9/14/2012. Welcome! Topic: Collaboration Critical: Expert Panel Discussion Facilitators: Diane Koch, 3M Susan Flynn, 3M

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1 3M Sterile U Network 3M Sterile U Web Meeting September 20, 2012 Collaboration Critical: Expert Panel Discussion Today s meeting times: 9:00 a.m., 11:00 a.m. and 1:00 p.m. CST 1 To hear audio, call and enter access code Phone lines are muted. Audio will commence when the webinar begins. Introducing the 3M Learning Connection: New Name, Same Great Courses It s an educational resource bringing you 3M Sterile U and other Infection Prevention courses. You ll soon see some exciting new benefits as our program evolves! Improved features: Add to my Calendar feature Other 3M courses will be more accessible as we expand our offerings. What do you need to do? Nothing. Your current registrations remain and our Sterile U offerings have not changed. 2 Welcome! Topic: Collaboration Critical: Expert Panel Discussion Facilitators: Diane Koch, 3M Susan Flynn, 3M Housekeeping Questions Mute feature (*7 = unmute; *6 = mute) Chat feature Technical difficulties Post session follow-up For more information: 3 1

2 How do I get a CE Certificate? Next week, all of today s meeting participants will be sent an containing instructions for obtaining a CE Certificate for today s meeting. The will be sent to the address you provided when you logged-in to today s meeting. If there are others listening with you today who did not log-on, you may forward the CE certificate to them. 4 Learning Objectives Review the role of the CSSD in your facility s Infection Prevention strategies Discuss device integration to optimize CSSD management Discuss collaboration and communication between the OR and CSSD 5 Meet the Expert Panelists Jacqueline Daley HBSc, MLT, CIC, CSPDS Director Infection Prevention and Control Sinai Hospital Baltimore MD Mark Duro CRCST, FCS Manager, CSPD New England Baptist Hospital Ivelisse Vicente RN, MSN, CNOR, CRCST Clinical Nurse Administrator of Sterile Processing University of Rochester- Strong Memorial Hospital 6 2

3 REVIEW THE ROLE OF THE CSSD IN YOUR FACILITY S INFECTION PREVENTION STRATEGIES Jacqueline Daley HBSc, MLT, CIC, CSPDS Director Infection Prevention and Control, Sinai Hospital Baltimore MD 7 Disclosures - Jacqueline Daley Speaker s Bureau 3M Sage 8 According to the CDC In the United States, approximately 46.5 million surgical procedures and even more invasive medical procedures including approximately 5 million gastrointestinal endoscopies-are performed each year. 1 Surgical Site Infections are the most common adverse event for surgical patients. 1. Rutala, Weber and HICPAC. CDC Guidelines for Disinfection and Sterilization in Healthcare Facilities,

4 Burden of Surgical Site Infections (SSI) Outcomes Associated with SSI Approx additional post-op hospital days (deep and organ-space infection much longer) Are 5 times more likely to be re-admitted Have a 60% increase in ICU admissions 2-11 times higher risk of death 77% of deaths among patients with SSI are directly attributable to SSI. Attributable cost estimates range from $3,000-$29,000 (maybe more for deep and organ-space infections) SSIs are believed to account for up to $10 billion annually in healthcare expenditures. Anderson, DJ, Kaye, KS et al. Strategies to Prevent Surgical Site Infections in Acute Care Hospitals. SHEA/IDSA Practice Recommendations Prevention Compendium Why is Collaboration Important? Accountability, transparency and Patient Safety External entities CMS COP TJC IC standards Public reporting of infections Internal Entities Administration Patient Care Ancillary Departments 11 Infection Prevention in the CSSD relies on Infection Preventionist to: Communicate Best practices Regulations Standards and guidelines Participate Infection Prevention and Control Committee Operating Room Committee Collaborate Policies and procedures 12 Anticipate Risk assessment Tracer and rounding activities Educate Impact on infection prevention Surgical site infection Financial burden Never Events Public Reporting 4

5 Key Areas for Collaboration Annual Infection Prevention and Control Risk Assessment Cleaning process verification Monitoring of the sterilization process Management of implants Recall procedures Issues Loaner instrumentation management Extended cycles TASS 13 CMS Conditions of Participation The hospital must provide and maintain a sanitary environment to avoid sources and transmission of infections and communicable diseases. All areas of the hospital must be clean and sanitary. This includes all hospital units, campuses and off-site locations. The infection prevention and control program must include appropriate monitoring of housekeeping, maintenance (including repair, renovation and construction activities), and other activities to ensure that the hospital maintains a sanitary environment. Examples of areas to monitor would include: food storage, preparation, serving and dish rooms, refrigerators, ice machines, air handlers, autoclave rooms, venting systems, inpatient rooms, treatment areas, labs, waste handling, surgical areas, supply storage, equipment cleaning, etc. 14 The Joint Commission National Patient Safety Goals NPSG Implement evidence-based practices for preventing surgical site infections. EP3: Implements policies and practices aimed at reducing the risk of surgical site infections. These policies and practices meet regulatory requirements and are aligned with evidence-based guidelines (for example, the Center for Disease Control and Prevention [CDC] and/or professional organization guidelines). The Joint Commission Hospital Accreditation Standards 15 5

6 The Joint Commission Standard IC The hospital reduces the risk of infections associated with medical equipment, devices and supplies Elements of Performance related to Cleaning and performing low-level level disinfection or medical equipment, devices and supplies Performing intermediate and high-level disinfection and sterilization of medical equipment, devices, and supplies Disposing of medical equipment, devices and supplies Single use devices 16 Role of Central Sterile Department (CSD/SPD) in Infection Prevention The importance of this [CSD/SPD] role in the prevention of nosocomial [HAIs] is clear: reusable medical devices improperly handled, disinfected, or sterilized provide a source of contamination and increase the risk of transmission i of infection to both patients t and the staff involved in reprocessing procedures. Pugliese, Gina and Hunstiger. Central Services, Linens and Laundry. In Hospital Infections. Edited by John V. Bennett and Philip S. Brachman. 3 rd ed. 17 Sterilization Risk Analysis Risk analysis = risk assessment (FMEA) + risk management (RCA) + risk communication (Recall) The sterilization risk analysis should be part of the overall infection prevention and control risk analysis in accordance with accreditation agency requirements. Risk assessment (FMEA) Risk management (ANSI/AAMI ST79, Root cause analysis) Risk communication (Recall procedure) It should be performed annually and should be reevaluated whenever significant changes occur. ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 Section

7 DISCUSS DEVICE INTEGRATION TO OPTIMIZE CSSD MANAGEMENT Mark Duro, CRSCT, FCS 19 Disclosure 20 Integration noun in-ti-grey-shun 1. an act or instance of combining into an integral whole. 2. behavior, as of an individual, that is in harmony with the environment. 3. combination, blending, fusing Automation aw-tuh-mey-shuhn noun 1. The technique, method, or system of operating or controlling a process by highly automatic means, as by electronic devices, reducing human intervention to a minimum. 2. A mechanical device operated electronically, that functions automatically, without continuous input from an operator. 21 7

8 Why Integrate? Integrating devices can ensure better control of CSSD operations. Collecting data such as washer cycle results, sterilization and biological results keep data centralized. Integration ti can safeguard against poor or inaccurate selections by operators (correct packaging materials, processing guidance as well as sterilization parameters). Integration can make certain all pertinent information needed for record keeping, assembly and general documentation is collected and managed effectively. 22 Example of Integration The sterilization hub is interfaced with the 3M auto reader and Microsystems tracking. Technicians are prompted through the biological planting process. Biological status is updated in real time showing time planted, lot, and when results will be ready. Technicians are prompted to associate the load with the biological and confirm that biologicals have corresponding lots that match controls. All biological results can be reviewed for any load that has been run. This can be sorted by sterilizer, day, tray or any variable built into the system. Real time information from the auto reader is displayed on the monitor including the sterilizer it was run in, who planted it, the time, estimated completion, technician and date. 23 Example of Integration with Automation Technicians document loads via wireless scanner at sterilization hub Loads automatically load into sterilizer via injector signaled by photo sensor Sterilizers are double door automated pass through Belimed 8535 software sends handshake file to Microsystems tracking Tracking waits for cycle to start and prompts user verification Tracking confirms all parameters were met with technician Sterilizer sends print out reports via two PDF s to tracking for review 24 8

9 Example of Integration with Automation Technicians can review and select two types of cycle printouts along with settings for verification. PDF files contain all pertinent Info specific to the cycle Minute by minute PDF breakdown of sterilization cycle The system is interfaced with a touch screen monitor. No mouse needed. The need to look for records via opening load folders is no longer needed. Cycles can be reviewed by a touch of the screen, any load can be reviewed at any time with any information that could be needed. Any issues or alarms show up on printouts. Any compromising results in a process will not allow automated loads to advance and the tracking system will notify the operator. 25 What do we need to integrate and to better facilitate automating processes? Data Drop dah-tuh - Drop noun 1. A simple point at which you plug your CPU or device to collect data from the Ethernet or the Internet. 26 Data Drop Locations 27 9

10 Benefits of Integration and Automation in CSSD Increased work throughput via automated washers and sterilizers Space permitting Record of washer and sterilizer results Paperless record keeping 28 Benefits of Integration and Automation in CSSD Having items built into your tracking inventory has multiple benefits: Name of item Processing Instructions (IFU) Sterilization Parameters Location of item 29 Reporting from Tracking and Sterilizer/Washer Interfaces Even without tracking some equipment manufacturer interfaces can supply important data that can better ensure adequate staffing Reports from tracking systems are invaluable After systems are implemented, Administration i ti can be aware of the productivity of the staff and its equipment to asses if both are over utilized Some benchmark information outside of the actual data collected could be corrupt if benchmark facility data has shortcuts in place 30 10

11 Conclusion Technologies for sterile processing have evolved to make our jobs easier To implement these technologies CSSD needs administrative support There are numerous advantages to washer and sterilizer automation as well as integrating devices As the Heart of the Hospital CSSD needs to be considered for technology and enhancements to ensure better patient outcomes as well as improving the efficiency and safety of our staff 31 YOU SAY HEMOSTAT, I SAY ; COMMUNICATION & COLLABORATION BETWEEN THE OR AND CSSD Ivelisse Vicente RN, MSN, CNOR, CRCST 32 Background Perioperative Nurse turned CSSD Clinical Nurse Administrator 33 11

12 We Speak a Different Language Appreciating the differences Clinical expertise Technical expertise 34 I Knew How To Clean Instruments Proper PPE Right detergent Right concentration Clean below the water level Follow IFUs (instructions for use) Right ventilation 35 I Sent All My Instruments Back To CSSD 36 12

13 Anything Can Be Sterilized 37 Conspiracy OR VS CSSD CSSD VS OR 38 I Would Be Better Without The CSSD Staff 39 13

14 I Had No Idea Of the complexity of the process The staff was so eager to learn more They took so much pride Fall professionally in love 40 So What Would I Do Different If I Could Turn Back Time? Really get to know each other by names Ask more questions Offer more answers Learn more about AAMI guidelines Be a resource Encourage shadowing experiences 41 Time for Your Questions! 42 3M All rights reserved. 14

15 Ask the Expert Panel Is it possible to push for mandatory experience in CSSD during the education process of Clinical Technicians, RN, and other OR staff that works directly with CSSD for better working relations? Or is this an institution's issue to work out? 43 Ask the Expert Panel The surgery center where I am employed reuses single use instruments which are supposed to be discarded after use. The instruments are repeatedly used and resterilized even though the instructions clearly state single use only. What is your opinion on this matter? 44 Ask the Expert Panel How do you handle disinfection of hand wash items from the dirty side to clean side? Cords, older power that can not go through washer, scopes

16 Ask the Expert Panel Can you give any guidance on how to pick a good candidate for Central Sterile technicians, both experienced and inexperienced? 46 Ask the Expert Panel 1. What are the requirements for pre-cleaning with a detergent prior to transporting contaminated items to the CSSD? 2. When transporting contaminated items to CSSD, is a cart required for small, contaminated items when a smallsized, solid, clean transport container is used? 47 Ask the Expert Panel What do you do in a situation when one of the sterile instrument trays is contaminated - wet & with blood due to parts not being taken apart? Do you recall the entire load or just that contaminated tray? 48 16

17 Ask the Expert Panel How do you suggest we communicate to the OR: 1. Why it is important to let the instruments cool down before releasing them to them, because they want them right now! 2. Why it is important for vendors to bring instruments at least 24 hour prior to the surgery case? Not 3 hours! 49 Ask the Expert Panel Do you have a suggestion about how to convince people not to use re-usable needles (Silverman, Iowa trumpet, University of Illinois.) any more? Or do you consider this acceptable practice? 50 Ask the Expert Panel When cooling sterilized loads, is there a recommended temperature the load should reach before being released (using an infrared thermometer)? 51 17

18 QUESTIONS? 52 3M All rights reserved. Thank you! Next 3M Sterile U Web Meeting: When: Topic: Thursday, October 11 th Device Manufacturers' IFUs: Why are they Important? Register at