Becker's Clinical Quality & Infection Control

43 Executive Briefing How Adopting a Rigid Tray Container System Can Increase Efficiencies & Provide Patient Safety N orth Memorial Medical Center in Robbinsdale, Minn., recently started seeing an increased volume of high- er-acuity patients in its operating room, putting an immediate strain on the hospital's sterile processing depart- ment. To keep up with the rising demand while maintaining adherence to sterilization protocols, hospital executives knew something had to change. The cause of the increased demand was twofold. First, North Memorial Medical Center centralized the instrumentation of all the trays in the system, including outpatient and clinic instrument trays, to its hospital location. This dramatically increased demand on the hospital's sterile processing department very rapidly. Additionally, per the post-Affordable Care Act trend of sicker patients seeking medical care now that they have insurance, this hospital has seen a higher volume of more acutely ill patients, thus making the instrument sets needed for surgeries more complicated, according to Uggen Jigmey, the hospital's sterile processing department manager. He says demand in his department increased 15 percent since 2015. In addition to keeping up with climbing demand, the department is still required to turn the instruments out in a safe and timely matter. The North Memorial Medical Center infection control team had generally turned to immediate-use steam sterilization, or "flash" sterilization, to sterilize surgical instruments when in a time crunch. However, studies have shown that while IUSS allows for quicker tray turnover, it isn't ideal for infection prevention. Guidance from CMS published in 2014 says IUSS has been "implicated in surgical site infections and [is] con- sidered to pose an increased risk of complications because of potential barriers to thorough completion of all necessary reprocessing steps." The document continues, "Therefore use of IUSS, even when all steps are performed properly, should be limited to situa- tions in which there is an urgent need and insufficient time to process an instrument by using terminal sterilization." Given this information, the infection prevention team at North Memorial Medical Center knew it had to move away from IUSS. "We knew we wanted to do something about it, to reduce the number of times we used IUSS," said Stephanie Swanson, infec- tion prevention manager at the hospital. "We want all instruments terminally sterilized… There are a lot of factors for patients getting infections that we can't control, but this one we can." An All-Encompassing Solution Administrators at North Memorial Medical Center found the solution to both the increased demand for sterile processing and the focus on decreasing IUSS use in the One Tray system. The One Tray system is manufactured and distributed through- out the world exclusively by Innovative Sterilization Technol- ogies. The sterilization system includes a rigid container with patented design features and processing kits that include the proprietary filters. The tray design combined with the propri- etary filters allows surgical assets to be terminally sterilized much faster than with any other rigid container or wraps. In fact, One Tray has been validated for zero minutes of minimum dry/cool time, thus radically shortening the time needed to safely sterilize a tray. The Implementation Process North Memorial Medical Center has a phased implementation plan. Currently, the hospital uses the One Tray system for trays needed on the next case and on loaner trays because it allows for faster turnover. Further down the line, One Tray will even- tually be used on all surgical assets that can be processed in a rigid container. The hospital began the implementation plan March 1, 2016. Change doesn't always come easy, but thorough education eases the process, as North Memorial Medical Center found to be true when introducing One Tray to front-line staff. The biggest change, according to Mr. Jigmey and Ms. Swan- son, involves residual water in the tray at the end of the steril- ization cycle. When wraps are used, no water should be pres- ent if a tray is properly sterilized, but with One Tray, moisture in the tray is a normal part of the process. This idea represented the undoing of years of education for the front-line members of the OR staff. Something that was once a cause for concern or correction — water in the tray — is now an acceptable effect from the One Tray system. Sponsored by: "We knew we wanted to…reduce the number of times we used IUSS." — Stephanie Swanson

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