How One La Jolla Quality Team Improved Sterilization
May, 2008
Not long ago, the sterile processing department at Scripps La Jolla realized that they were using flash sterilization methods way too often. This quick, open-pan method for sterilizing surgical instruments can present more infection risk and shouldn’t be used more than five percent of the time, yet Scripps La Jolla’s rate was 28 percent.
The team closely evaluated the situation, and decided that a major overhaul was necessary. The change would be difficult, and would require close cooperation: “We knew that reducing flash sterilization by more than 20 percent would require a major shift,” says Jeanne Shirley, administrative director of clinical epidemiology. “We needed to work with surgeons, nurses, SPD techs and vendors to create entirely new processes. This was a big deal.”
A primer on sterilization
Instrument sterilization can be done a couple of ways. Flash sterilization often uses an open pan, raising the risk of contamination as the instruments are transported. As a result, flash sterilized instruments must be used as soon as possible. Wrapped instruments, on the other hand, can be stored indefinitely without fear of contamination.
Ideally, the flash process should only be used rarely, in an emergency, but busy operating
rooms require a constant cycle of sterile instruments, and flash sterilization takes significantly less time. “The most important thing is proper instrument decontamination,” says Shirley. “We were flash sterilizing too often — flash should only be used for emergency purposes and should not be a substitute for inefficient inventory.”
Making changes: Implementing closed containers and more specialized techs
To get started, the team looked at how they were flashing. The first step was to eliminate open pan flash sterilizations by using flash containers. Eliminating the open pan reduced the risk of contamination while the instruments were being transported to the operating room.
The team also recognized that both nurses and sterile processing techs were conducting sterilizations. Each specialty was approaching the process differently and there were even inconsistencies within specialties.
To combat these problems, La Jolla changed the rules so that only techs would perform flash sterilization. In addition to giving the hospital more control over the process and training, the move also benefitted nurses, who had more time for patient care. While this change increased the workload for techs, it also created a group of specialists doing a specific task, which provided more opportunity to control and standardize the process.
As a result of these and other changes, flash sterilization came down from 28 to 17 percent. It was a great start but still a long way from the 5 percent goal.
Increasing instrument availability
The main reason for excessive flash use was case turnover and instrument availability. The sterilization team needed to focus on the inventory and how vendors were meeting needs. Bottom line, the team needed more instruments.
But it wasn’t enough to just buy instruments; they had to buy the right ones. They studied their needs and ultimately bought more ophthalmology and orthopedic instruments, which cost $966,000.
Equally important, they had to enforce the existing policy on loaner instruments. Under that policy, vendors needed to deliver instruments 24 hours before the surgery; but in reality, instruments often arrived the day of surgery or even an hour before.
“It was a difficult mindset to change,” says Shirley, “but we created vendor agreements and got more than 100 vendors to sign. Now, the vendors would not even think about bringing in instruments less than 24 hours before surgery, and we have 100 percent compliance. The process took two years, but we went from 17 percent flash sterilization to 1 percent.”
La Jolla’s success gets attention
Not too long after La Jolla achieved these low flash sterilization rates, representatives
from Loma Linda University came to discuss instrument bar coding. They noticed a commendation for the achievement and thought it was a misprint. They have since requested help in improving their own sterilization procedures.
In a similar vein, a surveyor from the Joint Commission noted the same commendation and was amazed, saying no one in California had even come close.
Meeting the challenge through discipline, process
“We were successful because we embraced the challenge. We reduced flash sterilization from 28 percent to 1 percent and increased documentation from 42 percent to almost 100 percent,” says Shirley. “But also, we provided a more disciplined environment for these technically complex problems and we gained a greater appreciation for each other’s contributions to the patient care process.”