Boone Hospital Center is a 375-bed full service hospital that is located in Columbia, MO, and managed by BJC HealthCare of St. Louis, MO. Boone Hospital Center specializes in cardiology, neurology, oncology, surgical services, and obstetrical services. The hospital maintains a 24-hour emergency center with hospital-based ambulance service and a helipad for emergency air transportation.

Boone Hospital Center’s Central Service (CS) department provides hospital-wide processing of patient care equipment and instrumentation, and is operational twenty four hours a day, seven days a week. The department is staffed by a CS director, a CS manager, a day supervisor, an evening and night supervisor, and a support staff of 22.5 full-time employees.

Past and present central services
When Betty Vaughn was hired as a CS attendant at Boone Hospital Center in 1974, the department was primarily responsible for sterilization and linen packing. The department had one Amsco steam sterilizer and one Amsco ETO sterilizer, and both were manually operated.

In response to the increasing complexity of surgical instruments and demand for instrument processing, in1987 the CS department moved into a new building designed to provide an effective workflow and improve productivity. As part of the upgrade, the hospital purchased additional state-of-the-art Amsco sterilization equipment.

In 1995 a new CS director was hired to manage Boone’s CS department. The new CS director encouraged the purchase of cutting edge technology. Outdated equipment was replaced with the latest Amsco equipment, which was reliable and efficient and was supported by what was considered to be excellent technical service.

The future of CS at Boone:
planning for efficiency,
safety, and productivity
In order to keep up with ever-changing demands from the surgical department and to continue their commitment to excellence, Boone Hospital Center’s CS department will be moving into a four-story, 57,000 square foot addition to the hospital in 2005. This addition will centralize and improve access to the hospital’s outpatient services and provide 6,242 square feet of space for the CS department.

Designing a new department is a challenge that many never have the opportunity to experience. The Boone CS staff has been working with the architects and their STERIS representative to create a department that will fully support the processing of current and future instruments and equipment.

In preparing for projected reprocessing needs, Boone’s facility planners have considered a number of factors, including:
• Employee and environmental safety: protecting personnel from current and emerging microorganisms by replacing manual cleaning methods with automated processes

• Distance, time, and logistics: optimizing workflow to reduce wasted labor

• Current and projected numbers of surgical cases and volume of instruments

• Types of devices and their reprocessing requirements: providing sufficient equipment flexibility for a variety of device designs and decontamination methods

• Instrument tracking: to avoid loss of instruments and unintended use of damaged instruments

Technology for total instrument management
Boone’s CS functions will be fully optimized through the use of the latest in equipment and instrument tracking software. The department will improve its instrument management system and process by doubling the number of computers. All CS and surgical instrument count sheets will be maintained and updated through the instrument management system.

The department is purchasing instrument management software that will interface with its sterilizers and disinfection systems. Instrument trays will be scanned through all work stations, providing real-time tracking. Comprehensive reporting options will allow critical business decisions to be based on accurate, real-time data. This will ensure that Boone can optimize instrument usage and avoid unnecessary costs.

Two existing medium steam sterilizers will be relocated from the old CS department to the new one. A small steam sterilizer will also be relocated to process fast-track requests from the operating room. An Amsco 3017 ETO sterilizer and Eagle EO monitor will also be relocated, along with two STERRAD 100 sterilizers.

A new Amsco Century prevacuum steam sterilizer with a sixty inch chamber will be added to increase the department’s productivity. The deeper and wider chamber will allow Boone’s CS department to significantly increase the number of instruments they are able to process per load, compared to their current Eagle systems. One Hamo LS-2000 Washer/Disinfector will replace the existing Hamo unit that is over twenty years old. The plan is to process delicate surgical instruments in this new washer. Planners are investigating the possibility of adding a STERRAD 200 system as well, for heat and moisture-sensitive items.

A cannulated instrument cleaning system will also complement the decontamination area. This unit is equipped with pulsed sonic irrigation for cleaning inside and outside of all cannulated and small-lumen surgical instruments. An Amsco Sonic Energy Console with rinsing and drying systems will also be added for surgical instrument cleaning, to remove soil from difficult-to-reach places that washers and manual cleaning may not remove.

An existing double-door cart and utensil washer/disinfector will relocate to the new area, and an additional double-door cart and utensil washer/disinfector will be installed that features an automatic tilt floor system to properly drain the flat surfaces of carts. The floor of this unit will automatically return to its level position at the completion of the cycle (about ten minutes) and microcomputers will monitor and control washer operation and functions.

As part of the improvements being made, the Surgery department at Boone Hospital Center will receive a sixth Century steam sterilizer, as well as a fifth SYSTEM 1 Sterile Processing System for their heat-sensitive, immersible devices. The hospital believes that this will ensure that the surgery department has an adequate number of sterilizers to handle all potential intraoperative needs for flash and just-in-time sterilization.

Storage and workspaces optimized
The team has also planned equipment that will optimize storage and workspaces. Three additional STERIS consoles with stainless steel pegboards will provide storage for instrumentation, and new cabinetry will be added for increased storage. Ten new adjustable workstations will be available for staff use and sterile supplies will be stored on metal shelving.

Ample space will be provided in the new department for the staging of soiled case carts before they are processed and sent through the cart washer. The area will feature four Reliance Synergy washer/disinfectors that are designed to improve productivity through faster cycle times and reduced utility consumption. A Reliance Automated Transport System will also be incorporated, to facilitate the movement of loads into and out of the washers.

Cleanup counters will be provided for heat and moisture sensitive items and small equipment. A pass-through window will allow transfer of heat and moisture sensitive items to the preparation and packaging area. Sinks will be supplied with splash guards to reduce aerosolization and splashing.

A designated room to clean equipment such as IV poles will feature a floor drain and sprayer. Planners are also investigating real-time asset locating systems (their equipment is currently tracked on a daily basis by an equipment tracking technician).

Supporting the staff
The heart of the CS department, the staff, will be thoroughly prepared to carry out their responsibilities. They are already enthusiastically committed to their jobs and dedicated to the future of the central service profession, which is part of what makes Boone Hospital an excellent place to work and receive healthcare.

The hospital’s goal is to foster trusting and supportive management-employee relationships and improve the CS staff’s professional skills by providing an environment conducive to personal growth. The department will also continue to encourage the education of Central Service technicians through certification. Study guides and workbooks will be provided at no cost to the employees who want to become certified. Certified individuals will be recognized with a salary increase and a title change from Central Service Assistant to Certified Central Service Technician.

Prepared for the future
Boone Hospital Center will meet the challenge of moving the CS department by working with the hospital’s Infection Control department, STERIS experts, and their surgical and CS department teams. The Boone CS staff is enthusiastic and extremely knowledgeable. They receive strong support from the CS director and the Boone Hospital Center administration. The CS department continuously invests in the best technology and employs best practices in patient care in order to improve the health of the people and communities they serve and to ensure that their patients have the best possible outcomes.