Sanford Health’s Instrument Quality Conundrum

Nov. 28, 2023
Lead coordinator, Central Processing/Surgical Services at Sanford Health shares with Healthcare Purchasing News how she became a water quality expert

In 2021, Sioux Falls, S.D.-based Sanford Health’s sterile processing department (SPD) received a conditional level finding from the Joint Commission due to poor instrument quality. The finding came with an increase in executive leader engagement and pressure to fix the problem. The Sterile Processing leadership team worked 6-7 days a week for several months to go through all of the instrumentation, repair, replace and educate to new practices. The Joint Commission conducted the revisit, and the team was successful in showcasing the work they had done and plans to continue the work in the future.    

With the addition of about $2.5 million of new instrumentation in the department, 2022 was off to a great start. Or so it seemed, that is until some instruments started to show signs of rusting and staining.  Following the education provided the year prior, team members brought forward the instruments and a thorough investigation started. This investigation started with looking at techniques for washing instruments, assembling, and sterilizer practices. Sanford SPD equipment vendor Getinge was assembled and found no deviation from IFU guidelines or equipment functionality. Still, rusting was happening before sets were ever used on patients.

Healthcare Purchasing News (HPN) spoke with Lori Buskol, lead coordinator, Central Processing/Surgical Services at Sanford Health about this very situation to gain her perspective.One of the main challenges after the visit from the Joint Commission, Buskol says, was that Sanford Health has tens of thousands of instruments and thousands of instrument sets. She comments, “We had to start making spreadsheets immediately on everything that we owned and that wasn't even everything that we owned that is used in the operating room, it was everything that we used at our clinics too.”

Teamwork makes the dream work

“We had one person on our team who was really good at getting these spreadsheets put together and a few team members that were really good at finding instruments, which can be very challenging when you have a facility of our size,” Buskol adds. “We had 30 days to do this process before the Joint Commission was rescheduled to do their revisit. That is not a lot of time to ensure we got through everything. The staff was very engaged in this process, there was a ton of information given out to them. We do three reports per day for each shift, and we would talk about what the instruments needed to look like.”

Buskol notes that there was a lot of education for the team, even so much so as having their mobile repair vendors come in and help by educating staff as to what to look for and what needed to be done. Even the purchasing team was educated on what instruments to order.

“This was extremely challenging because this was also during COVID, so everything was on back order,” she says. “We had to come up with a process for instruments that were still good to use but needed to be replaced fairly soon—how we kept track of those to make sure we could gather them later when the replacements came in.”

Buskol goes on to explain that when new instrumentation came into the facility, they were put through a unique device identifier process that was very time consuming. As she was working on this process, the team realized that the new instruments were just not holding up as well as they should. There were issues with rusting before instruments were even used.

This lead Buskol’s team to a water investigation. She tells HPN that she ran numerous tests and increased their reverse osmosis (RO) water to have a longer run cycle in their washers, which helped a bit. But she still couldn’t pinpoint where the problem was. “The more I looked into this, I noticed people on sterile processing websites talking about their instruments rusting and water quality being an issue,” she comments. “So, I started doing a lot of research on water quality.”

The investigation

Through experimenting, rusting was isolated and found to be happening from the wash cycle. Sanford’s instrument repair partner Agiliti started putting an additional passivation layer on the instruments to try and protect them, but rusting was still showing up.  It wasn’t happening to every instrument, but it was happening to all of the new instrumentation throughout a variety of manufacturers. The SPD team leaned into the project trying to figure out what was happening but also trying to communicate to all customers to alert them of the issues.  

At the end of 2022, an Aesculap Technical Process Analysis (TPA) was conducted to see what was happening.  The results concluded that the water conductivity was three times as high as it should be. To remedy this problem, Aesculap has recommended switching to all critical/RO water for the entire washer cycle. In experimenting, this has eliminated the rusting on the instrumentation that hasn’t built up the passivation layers.

Buskol is now known as a water quality expert at Sanford Health. The advice she gives to SPDs? “All over the nation, people right now don't even realize that maybe the situation that they're having with their instruments involves water,” she states. “But it does a lot of times. It often goes to that whether it's the steam coming out of the boilers, whether it's your RO system, whether it's your water that you use straight from the sink, your city water that comes in, those were all things that I looked at investigated with. I tried to find the leading experts around our area to pick their brains and figure out what kind of information there is.”

Buskol concludes, “And don't be afraid to have a voice. You have a voice in sterile processing. You just need to be brave enough to use it.”