Sterilization Station: A Sterile Processing Empowerment Podcast
Welcome to "Sterile Processing Empowerment Podcast, the podcast dedicated to elevating the field of sterile processing and surgical services! In an industry where precision and care intersect, we believe that knowledge is power. Our mission is to empower, encourage, and motivate every professional engaged in the transformative world of healthcare.
Join us each week as we delve into enlightening discussions that shine a light on best practices, emerging innovations, and the critical role sterile processing plays in patient safety. Whether you're a seasoned expert or just starting your journey, our panels and expert guests will provide invaluable insights through engaging conversations and real-world stories.
From the nuances of instrument handling to the latest in sterilization techniques, we cover it all. Expect thought-provoking interviews, educational segments, and motivating content designed to inspire you to elevate your craft. Together, let’s foster a community that champions excellence in surgical services and celebrates the unsung heroes of healthcare.
Tune in to where expertise meets passion, and every episode empowers you to make a difference in the operating room and beyond.
Sterilization Station: A Sterile Processing Empowerment Podcast
Your Hands Matter: The Art of Assembly and Inspection in Sterile Processing
Cliff Russell from SterisIMS takes us through the "Y" in our CYCLE mini-series, focusing on "Your Hands Matter" - the critical assembly and inspection phase where precision becomes patient protection.
• Assembly and inspection as the last checkpoint before instruments reach surgery
• The hidden complexity behind "just putting trays together"
• Real consequences of missed defects, including instrument failures during procedures
• Using appropriate testing materials for different instrument types
• Balancing time pressure with thorough inspection
• Scissors as the most commonly undertested instrument in SPD
• Creating standardized workstations with proper testing tools
• The importance of checking box locks and inspecting for cracks
• Using vendor partners for education, audits, and competency validation
• Making IFUs accessible through daily huddles, trivia, and interactive learning
• Building confidence through peer mentorship and creating a culture where mistakes can be discussed
• Pro tips including proper instrument placement, matching correct components, and using magnification
• The role of technology in transforming instrument inspection
Use your vendors as resources for education and audits - they're here to partner with you in creating the safest patient outcomes possible.
Welcome back to another episode of the Sterilization Station. This is Bill Rochelle and I hope you all had a good day today and we are back to talk about our mini-series on the word cycle. We're with Cliff Russell from SterisIMS and we are still working through this acronym of CYCLE. You don't need a scalpel to save a life in sterile processing. Sometimes all it takes is your hands, and so welcome to the Cycle of Sterile Processing cell processing, a mini series taking you through every critical phase of our workflow, from dirty to ready In this episode, we're going to dive into the letter Y, which is your hands matter, focusing on assembly and inspection, where precision becomes protection.
Speaker 1:So every instrument passes through human hands, and that's yours. Right as the technicians, but with time. Right as the technicians, but with time pressure, complex sets and overlooked defects. This stage is where problems can begin, or where safety is ensured. And so, to guide us through it, we're joined by someone who knows this space inside and out, and that is Cliff Russell of Steris IMS. So, from field experience to education, cliff has seen that this works, what fails, what works, what empowers the teams to rise above the challenges. So we're going to jump into this session. So, cliff, how's it going today?
Speaker 2:Good Bill, excellent, thank you for having me. I appreciate being here.
Speaker 1:Yeah, I'm really glad you're back again. We've been really enjoying this. The viewers are enjoying it and we're just learning a lot. And, more importantly, we're empowering. And that's what the Sterilization Station is all about. Is this empowerment podcast to help sterile processing? So, cliff, to set the stage today, why do you think the assembly and inspection phase is so mission critical in SPD.
Speaker 2:Well, first of all, I want to acknowledge the bombs you were dropping coming on there. But you said it that just because we don't have a scalpel in SPD, that doesn't mean we're not saving lives when you clock in and you get into SPD. You're saving lives. You don't have to be over the patient. I say that all the time in my in-services, so it's funny that you said that.
Speaker 2:You have to remember if you're in SPD and you're assembling trays, when you lock down that tray, you're the last person to see that until it's ready to use, right that scrub tech they're checking for how it feels and trying to make sure, but they don't have the testing material. They don't have all the resources that we have in SPD, or that you should have an SPD that will help you validate and verify that those things are working.
Speaker 1:The way they're supposed to work, right.
Speaker 2:So I think it's unbelievably important to have, as an SPD person, make sure you know not only what to check, but how to check, and where to check. You can do a lot more to ensure a positive patient outcome.
Speaker 1:Yeah, I think that's great for sure, and I think there'll be a lot of takeaways from this assembling and inspecting, and so I'm definitely looking forward to going further into some of the things that you already mentioned and think that this is going to be a great conversation because, as you're aware, many techs see this as, hey, I'm just putting together trays, but what's often underappreciated or misunderstood about this phrase from your experience. What's often underappreciated or misunderstood about this phrase? That people are saying hey, I'm just putting together trays.
Speaker 2:Well, they've never had surgery and they've never witnessed the surgery. I mean, I think we talked about on the last episode. One of the best ways to get your SPD staff to understand how important their job is is, if you can, just to watch some surgeries. You know, observe, and even to the point that sometimes you know being in the OR and being an observer you don't get to see a whole lot unless there's video and you can see the screen or whatever.
Speaker 2:If you've got an open case. Unless you're over the patient, you're not really seeing a whole lot right. But I recommend to repair techs and SPD techs all the time. Go to YouTube. I mean YouTube.
Speaker 2:You can punch in whatever procedure you want to see and it's going to come up and it's definitely something that's critical because when you see that and you see how it's used and you see how critical that clamp's got to be so it can occlude that bleeding, I mean you know it's going to make a whole world of difference, but just the awareness and education of what they're dealing with.
Speaker 2:You know, for years we were called dishwashers, right, and I kind of like that term, I embrace it. But we all know there's a lot more to it than scrubbing a basin. But the biggest thing, that's overlooked is just what goes into inspecting a tray Like you said it's not just putting together a tray.
Speaker 2:Are you looking at those clamps? Are you looking at those scissors? Are you testing those items? So you know there's a lot more to it than just that phrase of looking like putting together a tray. So I would say that the act looking like putting together a tray, so I would say that the act itself, is probably the most overlooked. If you want a long answer, yeah, no, I think that's good.
Speaker 1:I mean because, you're right, no-transcript, and they're expecting that those items are going to be functioning at like you know, just a game, right, tip top, tip, top shape. So just, making sure that we're able to supply that, those great products. And so, from your experience, how do errors at this stage show up downstream, like in the OR or on the back table?
Speaker 2:Okay, let's go worst case scenario, right, exactly. Let's jump off the deep end here, but for real, and I've seen similar things like this happen. But you know, say you're doing a lap procedure and you know lap instruments. A lot of people don't know a lot about them. You know, some people don't know how many.
Speaker 1:you know if they're taking apart how many pieces they're supposed to have right. So that's a lot of stuff that SPD has to know because if we don't know that we're not going to get it clean properly.
Speaker 2:So a lot of people you know if you're not looking at that jaw assembly area on those lap instruments, you know, take a look at those because they're put together A lot of times it's kind of hard to describe but you have two flat pieces of metal and they just have a hole in them and a pin through them and that pin interlocks them and that's how they move and that's how that actuates the jaw, right. Well, and we know our doctors never overload things, right, we don't ever grab stuff. They're not supposed to, right. But you know, if that happens that could stretch out that pin area, could loosen that pin. If it cracks the metal it could make it really loose. I've seen those pins fall out. Then you think about hey, what about? You know you're in those cannulas, you're not in an open patient, right, you're in the cannula. So you're looking up at a video screen. Do you think that that little pin that falls out, do you think you're going to find it with that one camera? Probably not, right?
Speaker 1:I mean, I always make the joke if you do, you better go play the lottery, because you're pretty lucky, that's. You know that's one in a million, so a lot of times, those types of things can end up becoming an open case, which is a huge difference for the patient right that type of stuff.
Speaker 2:And then you want to talk about worst case scenario. I've seen an incident where the jaw the jaw got misaligned because the pin came loose. It kicked the jaw sideways and they had a hard time getting the instrument out of the cannula so they had to go in from one side to the other, straighten the jaw out just so they could get it out, which if you've been in surgery, that is, it'll make you have nearly a panic attack thinking about it right.
Speaker 2:Because all those things going wrong and you've got a patient right there. So that's why it's important for SPD to check those every single time, not just for the insulation, but you never know what happens and what they grab in surgery right and so I just think that's unbelievably critical and I use a lap instrument as this is because it's a good example. But you could use needle holders. You know, if you're not checking those needle holders and they're coming back splayed out like this, then you know, are you not checking that box lock?
Speaker 2:there could be bowel, bowel burden, possibly bowel film as well, as if that stuff's getting stuck on those instruments, it's going to corrode, which can eventually cause a fracture or crack, or you know, and we could go on and on, and on, but.
Speaker 1:But you see, what I mean.
Speaker 2:It's just vitally important that we check this before our scrub techs get them, because our scrubs can't do anything but reject them and then, and then it looks.
Speaker 1:Not only is that a bad thing, but it also looks bad on our department right.
Speaker 2:We should have caught this right. So again, um, I think that's just critical that's really good.
Speaker 1:I appreciate all that you mentioned because there was a lot in that you just said and just thinking about pitfalls in inspection and how to prevent them. One of the most common pitfalls in this phase is missed damage Things like cracked box locks, dull scissors or even frayed insulation, like you mentioned. So what habits or tools can help techs catch these issues consistently in your department?
Speaker 2:Use your vendors, your vendor partners should have tools. I mean, I'll speak from ours, just because it's where I'm from, but we have our sharpness test kit, that everything that goes into a surgical tray, whether it's a pituitary ronger, scissor, arthroscopic punch, biopsy punch. You're supposed to be testing those to make sure that they're working properly, right so?
Speaker 2:having those type of tools at every workstation. I myself push heavily on my accounts to standardize their workstations. Every workstation should have the same setup. That way every tray can be put together. And I know that there's exceptions of that. There's some places that have two, three workstations for ortho and two or three for neuro, and that's great. But even within those they should standardize right, just because that way they all have the same resources, the same tools, the same testing material, and I think that's critical. But use your vendors on that, because they can get you some of those tools as well as the education.
Speaker 2:I know we have a really good workbook series that goes through I think it's 18 of the most common used surgical instruments, everything from clamps, forceps to scissors, to needle holders to laps, bonjours. But it goes through. Where are we looking? Are we looking for? And then, how do we test? Because I mean, if you're testing a bandage scissor on the yellow testing material, it's kind of overkill and you're probably not going to get a good result because it's not made to cut that stuff right.
Speaker 1:So just having that awareness, having the awareness and the resources to be able to test those, because, and understanding that you're the last person to touch that instrument before the surgeon's going to see it right or before the scrotex season it's so important that the instruments are checked before they're going up and making sure that you're using the appropriate, like you said, scissor testers. You know whether you have the yellow, whether you have the red one, just making sure whether you're you're testing, you know your kerosene or whatever you're testing. I mean I know the insulation tester, we're using the Steris one that we purchased and I mean it's a great value add to have and it's really there to protect not only the patient but also the employee, so I think that's really really great. And then talking about like functional checks, like testing ratchets or ensuring scissor tension sometimes these can be skipped under time pressure. What's your approach to reinforcing thorough?
Speaker 2:function testing. You know audits. You know random audits. Again, you know and I can speak from what I do on a daily basis but you should use your vendor partners, your repair partners, because they can come in and do audits. You know, I'm sure that you've got about a million things to do in a day and it's not easiest for you to take 30 minutes to an hour to do a tray audit right.
Speaker 2:But at least if you can use your repair partners, they can come in, they can audit the tray, give you some feedback on that and make sure that you get the information and it helps you with your time management when you can use those type of resources. But, yeah, definitely making sure that we can do those type of audits.
Speaker 2:And then competencies, you know, just because we're always shorthanded and we're adding volume every day, seem to become a harder thing for hospitals and departments to do. But I always like the idea and I love, like education days, doing a Saturday education day but I also like setting up these workshop days to where, and if you do it in your hospital, you can set it up based on your processes, right? Not just best practices, because we're not always at best practice in every step.
Speaker 1:We're constantly working there but doing a workshop and using your vendors to come in and train on why you're asking your staff to do it this way, right, so this gives them more insight.
Speaker 2:You know to that. But education is a big one, you know. For me, I think, it helps one. It helps your repair partners connect with your staff. So, again, I think that it bonds us with our customer and you know we get to work alongside with our customer.
Speaker 2:And it also and coming from the industry, I'm a little kind of backed into the sales part of it. But, like with sales reps that haven't had a whole lot of experience and maybe they've got their CCSVP but you know they haven't seen a lot of stuff it's great for them because they learn just as much as your staff does, right? You know, on the other side of that, they may be teaching something here, whereas they're going to learn something from your staff. So I find it just as valuable for us as it is for the SPD staff.
Speaker 1:I think, yeah, the audits are important, like you said, and then having those competencies and then really making sure that you're utilizing the vendor services right. I think sometimes we forget that the vendors are working in collaboration. It's a partnership and they're there to service us.
Speaker 2:Right Vendors out here. Sometimes they don't mind that you forget.
Speaker 1:Right, exactly.
Speaker 2:All joking aside, I mean I haven't seen any vendor that is not willing to come in and educate you. I mean you might have to reach out and request it, but that's just because they're juggling. You know 15 calls for a new round of in-services from those OEMs, from us. We can always come in and help Things that you have an OEM's product. They should be coming in on a routine basis. You know in-servicing your staff just to make sure everybody is level set from time to time, because things get busy, sometimes things happen. And the next thing you know in-service and your staff just to make sure everybody is level set from time to time, because things get busy.
Speaker 2:Sometimes things happen and the next thing you know, that's part of our routine right, and you're like hold on.
Speaker 1:How did?
Speaker 2:that become part of the routine that's not supposed to be there.
Speaker 1:So those routine audits, those routine in-services- will keep that awareness fresh, and you know that way, things don't slide off the scale, so to speak. Yeah, no, that's really good, that's excellent. How important do you think? I know it seems kind of common sense, but we know in instrument assembly that sometimes you just need to be reminded or even kind of just want to bring this up as I just want to hear your thoughts about how important is instrument placement within the sets. Is there a proper or improper way to do that?
Speaker 2:I mean, you know, I've seen both where you do this trade, just like this, but really it comes down to you know, welfare of the instruments, making sure things aren't, you know, and I won't say eliminate, because you know in this arena, with all the instruments and the number of instruments and in trades, you know it's really hard to be at zero but you really want to try to reduce the opportunity for damage. You know, not putting your cords, you know laying on top of the strong instruments, but your scissors are there open, right, so you know everything's got to be open for sterilization so those cords could get in there and cause damage to the. You know, on the scissor blades, even some of the clamps, you know what is it? Leahy clamps got those sharp prongs, that type of stuff you know, even some, you know, cokers, the 1x2s.
Speaker 1:they have teeth, so just making yourself aware.
Speaker 2:I wouldn't call it a right or wrong, but you're trying to reduce damage as much as possible, not putting heavy retractors on lap instruments. You don't want to necessarily lay your lap instruments in the bottom of your tray and then lay everything on top of them, right? So making sure your staff has that awareness because, again, there's so many different variations and it all comes down to the count sheet and the weight and you know that there's so many different. I wouldn't say there's a locked-in way to set the tray. It's just about minimizing organization, minimizing damage and organization.
Speaker 1:And to speak on that really quick.
Speaker 2:I've heard from different customers recently that they are coming in and really hammering hospitals on weight. So I know we're all supposed to be under 25, but I know they're coming in and they're checking and they're testing and some of our most common containers that we use was a surprise to me, but some of the most common containers, empty, weigh about seven, seven and a half pounds, which was I never thought about it how much an empty container weighed, but so now what is that?
Speaker 2:Now that everything inside there has got to be under what? 18 pounds?
Speaker 1:So again, those type of things.
Speaker 2:So I wanted to mention that because I have been getting some of that feedback that surveyors are coming in and starting to weigh trays and starting to scrutinize that a good bit.
Speaker 1:Yeah, that was actually my next question, what it was going to be about overpacking. So that was perfect. No, you're good, you're good. And then IFUs are often overlooked due to time or complexity. So what practical strategies can teams use to stay current with IFUs?
Speaker 2:I would include them. You know there's all kinds of things you can do. I've seen places that would like include them in, like their daily huddle, like going over a different IFU every day, or you know certain things in that IFU, things that might be tricky or confusion that might have came up when they were doing training or whatever. So using them that way, use them as a training method, even trivia questions. Hey, how do you?
Speaker 2:you know what's the step to do this, or you know however you want to lay it out, but really just making it interactive because I know, like myself, a lot of SPD folks are hands on and they learn by doing and they learn by seeing, which I do 100 percent.
Speaker 2:And so getting in there and making it interactive like I said, with trivia, even I used to do this all the time I get like 10 instruments and I usually one or two might be okay, the rest of them there would be something wrong with. And then have my staff, you know, come in and inspect the instrument and tell me what was wrong with it and go through all of those and then like whoever got the most right got a prize or you know something like that, but their hands are on the instruments, they're looking for stuff they're knowing, you know, and then like if you mix in one or two that there's not anything wrong with it keeps them honest, right Cause now is something wrong with it or not, you know, and I always told them that may or may not be wrong.
Speaker 1:You know, something may or may not be wrong.
Speaker 2:So just those types of interactive things and and people, naturally, are competitive.
Speaker 1:So they want to do better than their co-worker. You know so. So I found those type of things are very valuable and on that again, use your vendors, I mean, there's all kind of stuff that that we can come in and help do and make it fun.
Speaker 2:At least some of the stuff we do is pretty fun, but yeah just being, just being, uh, you know, involved, um, you know, and, and making those resources available to the staff yeah, no, I think that.
Speaker 1:I think that's great. So we're going to take a quick break. I'm going to hear from one of our sponsors, rita, an advertisement, and then we're going to jump right back in and we'll get right into time and pressure versus patient safety. So if you are, looking for an excellent educational and learning tool, whether it be for your sterile processing department or for help with studying for certification exams. You need the world of surgical instruments.
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Speaker 1:And so time pressure is real, especially in the facilities we work in with quick turnovers. So, cliff, how can tech stay efficient without compromising accuracy in sterile processing you?
Speaker 2:know, I mean of course staying on task, but really, you know, having a having some organization to your inspection, you know, and not that everybody does this but you know, just dumping the tray out and going through instruments singly. You want to have some organization to you, knowing what you're supposed to test and like I was saying earlier, the knowledge of knowing where to look what your inspection for, as well as knowing what to test and how to test it, that's going to speed you up in itself right and I know people were like, yeah, if I do that, if I didn't do that, I just put it together, it'd be a lot faster.
Speaker 2:True, absolutely, but you got to think like you were talking about patient safety.
Speaker 1:We're looking for patient positive patient outcomes here, and I mean otherwise we could work in a car mechanic shop and work on cars all day, because it wouldn't matter if we just banged up a car a little bit right.
Speaker 2:But patients are a different, a whole different story. So you know, just be honest One. You've got to be honest with yourself that you want to get better, and that means not pushing yourself right, as well as working with your leadership on being realistic If you've got a layout that says it's supposed to take, you know, whatever, just the arbitrary number, five minutes to do and realistically it takes six and a half.
Speaker 2:Well, let's talk about that, because you know we can look at that and if that's legit then we can work that into our process, which will work into the productivity later on and how we achieve that productivity. But it's got to be realistic, right.
Speaker 1:What type of errors or shortcuts do you commonly see when techs feel rushed in? Spd.
Speaker 2:Scissors not tested. I mean, every surgery starts, you know, starts with a scissor and ends with a needle holder right.
Speaker 1:I mean so not testing.
Speaker 2:the scissors is a big one, you know if you say overlooked, but you know checking the box locks. You know some people, you know a lot of people don't even glance at those. And you have to understand with those type of clamps and with the box lock type function, you know if there's a defect in there and you put more pressure on it it's just gonna, you know, tend to fail.
Speaker 2:Even more so if it's a crack and you go to overload the needle loader man, I think that crack's gonna open up right. So it just creates more opportunity for even not only even further damage to the instrument, but to the patient as well I mean last thing you want. I mean when something cracks. Stainless steel is only stainless on the outside. When it cracks, that crack is basically wrought iron steel and it's going to start oxidizing as soon as moisture is on it so by the time. We usually catch a fracture.
Speaker 1:On the inside it's already oxidizing.
Speaker 2:So, and if something like that breaks.
Speaker 1:You never know if a flake would fall into the patient or could fall into the patient. You know other debris could fall into the patient, so you know our top priority is patient safety and you know that's key.
Speaker 2:But as far as things that are missed a lot of times, like that, I would say that number one is not testing the scissors, or any of the cutters really, but scissors are the most commonly used, so I would go with. That would probably be my number one is scissors not being tested.
Speaker 1:And very good, very good insight, Very good With your company doing instrument repair. You see it all right. I mean, I remember being with you one time where you went to a site and you were just looking at some instruments that just happened to be lying around and you were like they need us to come in. That was great. Well, I mean to see it.
Speaker 2:Yeah, I've repaired instruments for 14 years, so you know you kind of pick up on things how to read an instrument out. You know I can, and not just this isn't a talent that I have, but most people that have been have repaired these instruments for a while they can read an instrument and tell you if someone has sharpened it before or you know those type of things and tell you how important.
Speaker 2:Keeping the same angle on those are because not only does it keep that sharp edge, but it also reduces the amount of metal that you're losing, which prolongs the life of your instruments. So you know again. It all goes back to trying to prolong the life of those instruments, which is going to save you money with a replacement cost.
Speaker 1:Yeah, no, that's good. And I've heard I mean I've heard so many people say that an instrument, every instrument, tells a story. I mean, whether you're taking good care of it, whether you're not taking good care of it, whether you're making sure it's getting serviced, that instrument's going to tell a story If it's got banding, color banding, that's cracking. It's telling a story If the blade's dull it's telling a story.
Speaker 2:So every instrument that's used in surgery is telling a story. So I think that's really good. Every K-wire mark every pin mark?
Speaker 1:No, absolutely, absolutely. That's really good. Have you seen any successful systems or habits in departments that balance speed and safety?
Speaker 2:What I see key and what I mean and what I deem successful is when the staff knows the procedure. I mean or not the procedure, but the process and the policy. Right, you know? I think I mentioned it on the last episode when I'm in decon and.
Speaker 2:I see case cards coming through and everyone are separated differently, sprayed differently, open, closed all over the place. That tells me that the scrub techs don't really know what's expected. They're doing what they were taught when they first started there. They do what they were taught in scrub tech school or you know. So they just don't really know and it's something that gets you know. It's easy to fall through the cracks because it's not the easiest thing in the world to do for the OR to come together and have a training hour right when they go through their processes and make sure of that. So it is a difficult thing to do. But again, where I've seen success is where they've really made the effort to make sure that that happens, because, again, you know if things are coming down sprayed and separated it's going to make for a quicker turnaround time less damage.
Speaker 2:There's going to be a lot less trays down because of damaged instruments, so it's a trickle down effect and it ends up being a really big effect down at the bottom of that trickle, if that makes sense.
Speaker 1:It makes a lot of sense, absolutely. So just moving into our next section on building confidence, culture and ownership and we want to empower techs to take pride and initiative at the assembly table. So confidence is key right, especially for newer technicians. So how can leaders build confidence without fear of mistakes?
Speaker 2:Good Well I say good leadership but you know, having good, you know, and I know everybody strives to have good staff members and good chef leaders, but I find that key empowering your staff to not only know how you expect them to do it and what your process is, but believing in them enough to go and train those new people and help mentor those new people.
Speaker 2:I think you have a series on mentorship, so I think that's a great thing to discuss, because I think we need more mentorship, and I don't think mentorship just means like from a SPD director role to their staff, but from tech to tech right, you got to mentor each other.
Speaker 2:Some people walked in here yesterday. Other people's been here for 20 years, you know. And what's funny is I find that on both ends of that spectrum the people that walked in yesterday and the people that have been here 20 years both can learn, because the person that's been here 20 years is maybe still be doing things the way they did them 10 years ago, and it may not be best practice, whereas a new person may come in and know that best practice.
Speaker 1:So they can mentor each other.
Speaker 2:You just have to be open and be willing to be better.
Speaker 1:One of the biggest things I see is having that bond with your staff and SPD to say, hey, let's talk about it.
Speaker 2:If you make a mistake, come ask. Let's get it on the table, so we all know how to deal with it. Moving forward, right, so?
Speaker 1:and that can be hard too because nobody, you know, nobody wants to make a mistake and surely nobody wants to highlight their mistake, Right.
Speaker 2:But again in our industry, I think it really makes us better as a whole if we can just have that circle of trust when we're asking those questions.
Speaker 1:Yeah, no, I think that's good and I think mentorship is really important. I'm mentoring employees, your peers.
Speaker 2:If your vendor gets on your nerves when they come in, coach them, mentor them, they'll change. I promise they don't want to make you mad, absolutely, so tell them say hey, man, when you come in, I need you to do this Nine times out of ten. They'll gladly comply because they don't want to be the pain in your side.
Speaker 1:So mentoring goes in all directions, really Did you hear that Mentoring your vendors, that was good. Sometimes you got to hold the vendor's hand. Those dang vendors, right, exactly. No, that's great, that's really great. Cliff, could you share a story where a tech's attention to detail in assembly directly prevented an error or protected a patient?
Speaker 2:I can tell you, I can give you a personal one. I was scrubbing a case and at one time I worked at a surgery center and we kind of did everything you know from case setup to case breakdown, to decon everything. And I didn't know it at the time, but this doctor was notorious for complaining because he always got sharp wheat lanters, small wheat lanters, they were sharp and he always complained because he got sharp and he wanted to do all.
Speaker 1:I didn't know this, I had actually just been working there, I think maybe a month or so, and there was, was like eight or ten doctors, so I was just getting around to working with all of them. But I remember this because I remember distinctly going.
Speaker 2:I'm so glad I read the count sheet exactly I was in the case with him and I did the tray, um, and it was, you know, and he was like hold up, you know, he was a good guy and he just kind of was busting on us and and he was like I can't believe it.
Speaker 2:I got a dull one, but he was just very happy that he got a dull one because a lot of times it seemed like people weren't paying attention and were just throwing in whatever they had Right, and so that sticks out in my mind because I felt like the hero.
Speaker 1:That day I was like, oh, and you know, at the same time I was like I'm a new guy. And I thank God.
Speaker 2:I read the account sheet and put a blunt where it was supposed to be, because that happens quite a lot and that can cause damage Now most doctors, they're good about looking at it before they do it. But still using a sharp, just a wheat ladder or anything like that in an area that it could be delicate or could cause damage it can make extra work for the surgeon and extra recovery for the patient. But that's one that jumps out at me, yeah that's really good.
Speaker 1:Now I know I jotted down 25 pro tips to consider when assembling medical instruments and these come from field-tested best practices across sterile processing, and so we'll just go through these If you want to comment on them, if um to, definitely feel free. But under the topic of general best practices and know the instruments function, you know, follow the ifu every time, right now let's talk about ifus yeah, absolutely go for it ifus.
Speaker 2:By far you should go by the ifus. They come from the. But again, some of them can be quite confusing and some can make you question why you test certain things certain ways. So ask questions If you are. If there's any confusion, always get some kind of clarity on that. Whether it be from the, I would start with the OEM who published the IFU, but also you can always get some insight with your repair partners as well. But IFUs are super important but they can be a little confusing, don't be surprised.
Speaker 1:And ask questions. That's super great. I think knowing your instrument's function is important. I think we talked about that following the IFU and then just handling with care, you know, like really making sure that you're protecting your instruments. Awareness, absolutely yeah, and then using the proper tools that are given to you during your inspection and assembly phases is super important, wouldn't you, wouldn't you?
Speaker 2:Greg, absolutely, and I know it's very common but we are supposed to be trying to get away from it. And that's having brushes on the clean side, yeah, like the pipe cleaners, and I understand, don't get, don't shoot the messenger.
Speaker 1:I've used them, but, but, but again, now that we have tools like the boroscope and those type of things they really trying to get rid of brushes on the clean side just because of the cross contamination you know I've seen people like have the flexible, long flexible brushes and they have them velcroed right over their workstation.
Speaker 2:I'm like well, if there's anything, on that brush it's going to end up in your tray right, so again just, you know, try to do what you can to get those out of the clean side. But again, I know that they come from a good space and we've used them for a long time, but we've got to start moving them.
Speaker 1:Yeah, no, that's great.
Speaker 2:And then checking for damage as well. Right on your instruments you're testing the functionality, learning what a pit mark is, learning what the difference between a stain and what might be a like a calcium stain or water stain.
Speaker 1:That that's always good too. Can you touch on those real quick?
Speaker 2:on some of those what those are and what those mean well, like in california, you know we have no, we're notorious for having the hard water.
Speaker 1:We have a lot of limes.
Speaker 2:the limestone like a lot, of, a lot of minerals in our water and so that can cause buildup and spotting and staining and and stuff like that on our instruments. That's why now most hospitals their sterile processing department has a, has a dedicated boiler, because then it's a much cleaner water. A lot of hospitals are now making the investment into RI water I mean RO water, reverse osmosis water throughout their whole system, because then they can basically eliminate that right.
Speaker 2:But I've seen hospitals that share a 60-year boiler with the rest of the hospital and then they don't have any filters in place and wonder why everything stains.
Speaker 1:Well, I mean, that's exactly why.
Speaker 2:So that's super important and you know, if you feel like you got staining, of any kind, it is best to get someone in there to test it, find out what's in your water, because then you can find out how to treat it. Went in there to test it. Find out what's in your water, because then you can find out how to treat it. Your chemical?
Speaker 2:the companies that specialize in your cleaning chemicals can basically give you a recipe that will help your water specifically knock some of that descaling off, get some of those stains off, you know. Train your staff to check and double check when they're changing chemicals because sometimes even a slight of the wrong chemical can cause a reaction with those chemicals which can cause stuff on the instruments or stains, all kind of stuff.
Speaker 1:So you know, when it comes to water, you know that's the main reason st 108 came out right is to make sure our water is up to certain standards and california is going to be challenged because we have ultimately really hard water to begin with.
Speaker 2:So, but those are. Those are a lot of things to look at and you know those are a big culprit with with instrument damage when you're talking about passivation layer and that type of damage. Those are the things that do it, so water is is a super key component.
Speaker 2:And and use your vendors. If you've got a big contract with a vendor, whether it be whoever it might be, hey, do you guys test water. They might even waive that fee to test your water if you're a big customer there. So make sure you're using your resources. Stairs didn't hear me say that.
Speaker 1:Right for sure. And then, too, another pro tip is also using the magnification right. So a lot of facilities have magnifying lenses super good and use, very, very important.
Speaker 2:And then a lot of the linkages on our instruments are super small and they're super easy to miss so absolutely yep.
Speaker 1:And another one is matching your components correctly, right? So I've been in facilities where you got your pool suctions and they come in different sizes. And someone will just say this is the same size and it does not, you know, screw in, it doesn't function properly. So making sure you're matching the appropriate components together is super important as well hey, and you wanted an example now again, I'm being very general here, but think about that and hopefully, um you know either way it could cause issues but you know, say now, most of the time they're going to put that pool suction together before the case, right, but if
Speaker 2:the inside now being too long, they'll be able to notice that it won't work right. But if it's too short, then it's still going to go on, but the inside is going to be really short. So again, if they go, take that into an area that's pooling, it may not even be deep enough to reach that yet. So it's not going to work properly.
Speaker 2:And then once they notice that then they've got to get the right size. So now you've got an area of the patient that's pooling blood and you don't have the right suction right, so that can cause some frustration right?
Speaker 1:No, that's great, that's really great. Yep, I'm going to buzz through a few of these. You know and always remember don't over tighten the components. Lubricate when indicated. Assemble in proper sequence. Especially when you're doing your count sheets, make sure you're paying attention. And then, a lot of the facilities that have tracking systems have photos or diagrams where, if you're old school like where I'm at and you still got a binder book, make sure you're using that binder book. There was a lot of time and attention that went into being able to have the resources and then organize your sets by procedure and then use your instrument protectors. I know that's pretty huge in every facility, making sure that you're protecting the instruments which is also not just for protecting the instruments but can be for protecting your surgical technicians when they're taking the instruments out of the sets.
Speaker 1:And then I think we spoke earlier about not overcrowding the trays, which is really important.
Speaker 2:You talk about using like protection tip protectors make sure you communicate with the end user, because there's all different types. There's vented, there's non-vented. You know, you've seen them built.
Speaker 1:Mm-hmm, and you know I was at a place where you know I was like why are you guys not using tip protectors.
Speaker 2:They were like because the OR hates them and don't want them on there, and then I got to the. Or and they were like yeah, but they were the non-vented and they were getting stuck and we couldn't get them off, and so a little communication they ordered the vented ones.
Speaker 1:The vented ones came and they come off easily and they were fine.
Speaker 2:So just a little communication work goes a long way there. Yeah, that's a, that's a really great pro tip.
Speaker 1:I know we've we've got both at my, our facility. And then then just what I've noticed in reading the ifu too just I just recently learned this was that the paper tip protectors are validated only for pill packs.
Speaker 2:So making sure that you're using the appropriate one.
Speaker 1:Sometimes you're putting that paper in the tray because you like the style of that. But make sure you're checking with your manufacturer's IFUs because some are not validated, have not been validated to be in trays but only for pill packing. So just make sure you're reading up on that and once again your vendors are there to.
Speaker 1:I always say put the vendors to work right, so call them if you have questions. It's really important. And then just wearing full PPE, include indicator strips, avoid touching contamination and then use clean, lint-free surfaces and then report and replace damaged items. So it's always important that when you do test an instrument and it is not functioning properly, make sure you tag it and put it wherever you have designated. We have a red bin that we have that everyone knows to put the instruments in, and then our instrument repair company comes by.
Speaker 2:Sorry, it's good to use that protocol as well. Out of the OR what?
Speaker 1:does the OR do when they have?
Speaker 2:something that's not functioning right, because if they don't identify it and we're not testing the scissor, guess what it's going to end up back in that tray again next time. And I get that a lot where surgeons I go talk to surgeons and you can almost see the steam coming out of their ears. They're like I'm tired of getting the same dull scissor in that tray every single time.
Speaker 1:And I understand the frustration. But then I turned to them and the scrub tech and I'm like how do you?
Speaker 2:identify it and they're like we just throw it back in the tray. Well, how you know, unless just by chance the repair company grabs that tray and services it how is anybody supposed to know that that's dull right? And, of course, going back to our point earlier, if you're using a scissor and you're testing the scissor, well, then you might know right, then you can catch it. But again, it's both sides of the.
Speaker 1:I say both sides of the creek.
Speaker 2:It's the OR as well as the SBD, but it takes some communication because most of the time, the damage happens, and it's if it happens in the OR and it's noticing the OR and they don't tag it. Well then it's a lot easier to slip through and get back in that tray. So I would recommend that.
Speaker 1:I think one challenge we notice is that the doctor will complain about the scissor. We get the scissor back and my team knows the first thing I do is test that scissor. You know, I say well, let me see, I test it. And then sometimes you know the scissor is functioning properly, there's no snagging, it's cutting precisely, and so this is a common issue.
Speaker 2:right that the surgical team is complaining about it.
Speaker 1:We get it back, we test it, it's functioning properly. So what I usually say and this is me I usually say put it back in the set if it comes back again the second time well, we say that for a fair, but you did your diligence you tested it, the oem standard it passed the test I'm not sure what's wrong with it okay no, like if it was a critical item or something. You could always go to the lead and say, hey, what I?
Speaker 1:tested this and you know I didn't get anything, so you know communication there, but with a pair of scissors. Yeah, you test it and it passes.
Speaker 2:It should pass.
Speaker 1:If it comes back, we definitely want to investigate, but that's a, that's a good that's a good policy to have, so for sure, yeah, no, I've always tried that, and the team knows it and of course we always laugh and joke when it comes back and we test it and you know and it passes. Of course we're sitting back there in sterile processing and we're just, we're cracking up and everyone's always cracking jokes like it's a what do you call it user error, right, so it's kind of funny. In svd we have fun on the job, but, um, and then moving forward to looking forward, looking for tech tools and some lasting lessons and then wrapping up with the vision, encouragement and some practical takeaways With all the new tools coming AI, smart tracking, digital IFUs how do you see technology transforming, assembly and inspection?
Speaker 2:Well, I see it helping tremendously, especially with the AI stuff, because now instead of us having to go, like you said, back in the old days and do our binder book and we'd have to take the picture and print the picture off and put it in the sleeve, you know we had to do all that.
Speaker 2:Now you can say you know, show me a picture and a description of a Deaver retractor and boom, it's going to pop up, right. So I think, with some of that training, some of those training tools, it could be really, really helpful. But again, my next thing would be use your resources, use your vendors, use your repair partners.
Speaker 1:They should have tools and validations for whatever. For us, it's knowing what to test the instruments on making sure they function properly.
Speaker 2:But use them for that knowledge too, because they can really help you spread the word to your staff, get that message across, whereas you, as a leader, you've got 47 different things to do and at your huddle you know that may be something that you forget to go over right. Well, your vendors can help. Your vendors can bring that education in and bring some of that awareness.
Speaker 1:Yeah, no, and that's really great. And I just want to kind of give a shout out to a company that I was made aware of just through LinkedIn. The company's name is L-A-Y-E-R, l-a-y-e-r-j-o-t. They have a technology called SID 4.0. It's free, it's in the Android and App Store. It's the most powerful surgical instrument identification and inspection app. You literally take a picture of the instrument, as long as it has a part number, and within seconds it loads up the description. This is a great tool for, you know, for students or for those who are learning, and this is not an advertisement, I'm just saying we use it in our department, it's very helpful, and so you can definitely look them up.
Speaker 1:Layerjot and the technology. The app is called SID 4.0. It's in the App Store and Android, and so that's great. Great team there. Ette over there is a great guy, and if you're going to the conference, he's definitely going to be there and you'll be really impressed with this technology. And then, if you had just one message to leave with any SBD tech at the assembly table today, cliff what would it be?
Speaker 2:Be confident, Know your stuff. And if you know your stuff, it's easy to be confident right, because you guys have just as much authority and power to throw a red flag up and say this is not safe. I mean, I know when I came up there was people scared of OR people that you know they and they would come in and say something, and they were like we're not supposed to do this.
Speaker 1:I'm like, well, didn't you tell them? No, they're from the OR. I didn't want to tell them no.
Speaker 2:And you're like guys, it's not safe, we can't do it, so have confidence. You guys are trained professionals. You guys are certified.
Speaker 1:Most of you are certified. If not, you're going to be soon, right?
Speaker 2:So just have confidence and know that you're doing. You're a patient advocate because if you don't catch it. Who's going to?
Speaker 1:Nobody, so just have confidence in what you're doing and believe in yourself.
Speaker 2:I know that's kind of cliche. I believe that wholeheartedly.
Speaker 1:Yeah, no, that's great. Those are some good words of wisdom to end this episode. And from forceps to flexible scopes, it's your hands that make the difference. Every tray you touch has the power to protect and to heal and to save. And just a huge thanks to Cliff Russell for breaking it down with wisdom, clarity and his real-world solutions. And if you're listening and assembling trays every day, remember your hands matter. So join us next time as we move to the next phase in the cycle. Acronym for the letter C, which is CONTAIN. We're going to talk about protecting the sterile barrier and packaging with purpose. Until then, stay sharp, stay strong and keep that cycle spinning. Thank you,
