Marjorie Wall, Director of Sterile Processing, Kaiser Permanente
In the past, Sterile Processing Departments (SPD) processed simple instruments using relatively simple technology and techniques. Today, surgical instrumentation is becoming more complex and less intuitive to process. SPD needs ever evolving technology to meet this growing demand and must become agile and adaptive to technological innovation, shaping their worlds, and ultimately ensuring safe surgical outcomes. Adapting and innovating is the only way SPD will be able to meet the increased demand, workload, and complexity that exists in today’s healthcare environment. We need innovators and innovation.
Surgical Instrument Tracking Systems
In the late 90’s the first surgical instrument tracking systems started hitting the sterile processing world. Unfortunately, many organizations still do not use them while many SPDs still rely on paper/manual systems. Tracking systems are essential to the success of departments. A surgical instrument tracking system will document the daily washer efficacy testing and routine sterilizer testing. Sterilizers and washers are interfaced with tracking systems to ensure accurate and consistent documentation. SPD techs are required to document decontamination processes, instrument inspection, on screen assembly with missing instrument tracking, sterilization cycles, and scanning to sterile storage and ultimately tracing surgical trays to the patients. Often biological incubators are interfaced with the tracking system, providing excellent and compliant documentation of test results. Many systems are interfaced with surgical scheduling systems ensuring SPD departments plan for critical trays needed for surgery.
Advanced departments are integrating competencies into these tracking systems to ensure competencies are documented for all staff as required. Staffs are not allowed by the system to process instruments or to use equipment that they have not been trained on. Surgical trays preventative maintenance is tracked and tied to the tray’s usage ensuring trays receive maintenance as they are used. As a result, surgeons have functional working instrumentation for every procedure. Workflows are built for complex instrumentation and endoscopes with complex instrument processing, ensuring SPD staff are compliant with the required steps and the patient has safe, ready to use endoscopes. Infection control has trackability in the event of a surgical site infection outbreak. The organization can see which tray is used on which patient, if all the required steps and tests were completed and documented, and if the tray was used on any other patients.
"Adapting and innovating is the only way SPD can meet the increased demand, workload, and complexity that exists in today’s healthcare environment"
An innovative SPD leader will use the information from the tracking system to make data driven decisions and build business plans. Usage exceeding inventory reports show which trays need to be invested in. Inventory exceeds usage reports show which trays are dead inventory using up valuable space. Staff productivity can be analyzed to ensure there are proper staffing levels. Quality event tracking can show trends like which technicians need education, which trays need to be simplified or revised, and which processes need education.
Machine Learning, Artificial Intelligence, and Accurate Data
Machine learning (ML) and artificial intelligence (AI) are revolutionizing our industry. Today we have companies building integrated data systems with hospitals. The result is predictive software that can predict the instruments and implants needed for specific procedures. Imagine a knee procedure where the organization knows exactly what instruments and implants are needed. Now only the required instruments are sent to the hospital. The hospital’s SPD department now only receives two trays instead of 10. The patient and surgeon get exactly what they need, and SPD is not inundated processing instruments that will never be used. The vendor saves money by reducing redundant inventory.
Machine learning algorithms are powering clever SPD Departments. Data scientists and samurai are analyzing existing instrument tracking databases to help clean up bad data. This new clean data powers accurate count sheets and drastically reduces the SPD instrument tray error rates. This data powers value of production and analyses which help bridge the gap with hospital financial leaders. SPD leaders can build business plans using the value of production to justify staffing and critical resources. Organizations can use data to show what surgeons are using to benchmark procedures, creating clinical and financial best practices.
Machine learning algorithms can analyze the manufacture instructions for use for surgical instruments and create workflow processing instruments, following manufacture instructions for use. This data can be integrated into instrument tracking systems, ensuring compliance with all phases of instrument processing. Imagine a system that analyzes the IFUs for every instrument in a tray. The system would then create a process flow where the tech would follow the identified steps for the specific tray and document compliance to those steps.
Visual recognition may be the biggest game changer coming to the sterile processing industry. Visual recognition can recognize and identify instrumentation using optical cameras. The system can then document in the tracking system that the instrument is there for the tray as required. I believe future iterations will be able to detect bioburden and instrument damage. This technology currently exists for instrument assembly but, may be deployed soon in the decontamination areas of the department as well. Imagine a system where an instrument is pulled out of the sink by a tech, the AI powered camera then recognizes the instrument and displays the decontamination steps. The tech then performs those steps, and the system documents the work as completed. This type of process on the instrument inspection/assembly and decontamination processes is what we need to ensure safe functioning surgical instruments.
Augmented Reality and Virtual Reality
There are a few areas where augmented reality (AR) makes a critical difference in SPD. Imagine apps on cell phones or tablets where an instrument can be scanned by the camera, and then the screen displays the inspection points on the image of the instrument. Also imagine a future where this technology is integrated with “google glass” or other smart glass technology, and the inspection steps can be displayed on the glasses worn by the tech in decontamination or assembly listing the required processes. Sterile processing technicians will have the data and AR technology to ensure success.
Virtual Reality (VR) is the future learning space for sterile processing techs. Today, most techs are trained using real equipment in the real world. This can lead to devastating results. Expensive instruments receive excessive wear and tear or are damaged. Imagine where sterile processing techs can learn and test their skills in a virtual environment.
The biggest fear for SPD leaders imagining the future is automation. Automation exists in the industry, and many fear that it will take away the jobs of technicians. There are robots that wrap instrument trays, automation systems that help techs assemble instrument sets, systems that use visual recognition to identify instruments, and dispense perfect peel pouches with labels. There are even sterile storage systems that dispense trays and robots to deliver case carts. The truth is that as this technology gets smarter and better with data and machine learning powering it, this technology is going to revolutionize our industry. I do not see jobs being replaced by machines, but I do see SPD techs transitioning to focus on inspection and servicing the operating room. Today is the time to be a part of how this technology evolves to ensure it is the best for man and machine.