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Background Surgical Instrument Cycle •  Opera&ngRooms(ORs)–Dictatesurgicalinstrumentneeds•  CentralSterileProcessingDepartment(CSPD)–Reprocessesand

managesallinstrumentsflowingtoandfromtheORs

Impact/Results

Acknowledgements •  IOECollaborators:MarkGrum,RamaMwenesi•  UMHSCollaborators:PatBuchanan,ElvieCasper,NicoleFarquhar,Laura

Giuffrida,JuliaJackson,ReneePrince,AmyRedmond,andJaniaTorreblanca•  ThisresearchisgenerouslysupportedbytheCenterforHealthcareEngineering

andPaRentSafety,theSethBonderFoundaRon,theDoctorsCompanyFoundaRon,theUMCollegeofEngineering,andtheMichiganQualitySystemGroup

A Systematic Approach to Improving the Reprocessing of Surgical Instruments Bill Zhang, Leah Raschid, Nina Scheinberg, Amy Cohn PhD, James P. Bagian MD PE, Joseph DeRosier PE CSP, Shawn Murphy MSN RN

2016HealthcareSystemsProcessImprovementConference

Problem Statement •  ORStaffreportedfrequentproblemsrelatedtothereprocessing

anddeliveryofsurgicalinstruments•  51%ofproblemsreportedwereduetobioburden/debris

–  47%ofthesewerecausedbytheMinorNeuroset

•  EfficiencyinsurgicalinstrumentreprocessingisacriRcalchallengeforhospitalsnaRonwide

•  MeeRngreprocessingstandardsrequirescomplexcoordinaRonofmulRplehospitalfunc&ons,resources,andstakeholders

•  TheUniversityofMichiganHealthSystem(UMHS)conducted51,583casesandreprocessed~15,000items/dayinFY14

•  Insufficientlycleanedinstrumentscontaining“bioburden”ordebrisnegaRvelyimpactinsRtuRonaloutcomemeasures,mostnotablypa&entsafety

Pa&entSafety Quality Timeliness Financials

StaffSa&sfac&on

Goal

Tohaveallitemsrequiredforthepropercareofthepa1entavailableatthe1meofsurgery,properlycleaned,sterilized,andinworkingcondi6on–whileensuringtheefficientuseofresources.

Solution Approach •  Examinedtheimpactsthati)instrumentcleanabilityandii)set

configura&onshaveonreprocessingoutcomes•  Hypothesis1:Instrumentdesignfeaturesimpactcleanability•  Hypothesis2:SeparaRnghigh-fromlow-riskinstruments

improvesreprocessingoutcomes•  Usedprocess-flowmappingtechniquestodefinethecurrentstate•  CreatedatooltoevaluatehowconfiguraRonimpactsreprocessing

outcomesandtorecommendopRmalsetconfiguraRons•  CurrentlydevelopingaCleanabilityIndexingsysteminpartnershipwith

clinicians

Pilot •  Separatedkerrisons(thehighest-riskinstruments)fromMinorNeuroSet•  DemonstratedhowthecleanabilityandconfiguraRonofinstrumentsina

setdirectlyimpactoutcomemeasures

1)Purchased

2)Catalogued

3)Groupedintosets

4)StoredinCSPD

5)UsedinORs

6)DecontaminatedinCSPD

7)AssembledinCSPD

8)SterilizedinCSPD

Instruments Set

Scenario1:NoSepara&on

Benefitsobservedassociatedwiththisinterven&on:1.  Nobioburdenincidentswiththekerrisonsets2.  TheaveragenumberofmonthlybioburdenincidentsinMinor

Neurodecreasedfrom15to33.  TheamountofRmesavedintheORswillresultinannualsavingsof

$23,490to$236,290(calculatedusingaveragebioburdeneventdelaysof5minutesto30minutes)

4.  Anengineeringapproachtoconfiguringsets(e.g.,high-riskinstrumentseparaRon)canincreasequality

Scenario2:KerrisonSepara&on

0 5 10 15 20 25 30 35 40 45

SET,MINORNEUROUH

STRYKER

ZIMMER

SET,URQUHARTLEGHOLDERORTHOUH

POWER,MIDASREXLEGENDFOOTCONTROLNEUROUH

POWER,ANSPACHTRANSPHENOIDALDRILLNEUROUH

ORTHODRILL

SET,WRIGHTEVOLUTIONPATELLAORTHOUH

COLONOSCOPE

SENTINEL

TRIATHLON

WRIGHTMEDICAL

NumberofIncidents

SetN

ame

SetsMostCommonlyReportedtoContainBioburden/DebrisJune2014–Feb2015

Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15

MinorNeuroaccountedfor~47%ofallevents

43

4

12

7 7

1

4

12 2

10

1

2

3

4

5

6

7

8

9

January February March April May July August September October November December January

2015 2016

Num

bero

fInciden

ts

Month/Year

MinorNeuroBioburden/DebrisIncidentsJan2015-Jan2016

Pre-SeparaRon Post-SeparaRon

0 5 10 15 20 25 30 35 40 45

SET,MINORNEUROUH

SET,WRIGHTEVOLUTION…

SET,FOOTORTHOUH

POWER,MIDASREXLEGEND…

SET,THOMPSONGENERAL…

SET,LAMINECTOMYIINEUROUH

SET,ZIMMERPERSONA…

SET,TRIATHLONEXTRAS…

SET,SCOPEHOGIKYAN…

SET,IMPLANTSYNTHES…

SET,IMPLANTZIMMER…

SET,BLAHAEVOLUTION…

NumberofIncidents

SetN

ame

SetsMostCommonlyReportedtoContainBioburden/DebrisAug2015-Jan2016(Post-separa&on)

Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16

MinorNeuroaccountsfor~13%ofallEvents