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Worth Repeating


“Characteristics of the surgery and sur- gical environment can place patients at higher risk. Patients who have longer duration surgeries are at increased risk of perioperative hypothermia due to length of anesthesia. Environmental temperatures in the operating suite can cause the loss of metabolic heat due to convection, especially in pa- tients who must have a lot of skin exposed for the procedure.”


Stephanie Stroever, MPH, CIC, Infection


Prevention & Control Consultant, Infection Prevention & Management Associates Inc.


“From our perspective we’ve wit- nessed a shift over the years in how hospitals manage and store their instruments. Between wrapped sets and rigid containers, the only way to ensure complete sterility is to never stack your instrumentation sets. When you stack containers on top of one another, there will be a good chance of residue build up be- tween containers and a reduction of airfl ow. ”


Ian Loper, Vice President of Sales and Marketing, DSI Inc


“You cannot improve a process that is not measured and observed. Begin by performing data collection and doing observations to compare re- source utilization to patient outcomes. Often the results and insight gained from seeing the processes show that non-standardized or high-resource utilization procedures are not al- ways associated with better patient outcomes.”


Kim Blakey, Executive Director, Sterile


Processing Department, LeeSar Regional Service Center


“There is a very fi ne balance between a truly germ-free healthcare environ- ment and the potentially detrimental effects that the presence of no bac- teria can have on the microbiome of healthcare. It is certainly the goal and target of infection prevention and control efforts to achieve a healthcare delivery dynamic where no patient endures the consequences of an HAI.”


Hudson Garrett, Vice President, Clinical Affairs, PDI


he concept of healthcare quality has undergone many evolutionary changes over the decades. Established in 1952, The Joint Commission developed the fi rst “minimum quality standards” for all North American hospitals. Medicare and Medicaid programs followed in 1965, redefi ning “quality of care” and leading The Joint Commission to require “optimum achievable standards.” Healthcare stake- holders have since discussed many aspects of healthcare quality improve- ment, eventually agreeing on the need for greater collabora- tion and for providing effec- tive, appropriate care more sustainably, standardizing performance measures, and promoting public reporting. The Affordable Care Act of 2010 later established national measures and reporting re- quirements for U.S. healthcare providers — the basis of today’s healthcare performance standards.1 Medical Center of the Rockies (MCR),


T


a 166-bed regional medical center in Loveland, CO, developed an evidence- based strategy — a continuous improve- ment case — that increased processing capacity and improved patient, staff and environmental safety.


Specializing in heart and trauma care, in


the mid-2000s, MCR was performing two to three heart bypass procedures per day. These typically required using transesopha- geal echocardiogram (TEE) probes, which are commonly used during open-heart procedures and for evaluating and imaging the large vessels and valves of the heart.2 Considered semi-critical devices, they re- quire cleaning and high-level disinfection before reuse.3, 4 To help assure a controlled process, MCR’s sterile processing department (SPD) was reprocessing the TEE probes using a manual soak process in PCI Medical’s GUS


56 October 2015 • HEALTHCARE PURCHASING NEWS • www.hpnonline.com


Soak Stations, with an opthalaldehyde (OPA) high level disinfectant (HLD). Each cycle required 12 minutes of soak time to achieve high-level disinfection. To assure staff safety, venting reduced the fumes and employees were monitored for the permis- sible exposure limit to OPA. A spill kit was also available if needed. Once the 14-day useful life of the OPA expired, the solution was neutralized before it went down the sanitary drain.


“Comparing the productivity of the two products, we validated that we could reduce the exposure time in each cycle by four minutes, increasing productivity by 150 percent. This enabled us to reprocess fi ve TEE probes a day with existing staff and equipment, almost twice the current number.”


New construction/ procedures — a benchmarking improvement opportunity


Around the same time, plans were in place to expand the cardiac program, which would add new procedures and at a higher volume. This provided every department the opportunity to audit current spaces, pro- cesses and performance and determine how they could be improved. Two challenges affected the processing of TEE equipment: Our SPD team was expected to expand productivity to meet the new surgical goal of fi ve cardiovascular procedures a day; and we were asked to seek greener processes and products that would support environmental sustainability initiatives and thereby help the facility achieve LEED status. We investigated STERIS Corporation’s high-level disinfection chemistry, Revital- Ox Resert High Level Disinfectant, which was compatible with our GUS systems and could address both these challenges and more. Compared to our existing HLD,


See PEOPLE & OPINIONS on page 58


PEOPLE & OPINIONS TEE reprocessing


gone green Evidence-based continuous improvement


for high-level disinfection by Damien Berg, Performance Improvement Consultant, University of Colorado Health


PEOPLE & OPINIONS


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