DaWayna Carter-Williams, Instrument Processing technician, inspects surgical instrumentation under a lighted magnifier.

Each year Instrument Processing cleans and sterilizes:
  • 31,500 flexible scopes
  • 147,000 instrument sets
  • 168,000 peel-packed items

That adds up to more than 5,000,000 pieces of surgical equipment! This number becomes even more impressive when you understand the exacting processes to decontaminate and clean – using the correct type and mixture of cleaning and disinfectant solutions, making sure items are sterilized at the right temperature… and for an exact amount of time. Behind the scenes, this team’s work is a well-orchestrated process that runs 24:7, ensuring that the right tools are available for every patient and every procedure.

“People tend to think you clean medical equipment with a squirt of Dawn,” said Tony Griffin, manager of Instrument Processing/Endoscopy. But, in fact, there’s a science behind it that does not allow any deviation.

The Technology of Cleaning

IP cleans all equipment and instruments used in the hospital’s 31 ORs and procedures on HUP’s medical/surgical units as well as those from outpatient procedures (such as endoscopies) from CPUP practices and clinics. And it’s always in accordance with the manufacturer’s specifications. For example, items with multiple parts require disassembly first, to ensure all areas of the product are effectively pre-cleaned and inspected, prior to being cycled through the washer decontaminator.

Techs also have to know how to “rebuild” an instrument set prior to sterilization. “Instruments cannot be arbitrarily placed in the sterilization container,” Griffin said. To help guide them, they use an online tool that lists the components of each set and a photo of how each set should be put together. But, before assembling any set – or readying anything for sterilization – the tech examines and tests each item to make sure it is not damaged in any way…. and clean. “You can clean without sterilizing but you cannot sterilize without cleaning.”

This tool also tracks the location and utilization of any instrument built into the system. In fact, many checks and balances are in place to help them internally monitor, evaluate and audit all processes for potential problems. This includes several apps, created with the help of Boris Zhitomirsky of IS. “These reports bring together critical information from multiple systems to help us look for trends and determine how to best address identified issues,” Griffin said.

Kirsten Hunter, IP technician, performs a manual cleaning of a flexible endoscope.

Keeping Up with Demand

The majority of used instruments comes through IP on the second shift, between 4 pm and midnight, but HUP’s open OR schedule means that some equipment needed for the next day are still in use in the evening – or even overnight. So how do they make sure they can fulfill all surgical needs every day? There’s an app for that too!

The daily “Instrument Conflict” report monitors how many instrument sets, endoscopes and other surgical pieces are available during the day compared to how many will be needed for upcoming surgical cases. It also lists start times, case length, and anticipated turnaround time for the instrument set. Every day at 1 pm, Griffin meets with a multidisciplinary group, which can include James Mullen, MD, corporate director of Peri-Op; Daniel Dempsey, MD, chief of Gastrointestinal Surgery; and nurse managers, to discuss and set the OR schedule for the next day and resolve any potential conflict.

As Griffin explained, “Let’s say a surgeon has scheduled five consecutive cases which will need a specific instrument set but HUP has only four. Do we have enough turnaround time [generally around four hours] to clean and sterilize the set used in the first case in time for the last?” The conflict can sometimes be resolved during the meeting; other times they’ll reach out to the surgeon performing the cases to help work out a resolution. Even a small adjustment – like moving the last case back 30 minutes – can eliminate the problem.

Because this daily meeting takes place early in the day, the group can work out conflicts in the next day’s schedule by the end of the previous work day. Before the advent of “Instrument Conflict” app, Griffin had to manually pull information from several systems and scour it for problems. “But I wouldn’t know until late in the evening, so the nurse manager or surgeon had to be notified first thing in the morning,” he said. “The sharing of the critical information has paid tremendous dividends in providing a smoother workflow to each surgical day.”

“Sterile Processing is a key contributor to the effective functioning of a busy OR,” Mullen said. “The team delivers an extraordinary performance, 24/7.”

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