Reducing errors in sterile processing of OR instruments
The Joint Commission Update for Infection Control
Targeting lower infection rates. reduced costs
Although health care providers are well aware of how important it is to clean, disinfect, and sterilize medical equipment, devices, and supplies, The Joint Commission has observed several significant missteps in these processes in recent years, the American College of Surgeons (ACS) reports.1
The ACS cites "issues related to the proper use of steam sterilization as well as the unprecedented pace at which new devices and resistant pathogens have emerged and generated concern. In response, The Joint Commission has revised a standard and two elements of performance related to reducing these risks in ambulatory care facilities, critical access hospitals, hospitals, long-term care facilities, and office-based surgery centers, the ACS reports.
To address such issues, the ACS recommends a recently published description of the program at Virginia Mason Medical Center in Seattle, WA, where quality improvement interventions in the surgical instrument sterilization process were based on adoption of a specific set of Lean production improvement methods called the Virginia Mason Production System (VMPS). An article in The Joint Commission Journal on Quality and Patient Safety describes how the center used VMPS to improve surgical sterile instrument processing in its 24 operating rooms, where approximately 18,000 operative procedures are performed annually.2
The 37-month project at Virginia Mason relied on a quality monitoring approach that was developed to identify and categorize errors in sterile instrument processing through use of a "daily defect sheet." The organization used Lean methods to reduce risks in sterile processing of surgical instruments by creating separate steps of defined work related to assembling and packaging the instruments and by rearranging the physically confined sterile processing workspace to accommodate the new work processes. The center also developed a brief checklist and other processes to mistake-proof sterilization, created an instrument sterilization certification training program for staff, and sought continuous feedback on the sterilization processes, the ACS reported.
As a result of the project, the instrument sterilization error rate decreased 50%, going from 3.0 per 100 surgical procedures at baseline to 1.5 in the final sustainability period. Improvements were observed in multiple categories of error types, particularly assembly errors in packaging and foreign objects such as pens and paper clips. Although process reviewers at Virginia Mason were unable to directly measure and attribute specific clinical outcomes to the surgical instrument processing interventions, reviewers anticipate the improved processes will contribute to lower infection rates, fewer surgical errors, and reduced costs, the ACS concluded.
- American College of Surgeons. Using Lean methodology to improve sterilization of surgical instruments Bulletin of the ACS. June 1, 2013: http://bulletin.facs.org/2013/06/using-lean-method/
- Blackmore CC, Bishop R, Luker S, et al. Applying Lean Methods to improve quality and safety in surgical sterile instrument processing. Jt Comm J Qual Patient Saf 2013;39(3):99.