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Safety Matters by Karin Lillis
“We’ve been consistent for at least five years,” says Rose Seavey, RN, director of the sterile processing department at The Children’s Hospital in Denver. “We’re using the same line of disinfectant products since we moved into our new department five years ago. There’s no reason for us to change. We get good pricing through our group purchasing organization, and the company has been very loyal to us in terms of customer support. The biggest thing, though, from a manager’s or director’s point of view, is product standardization – that the same line of products is used to disinfect throughout the hospital.” Like her counterparts at other hospitals, Seavey is keenly aware of the time factor. At Children’s, individual packets of instruments used in the OR are soaked in an enzymatic solution on the way to sterile processing. “The instruments have a five-minute soak in an enzymatic solution en route to our department, so when we get them, for the most part, all we do is put them in the manual washer,” she says. “Of course, our dream system would have absolutely no hands-on contact. It would literally clean out the lumens and take care of the instruments with no manual cleaning involved. There isn’t anything out there like that, but if there was, we’d have it.” Safety matters Carole Barksdale, RN, coordinator of OR and CPD materials processing at Children’s Hospital Boston, says the pasteurization process using hot water that’s employed at the 320-bed institution is a safe and economical way to treat those items that need only medium- or high-level disinfection, rather than sterilization. “In our particular situation, anything that goes into a joint or an enclosed space – like the head or thorax – has to go through a high-level disinfection process, then sterilization by another method, like ethylene oxide,” Barksdale adds. When it comes to sterilization, “we’re pretty much a STERIS hospital,” Barksdale says, referring to the Mentor, OH-based infection control products manufacturer. About 97 percent of the hospital’s sterilization is done by steam sterilization, she says. Other methods include ethylene oxide and peracetic acid. Children’s Hospital Boston generally uses the cleaners and solutions sold by the equipment manufacturers, says Barksdale. “All of our detergents come under the STERIS umbrella. We use their enzymatics, and we also have their solution for our automated washers and decontaminators,” Barksdale says. “Generally, we try to stay with the same companies, although we don’t with the pasteurizers. For the washer part of that process, the company makes a detergent, but it has too high of a pH level.” New detergent, old equipment Dorothea “Dottie” Conroy, RN, central supply manager at the 209-bed Methodist Hospital in Henderson, KY, recently began using a new detergent that she says has helped the hospital cut costs and improve quality. For the hospital’s HAMO T-21, Conroy’s staff uses RPS, distributed by Critical Care Innovations. “The detergent cleans better, and instruments come out with no residue,” Conroy says. “It also lubricates metal equipment, and on plastics, it doesn’t. So you don’t have to use a lubricant when metal instruments come out of the washers.” Conroy considers herself fortunate because her hospital considers in-depth cost-effectiveness rather than more superficial savings in transactional costs. For instance, RPS could be termed expensive at $140 for five gallons of detergent. But since the hospital’s previous detergents cost about $160, or $80 each for containers of alkaline and acid detergents, plus another $164 for a five-gallon container of lubricant, the cost picture takes a different turn. “We did a cost-free trial and found that the staff didn’t have to clean spots off instruments when they came out of the washer,” Conroy says. “Metal equipment was already lubricated, and the equipment wasn’t tacky or sticky. They come out cleaner. Moreover, we can now eliminate the acid detergent rinse, and so using the RPS cuts down on our cycle time.” Conroy’s biggest challenge is the age of some of the department’s sterilization equipment. The CS department is due to move to new quarters in two years, so the hospital has postponed the purchase of new equipment. “We have an old Amsco sterilizer that we bought in 1983 that we’ll replace when we move to the new department in two years, but right now we just have to pat it on the side and say, ‘Please work another day,’” Conroy says with a laugh. The hospital plans to replace the weary Amsco with a newer unit that includes a Joslyn mouth. “My dream system would be a new Amsco sterilizer right now, but the hospital would have to move it a second time in the next two years. It’s not that they won’t buy something new; they want to wait until the new facilities are in place.” Group therapy “We are part of a GPO. They tell us what we must use,” says a central supply director of a three-hospital system on the East Coast, echoing the frustration of many department heads. “Our home office is pushing one particular product, but I don’t like it,” says the director, who asked to remain unidentified. “Sometimes we have to use a particular product because it’s under a preferred contract. It takes away my freedom to be able to choose the proper product that meets the demands of the hospital. If you have a specialty or niche project and Allegiance, for example, doesn’t make the product to meet the need, then I am permitted to go off-contract. For instance, we process a lot of orthopedic instruments, and we need a product that will cut through heavy fat and heavy grease. If Allegiance doesn’t make a product that can [adequately] do that, then I can order something else.” She says she “ends up getting really creative” with the contract to order some of the supplies that can offer the quality and capabilities she wants. She’s also challenged to find disinfectants and detergents that can work with the facilities’ current equipment, most of which is getting older. “You have to be careful that it will work with your current equipment. You need to make sure the concentrates and measurements are the same and that the pump function of the detergent works at the same level as it was using the manufacturer’s brand name. You’ve got to do your homework. If you have a real runny detergent versus a thick one, that makes a very big difference. Some detergents aren’t compatible with the machinery you’re using. All detergents are not created equal. I usually demand research data and other information on the product up front. I want to know what the manufacturer has used it for in their lab tests.” HPN |
November
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Choosing sterilants and disinfectants can be a tricky business
Central supply managers continually keep an eye out for those sometimes elusive products that can improve quality and efficiency without walloping their department’s budget. Some find themselves constantly evaluating and changing the product mix, while others have found a groove that’s comfortable enough to simply take along for the ride.
