Migration to Single Us Pre-Sterilised Individually Wrapped Small Orthopaedic

Implants in NHS Scotland

MARK HIGGINS SENIOR CHARGE NURSEMAIN THEATRE SUITE

ABERDEEN ROYAL INFIRMARY

HISTORIC PRACTICE

• 2 TIER SYSTEM-ARTHROPLASTY VS TRAUMA

• CONVENTIONAL SCREW RACKS

• PLATE BOXES

• GRAPHIC INSTRUMENT TRAYS

Why Change?

• Glennie Report 2001• Sterilization review across Scotland• Concerns over vCJD• Sub-group set up to review system in 2005

Can you guarantee that the implant you are about to use is

uncontaminated?

New screw

Mechanical Damage

Cleaning

Safety

• Organic Debris ?

• vCJD• HIV• others

Pros and cons of sterile, pre packed implants

Cons

• Increased cost• Storage issues – huge variety of screws/plates

types/sizes• Time consuming to open• ? Increased ischaemia time• Huge amount of “dead” stock• Staff unfamiliar with implants• Risk of contaminating patients by opening sterile

implants

Pros

• All implants follow same system• Guaranteed sterility• Implant traceability• Less costly- no separate sterilisation costs• Better stock management• One stop storage/usage can be achieved• Lighter/less instrument trays• Better for “loan” kits

Compliance

• 2006 letter from CMO• Offered advice and support• Questions and answers• Useful contacts• Met and engaged with the companies

How did we make the system work?

• Change the way we think about plates and screws.• Reorganise storage to be for both keeping and using the

stock.• Educate the staff how best to work with the changed

system- clear labelling, ergonomic• Ensure everything you need is there• Worked with Sterile Services- ? View pack existing

stock• Worked with the companies who provided suitable

storage solutions, such as Medistor.

Cost implications

• Sterile screws more expensive but no cost of sterilising screw racks- approx £70 per crate

• Less stock can be held if ordering systems can meet usage

• Current screws were “view packed” until used up (until 31st December 2007)

• Vast quantity of screws in racks will never be used-effectively have no “value” as purchased historically.

Deadline for changing

By 31st December 2007 all new plates and screws should be sterile pre-packed when bought new

Full text of the Health Department Letter (HDL) at-

www.show.scot.nhs.uk/sehd/cmo/CMO(2006)13.pdf

Aberdeen Royal Experience• Started move January 05• Initial resistance from some nursing and especially

medical staff.• Staff training vital as is ensuring all implants etc

together and clearly labelled• Systems were been moved one at a time• Instrument crate redesign- helps CDU with cleaning,

lighter, more user friendly• Now even most vocal opponent sees the benefit• New trainees have only worked with the new system

within Scotland

Next step

Questions?