitive financial realities of American healthcare, many hospitals seek to manage their operating room schedules at an ever-growing capacity, but are often not proactive in investing in the capital funds necessary to purchase sufficient levels of instrument inventory. For a patient, this means the instruments needed for the case may have to be rapidly "turned over" from a previous surgery, which could lead to inadequate inspection by Sterile Processing staff, delayed surgery schedules, and extended time under anesthesia. There are many services already available to hospital leadership which enables them to capture big data points to safely optimize their surgical inventory. 

5) Are surgical implant vendor representatives compliant with hospital policies?

Whether the surgical procedure is repairing a complex fracture from a traumatic car accident or a scheduled spinal fusion surgery, much of the instrumentation used will be supplied by external hospital vendors who sell the surgical implants necessary for the procedure. Because this instrumentation is often not hospital owned, it is imperative that all quality standards are met to properly prepare them for surgery. This includes requiring adequate delivery timelines for instrument processing (typically 48 hours prior to the surgical procedure), manufacturer's instructions for use, and FDA approved packaging methods. Vendor instrument delivered late or with incomplete documentation can be a root cause for a number of serious safety events in the Operating Room.

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Even though the quality of a hospital's surgical instrument program is a critical indicator for safe and efficient surgeries, patients do not currently have any means by which to research, compare, and advocate for higher standards regarding CS/SPD departments. The sooner this changes, the better for patient safety. Until then, patients should feel empowered to ask these questions of their healthcare providers and expect the right answers.

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W. Hank Balch &#; April 

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This article is the sole opinion of the author and in no way reflects the position of any employer or facility. 

You can find over 75 other Sterile Processing articles and commentary here, along with published articles in Becker's Hospital Review, Infection Control Today, AAMI News, and contributions to Healthcare Purchasing News. My CS team in Louisville, KY was named the " CS/SPD Department of the Year" by HPN, I currently serve as the President of the South Texas Association of Sterile Processing Services, and have been nominated for the  President-Elect of the International Association of Healthcare Central Service Materiel Management.

Article Overview

The origins of laparoscopic surgery trace back to the introduction of diagnostic laparoscopy in the s. Subsequently, the approach underwent a notable evolution, transitioning from a primarily diagnostic procedure to a surgical technique. Laparoscopic surgery has become the gold standard for treating many pathologies such as symptomatic cholelithiasis, Crohn&#;s disease, and benign ovarian cysts.1, 2, 3 Laparoscopy, a type of minimally invasive surgery, was introduced to address issues related to significant tissue trauma, large cosmetic scars, and prolonged hospitalizations. Various studies have demonstrated that patients undergoing laparoscopic surgery have reduced risks of perioperative mortality and postoperative morbidity in comparison to individuals undergoing open surgery.4, 5 In order to achieve safe and effective surgical outcomes, the operators are required to have an in-depth understanding of the basic and specialized equipment required. 

This video provides a step-by-step demonstration of the assembly, disassembly, use, and handling of laparoscopic tools on the example of a basic Karl Storz laparoscopy kit.

A set of requirements are established to guarantee the efficient handling of the instrument in both the sterilization unit and the operating room. Modern laparoscopic instruments have a distinctive design that enables complete disassembly of each instrument, facilitating efficient cleaning and decontamination. Every modular instrument undergoes validation to ensure that it can be sterilized while fully assembled.

The video begins by introducing the three primary sections of laparoscopic instruments: the insert, the sheath, and the handle. The next part of the video explores three commonly used types of laparoscopic dissectors: the dolphin nose dissector, which has traditional micro-serrated tapered tips; the Maryland dissector with curved forceps, which is ideal for precise manipulations; and the laparoscopic right-angle dissector, which has cross-serrations on its angled tip for grasping tissues in hard-to-reach places. The assembly and disassembly of these dissectors are demonstrated, highlighting the importance of utilizing the tools with non-locking handles to allow for smooth surgeon maneuverability during procedures. The instruments must be completely opened, and the ratchet must be slid into position to activate the locking mechanism; a clear click is produced upon connection. Subsequently, the operator ensures proper functionality by opening and closing the instrument. When the surgeon slides a specific piece down, the ratchet comes into operation. When closed, the ratchet facilitates a secure hold, maintaining the closed position until intentionally released. The removal process involves opening the ratchet, pressing down on a designated button, and effortlessly sliding the handle off. The disassembly of the instrument is completed by twisting and separating the insert from the sheath. This modular design allows for convenient cleaning, maintenance, and potential replacement of individual components.

Next, the video provides a visual overview of medical graspers, which come in numerous variants, distinguished by the inner side of their jaws. Traumatic graspers feature deep serrations or toothed tips for secure gripping, ideal for rigorous procedures. On the other hand, atraumatic graspers have finely serrated inner jaws, providing a gentler touch suitable for delicate tasks involving fragile tissues. The importance of locking handles for graspers, particularly in situations requiring a secure grip, is visually underscored. 

A distinctive feature explored in the video is the integration of a Bovie, an electrosurgical device, with laparoscopic instruments. Viewers are visually guided through the steps of connecting the Bovie cord to the laparoscopic instrument handle, demonstrating the technique of efficient cauterization.

The sterilization of laparoscopic instruments is crucial, with procedures varying based on safety standards dictated by different countries. Before sterilization, these instruments undergo a meticulous process, including wiping down and spraying with enzymatic cleaner. An enzyme-based cleaner is an enzymatic detergent solution, penetrating the hard-to-reach parts of the equipment for thorough cleaning. This detergent offers distinct advantages, such as increased activity on proteins (like blood, feces, and mucous) through proteolytic enzymes, advanced formulations for quick and thorough penetration of organic matter, and a safe, biodegradable base that is gentle on both users and the environment. Following the cleaning process, items designated for disinfection must undergo a thorough rinse to remove any residual detergent. Subsequently, the instruments proceed to the final phase of sterilization.

This video is meant as an informative guide to laparoscopic instruments in the field of surgical technology. The step-by-step visual guidance through the assembly, use, and decontamination processes enhances the understanding of laparoscopic instruments.

Basic Skills for the OR Series

Check out the complete series below: