How to Make Safe Surgery and Smart Tracking of Surgical Instruments a Priority

The inadequate cleaning of reusable instruments ranks as one of the top 10 health technology risks for providers in 2017. In fact, it has been identified as a hazard for the past six years in a row by the ECRI Institute, a nonprofit that researches approaches to improving patient care. Meanwhile, between 2,000 and 4,000 surgical items are accidentally left behind in patients each year in the United States, according to, a national surgical patient-safety project to prevent retained surgical items.

As healthcare providers work to improve the safety of patients in the operating room and throughout the course of their treatment, they are zeroing in on better processes for processing and tracking surgical instruments.

Refining the Process

Though the Joint Commission’s healthcare facility reviews include proper equipment reprocessing and cleaning, many providers continue to face challenges in meeting all the criteria. While it was once common to clean surgical instruments with flash sterilization—a quick modification of conventional steam sterilization for immediate use—that approach is no longer recommended for patient safety reasons. According to the Joint Commission, flash sterilization should only be used in extraordinary circumstances.

“There are multiple steps in the process of tracking and disinfecting instrumentation and equipment for reuse,” says Pam Delong, director of surgical services at HealthTrust. “Just one misstep could have very serious consequences. Some devices are difficult to clean and others, such as endoscopes, take multiple steps to ensure cleanliness and then disinfection.”

“In recent years, the topic of instrument disinfection and sterilization has been widely discussed, and suppliers are working closely with the Food and Drug Administration and the Centers for Disease Control and Prevention to ensure that appropriate methods are in place for removing all debris, tissue and bacteria,” Delong says. “Most suppliers also offer training on the cleaning and disinfection of scopes.”

Steps for Safety

Franklin, Tennessee-based Community Health Systems (CHS), which owns, operates or leases 158 hospitals in 22 states, has instituted a number of successful patient safety strategies. For example, five years ago, its affiliated hospitals began using the Stryker SurgiCount Safe Sponge technology to help ensure a more accurate, real-time count of surgical sponges in the operating room.

“Nationally, sponges account for 80 percent of retained items, and 90 percent of the time when sponges are retained the doctor was told that the count was correct,” says Pat Turner, senior director of surgical services at CHS. “The SurgiCount technology ensures staff is counting appropriately. Our affiliated hospitals perform approximately 1 million surgical cases each year, and there has been a significant reduction in retained sponges by the utilization of this technology.”

In addition to using sponge tracking technology, CHS promotes the use of a Safe Surgery Checklist, which is similar to the World Health Organization’s Surgical Safety Checklist. As part of these guidelines, everyone in the room should participate during the briefing and debriefing. Before every invasive procedure, a timeout is called and team members in the operating room go through the checklist together. “The checklist incorporates a briefing among the healthcare team, and it promotes teamwork in the operating room,” Turner says.

Also as part of the procedure, the circulating nurse introduces everybody in the room—including anesthesia professionals and supplier reps—who take turns talking about their role during the surgery, what they will do for the patient, and any other information to share about the patient or procedure.

The surgeon should say, “If you see anything that concerns you, please speak up,” one quick line that helps overcome any inhibitions that junior team members may feel about speaking up in front of senior-level professionals.

Such team conversations create an open, collaborative culture in the operating room, which Turner believes helps ensure patient safety. As part of the South Carolina Safe Surgery 2015 Project, CHS has worked since 2013 with Atul Gawande and Ariadne Labs at the Harvard University School of Public Health to develop safe surgery routines, and is part of an ongoing Harvard study about how to improve the culture of safety in the operating room.

“Many CHS-affiliated hospitals also utilize critical event checklists that were created by working with staff on OR-related events such as hemorrhage and hypothermia,” Turner says. “Several of our affiliated hospitals helped develop critical event checklists for events in surgery, and other departments such as obstetrics and emergency medicine.”

Tracking Trends

Hospitals that are focused on implementing the latest procedures to keep patients safe are seeing results, and the healthcare industry continues to fine-tune the solutions. In recent years, tracking technology has become increasingly important.

“Tracking systems can be used to count instruments sent for sterile processing, but they can also track repair histories, cleaning and sterilization processes,” Delong says. “Additionally, tracking systems can assist with instrument inventory. They can locate instruments and monitor their availability for surgical cases, which helps to prevent lost instruments.”

Today’s tracking systems have evolved so that they now can interface with other systems and devices, such as steam sterilizers and high-level disinfection equipment, Delong says. These features have become more critical as accurate records are needed for quality assurance recordkeeping of sterilization and high-level disinfection documentation. Some advanced tracking systems can include each instrument’s instructions for use (IFU) or recommended cleaning protocol, she adds.

“Appropriate sterile processing can be challenging, with the high volume of sets needing to be reprocessed, the complexity of the devices, and the numerous and conflicting IFUs and recommendations,” says Marcia Frieze, CEO of Case Medical, a U.S. manufacturer of products for instrument processing.

Healthcare facilities should establish standardized parameters and validate their cleaning process to ensure effective decontamination is the result each and every time, Frieze says. She recommends starting by reading the manufacturer’s IFUs for proper care and handling.

“Keep in mind that a few extra minutes of reprocessing time and elevated temperature for terminal disinfection can make the difference between a successful outcome or an infection that can be life-threatening,” she adds.

A number of “test soils” are available on the market to verify that the equipment and cleaning agent is working effectively, such as Case Medical’s product for routine monitoring. (HealthTrust Contract No. 7303)

Several published guidelines are available for hospitals to ensure their instrument cleaning protocols meet the latest standards: The Association of periOperative Registered Nurses’ Guideline for Cleaning and Care of Surgical Instruments 2015 and the Association for the Advancement of Medical Instrumentation Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities.

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