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
Behind the Steel: Care & Handling of General Surgical Instrumentation
General surgical instruments are the workhorses of every sterile processing department, yet they're often the most overlooked and where small errors create big problems in the operating room.
• Common problems include having too many instruments in general sets and not editing out excess instruments
• New technicians often start on general sets without proper knowledge of basic instrumentation
• Memorization of common instruments is essential for proper assembly and patient safety
• The "name game" causes confusion when instruments are called different names across facilities
• Proper inspection requires looking at box lock areas and hinges where blood and bioburden hide
• Separating rings and flipping instruments is the fastest way to spot contamination and damage
• For scissors, "take them for a walk" by opening and closing them to feel for proper tension
• Yellow test material is for scissors 4.5 inches and smaller; red for larger scissors
• Needle holders should be inspected by examining the tread, not by holding them up to light
• A proactive approach to instrument maintenance prevents OR complaints and delays
• Create fun contests to help staff learn instrument names correctly
• Technology can help but cannot replace proper training and human expertise
Join us next time where we'll tackle the complexity of orthopedic instruments.
Welcome back to the sterilization station. As general surgical instruments, these are the workhorses of every sterile processing department, yet they're also the most overlooked and where the smallest errors can lead to the biggest headaches in the operating room. So to help us break down the most common pitfalls, best practices and even some myths about these so-called basic instruments, we are joined by Rick Schultz, and so, rick, we're glad to have you back on the sterilization station.
Speaker 2:Well, thank you for having me Glad to share my knowledge.
Speaker 1:Yeah, this is really great, so really looking forward to this discussion we're going to have today. And so, rick, why do you think general surgery sets are often underestimated, even though they're used more than any other set?
Speaker 2:Well, there's a couple of factors. Where do I start? What's the first factor? Number one it's a global issue. There are too many instruments in a general set and what I mean by that is many hospitals never have the strategy to find out. You know they have 14 Halstead mosquitoes curved. They never found out, they didn't do the process to find out. Hey, every time we only use eight. You know the editing out of the excess instruments. The other reason there's problems with general instrumentation is where do you put the new technician to work on what tray? You sit them down and put them in front of a general tray, general surgery and you know they don't know the instruments. Yet that gets to.
Speaker 2:The one point of mine is in a lot of my magazine articles I talk about requiring memorization of instrumentation. And I'm not talking about you know knowing a Langley retractor or you know different complex instruments. I'm talking about the basic bread and butter you got to know your Mayo scissors, your Metz's, your hemostatic groups you got to know those. And an Atzen you got to know Atzen, tissue, atzen, brown, atzen, dressing Must know the difference and the problem with sterile processing. We're not getting the employees, but when we get an employee we rush them into the battle and that is where the instruments get put in the set that don't belong there. So it's a number of things I don't know where. If I was managing a department, memorization of instrumentation would be step number one. You got to know it. You got to know it.
Speaker 1:That's so true From your experience. Where do you see the most errors happening with high-use instruments?
Speaker 2:What I call the name game, where Rochester peen at one hospital it could be one instrument, at another it could be another or what they call it. You know they don't even call it the right thing, but the errors I see is in the instrument category. Kelly is five and a half inches and partially serrated. A cryo is five and a half inches and fully serrated. No, you don't substitute one for another. Will a good surgeon just go on using a cryo when it's supposed to be a Kelly? Of course the answer is yes, but sterile processing get it right, get it right. And you know what.
Speaker 2:I might have mentioned a scenario. I had a difficult surgery. It could have been difficult, and my one sales rep said to me do you want me to go down and make sure those sets are perfect? No, I don't want you to do that, and the reason is I have confidence in the staff that they're going to do everything right. But you know what? Those people putting those sets together wrong. I wonder if it was their mom on the table, would they do a little different?
Speaker 1:yeah, that's so true, yeah, so true. What are um? The common first sign that tells you a set hasn't been properly cared for?
Speaker 2:hasn't been cared for, or meaning mean assembled exactly, exactly assembled well.
Speaker 2:I always I love to open a set and look how perfect organized it is. You know, do they use stringers? Do they use sponge sticks to hold the rings together? Either or I'm fine, and that I don't find any hemostatic devices clicked, you know the instruments off the stringer. And let's start by. Let's look at the needle holders. Let's look at the jaws. Did they put a worn out needle holder into that set? Then let's go to after needle holders. You know your long, your sponge sticks, your tenaculums, things like that. You know, are they cracked longer in the instrument? You get the box lock cracks more often. Then I would dive into hemostats and usually the Halstead mosquito straight, then curved to the right, and then you get into the Kellys. Are they all curved to the right? And some of those Kellys do they mix in a cryo Right there? I know there's a problem with accuracy Right there.
Speaker 1:Yeah, that's really good Thinking about like hinge care, lubrication and visual inspection. So what's the most overlooked aspect of hinge or box lock care?
Speaker 2:Not looking. Just move the instrument from point A to point B, never separating the rings. And look what I just did on the camera here I'm inspecting for cracks, I'm inspecting for blood and guts in the hinged area and I'm looking at the serrations. If you separate the rings and flip it up and down, you see the whole instrument. Many, many times I teach people don't worry about what's below my fingers, worry about what's above it Box lock area, the box lock itself, serrations. That's where all the blood and guts hide. You know the rings and the ratchet they behave. But you know when you open and close a hemostat, that first click. I know this will work in surgery all day long by how precise the first click is. When a hemostat is sprung, meaning it's out of alignment, it won't click. That first click isn't excuse the pun engaging, it's not going in there tightly.
Speaker 1:That's good, that's really good. That's great. When you're doing a quick inspection, does the spot issue pass?
Speaker 2:Well, you know, if I have a tray in front of me I'm going to the needle holders because you know, does number one see if the jaws are worn out? That's my first go-to. If there's debakey or coulee forceps say it's some vascular tray, quickly look at those serrations, because here's what's important, bill, whenever you have a coulee or debakey forcep, that's usually a longer surgical case. That instrument can be used an hour on, then set down and not brought back into the surgical site for another hour. So it gets time to dry. People just grab vascular forceps and move them into the tray without inspecting.
Speaker 2:The next area is scissors. I will always open and close a scissor my terminology that I teach. Take it for a walk, open and close. It tells you everything. I don't need scissor test material to know the scissor in my hand. I feel enough tension on the blades that they're it's gonna cut. It doesn't have any burrs in it and it's not loose and it's not grinding. This has a good feel to it. So I open, I take all my scissors for a walk yeah, it's really good.
Speaker 1:I love that.
Speaker 2:That's awesome and what I've just taught about doing this move here. Open it, you know, looking that and taking the scissor for the walk. That's fast. I teach speed. I'm not gonna teach you. Okay, students, separate the rings and look. No, Separate the rings, roll it look. Roll it look. Teach the eyes where to look and you're going to be a great tech. A great tech knows where to look and Bill instruments the blood and guts hides in the same place, on the same instruments, every case.
Speaker 1:Yeah, that's right Know where to look. Yeah, that's so true. Yeah, that's right. No where to look? Yeah, that's so true. So, rick, how can frontline technicians in sterile processing tell the difference between normal wear and tear and damage that could cause failure in the OR?
Speaker 2:Well, with hemostats you really can't. You just you got to just make sure there's no blood and guts on your hemostats. There's no crack in the box lock, but wear and tear you'll see on scissors. Hemostats there's no crack in the box lock, but wear and tear you'll see on scissors, for example. And I can't wait to have an episode where we talk about the repair process. But let me tell you right now, across the world there's repair technicians sharpening scissors 100% wrong scissors 100% wrong. Yeah, and nobody knows that. I mean people. You know I write about how to test a repair vendor. Oh my gosh, you know one of the best things have the repair vendor bring scissors back in from sharpening and say Mr Repair Vendor, show me, teach me how you know they're sharp. I actually had a hospital where the guy grabbed a piece of copy paper and cut with copy paper.
Speaker 2:The consolidation in this marketplace has not been good for patient care. There's not enough training and they just aren't doing a good job. So wear and tear can be seen on the scissors. This will be hard to show, but on a blade, if they grind it too hard right here, you'll see where it hit the grinder. You should never see that. And then when you close the scissor, the reason scissors don't meet at the tip it's the hack in the repair van. He doesn't know what he's doing.
Speaker 2:You know, I am very our quality. You know, I was taught by German instrument makers, brought it back to my facility and I would teach them, I would show them and it was, and then I'd have a few people go over to Germany with me to learn. We had their standards. And the biggest thing with getting back to the question about wear and tear, this is the saddest thing going on all day. Tomorrow, across the country, there are new repair technicians in your vehicle, on your property, working on instruments your instruments while they're getting trained. My training was done on my inventory, not your inventory was done on my inventory, not your inventory.
Speaker 1:Yeah, that happened to us. That happened to us recently where they were trading somebody and we're a small facility so we don't really have a lot of extra instruments and the repair technician he had pulled so many instruments out of our trays. I was like and all the scissors, a lot of the scissors were just. We were getting so many complaints about the scissors. So I definitely understand what you're saying yeah, scissor.
Speaker 2:if I manage a sterile processing department and people that's listening to this podcast, teach memorization and make sure every scissor is sharp and make sure every needle holder has tread that the jaws aren't worn out, you will be promoted to super manager. If you do that every day, if your standards are sharp scissors and good needle holders, your surgeons will love you. The patient can't thank you enough.
Speaker 1:Yeah, that's actually really great. So, in regards to scissor testing, I know we have the red and the yellow testing rolls that are provided. What's the proper? How do I know which one should be? Which scissor size should be used for the red, the yellow, and how do you properly test the scissor?
Speaker 2:Okay, the issue of what's it called. It's not communique, it's now called insight, that issue yes, hspa, yeah, hspa, I thought it was communicated.
Speaker 2:They changed it again it's got some new name, but anyhow, the issue that came in the mail yesterday to me. Please read that, copy it, distribute it. I define where to use red material, where to use, and every time another educator that's on LinkedIn. He screws it up all the time. And some of these educators I am willing to train. If you're listening to this podcast and you're an educator, I will train you how to know about instruments. But the thing is, yellow test material is for four and a half inches and smaller. Red is for larger. Now what about a seven inch spring handle Jacobson scissor? The blades are very small. You use yellow, apply common sense. The instrument's seven and a half inches, but the blades are, you know, less than a half inch. Use yellow. The yellow material is for your small scissors and the red is for your larger scissors. And just for the heck of it, I knew this scissor was very sharp. This is the one I was exactly.
Speaker 1:Yeah just, I feel, with the instrument whisperer it better be yeah, yeah, that thing cuts through that like butter no, that's great, that's so true.
Speaker 1:And just to to add a little fun fact for the listeners or or something to look into is um in in r Rick's instrument book that he sells, he does have a chapter on how to assess your instrument repair company when selecting one, basically a checklist to go through to make sure that you are selecting the appropriate instrument repair vendors and sharpening vendors. Just FYI, if you don't have that book, I will add the picture to this episode later so you will see it. But just want you to know that that does exist and make sure you get yours, because it's loaded with information.
Speaker 2:Well, thank you, and the thing is for sterile processing personnel. If you're sending the instruments out to be repaired, restored, refurbished, whatever you want to call it, you should know your repair contract Meaning how much am I paying to have a scissor sharpened? And then I just wrote about it somewhere the repair vendors are taking things off site.
Speaker 1:Yes.
Speaker 2:And they are charging you a different price and that is not acceptable. That is not acceptable. Scissors should be sharpened $2.50 on location, $2.50 if they take it back to their facility. But, Bill, if they are taking scissors back to their facility, shame on them yeah that's right. They really should be doing scissors on location. Yeah, it's really sad how hospitals, patients, sterile processing personnel are getting ripped off.
Speaker 1:Yeah, that's really great. I just want to make sure I don't forget to add this in. I do know or a quick question, is, when you're verifying that your instruments don't have any bio-burden anything that's coming back from the dirty side as it comes through the washer. You got your instruments, the hinges are open so that they can go through the process and get washed effectively. Now, when you're testing your house mosquitoes, or your keloids, your cryos, your Rochester peens, so what are you looking for as it relates to functionality when you're doing these? Before you're putting it on that stringer, you're assembling it. What are some things some technicians should be verifying before they put on that stringer?
Speaker 2:Start at the tips. Are the serrations free of blood and guts? Exactly? I keep the world simple. We could call it bioburden, but everybody else knows well it's blood and guts. Okay, no blood and guts in the serrations. Separate the rings. Is there any in that hinged area? And then is the box lock cracked. Then open and just click the hemostat. Three clicks this one, perfect One, two, three. You're done with it, Move on.
Speaker 1:Okay.
Speaker 2:That is the process.
Speaker 1:Every time Right. So now we verified our clamps, we did our forceps, we did our scissors. Now for our needle holders. How is the technician we know we're verifying there's no blood and guts on it.
Speaker 2:Now how am I verifying that that needle holder is like? What is the test that we should be running or doing on that instrument before we put it on the stringer? Okay, everybody, please listen to me on this point. I have found nationally recognized educator gurus in the industry teaching the wrong thing. They are saying take the needle holder and hold it up to the light. That is BS, that is. There's only one needle holder you hold up to the light and that is a smooth jaw, webster or Halsey. The rest of the time, separate the rings and inspect the tread. They wear out at the tip first. Now I got to tell you this story and it's a battle that I can't fight.
Speaker 2:Okay mm-hmm I can't mention. It's one of the big instrument companies.
Speaker 2:I was this close to saying their name, but anyhow their ifu says hold it up to the light, they are so outdated. They're an old german instrument company. They're wrong. They're wrong because here is the fact of the matter. To get this is a five and a half inch Olsen Hager, meaning it's got a scissor in the middle. By the time those jaws wear out to see light through it, the carbide's gone. The carbide is totally worn out. In my book I have drawings of it and photos of it, but no book. I have drawings of it and photos of it. But no folks. Do not inspect a needle holder that way. Separate your rings. Look at the tread. It is exactly the same as the tires on your car or truck. Everybody listening knows what a worn out tire looks like. The tread is missing.
Speaker 2:Mm-hmm looks like the tread is missing and what that means. Here in ohio in the winter you're getting stuck when the snow and ice come. It's a fact, and with uh the tread, that the treads got to be there to grip that needle. And the quickest way is separate the rings and look Right.
Speaker 1:Okay, now, what about? I know in my career there. At one time I was told you click the first ratchet on the needle holder, flip it upside down so that you're holding it in your hand, and you would hit it against your palm to see if it releases. Is that still? Is that a myth, or is that the truth of the matter?
Speaker 2:You're right, church wrong, pew. All right Okay.
Speaker 1:You're talking my language now, Rick.
Speaker 2:Yeah, all right, what that is? It's anything with the ratchet, hemostat, needle, holder, tenaculums, anything that has these ratchets You're testing. If it's sprung, is the hemostat sprung. And what you simply do put it on the first ratchet and tap it on your work surface three times. Then you turn it over. You flip it over One, two, three, it still holds. The problem with your hand, bill, is you can't get it flat. And number two, it's soft. Use a hard surface.
Speaker 1:Your work surface. That's really good.
Speaker 2:So you're close, but anything with the ratchet. Now my teaching is this Don't test the ratchet unless surgery puts a tag on this. It doesn't hold. Or when you go to put it in the tray and take it for a walk Right?
Speaker 1:Yeah, we don't want to loosen the ratchet, yeah.
Speaker 2:If that first click is jumpy, put it in the repair box. Yeah, that's right.
Speaker 1:If it's not broke, don't fix it. Yeah, yeah, no, that's really good. I just want to take a second just to add about some of those common instruments that you might see in the sets and how we can, you know, just empower. Right, this is an empowerment podcast. We'd like to empower new technicians. You know technicians that have been doing it for a while and maybe not doing it. You know the correct way, so that was really really good information. Thank you very much for that. What are some risks of waiting until the OR complains versus catching these issues with instruments during reprocessing?
Speaker 2:Okay, that is called reactive, and reactive is the most expensive. My teaching is proactive.
Speaker 1:Right, that's good.
Speaker 2:The best example of that is the surgeon goes to use a mayo. It doesn't cut, doesn't cut, he throws it and then one of the folks in the operating room says we'll get that one sharpened. That is so backwards. As I said earlier, it's easy, easy, easy to have a scissor sharpening program in place at any department, any hospital, and it's very easy to have good needle holders with jaw tread. It's education. Negotiate with your repair vendor saying, hey, I'm not paying $9 to sharpen a sciss right, you should be down much, much, much lower in the $2 to $3 range.
Speaker 2:But these repair companies, they're getting away with so much Overcharging and, number two, not doing a good job. Nobody's holding a repair vendor accountable. And I'll say it again next time you have instruments brought back from being serviced, stop and have that person teach you how they know. It's sharp.
Speaker 1:That's good, that's very good. Wow, that's really good. That was a pro tip y'all. I hope y'all listened. That was a pro tip, right there.
Speaker 2:Yep Test the repair vendor.
Speaker 1:That's really good. What's the biggest myth about general surgery instruments you'd like to clear up today?
Speaker 2:The names. The count sheet should not have the wrong name on it. If it's a cryo, you put cryo down. If it's a Kelly, it's a Kelly, not five and a half inch hemostat, right, right.
Speaker 1:That's good.
Speaker 2:And yeah, everything starts with the count sheet and you know the count sheet. Accuracy is so important and we're going back to what we recently discussed. Bill, you got to know your instruments.
Speaker 1:Yep, yep, that's right, you got to know the right names.
Speaker 1:Great, that's good. No, it's really good. I know that there's a lot of. I think I mentioned this maybe on our previous episode or another episode I've had a chance of having on the podcast at May, daphne from LayerJot. They have all these AI technologies. They're incorporating these for training new staff.
Speaker 1:It's a scan of a part number, right. You just scan the part number, pulls it up, tells you what it is. It's a great resource for, say like, when you're onboarding or maybe you don't have enough people to do the one-on-one precepting. But there's a lot of good resources. They got a lot of the catalogs scanned into the system. Living in this different age where, like me, I'm old school, right, so I take pictures for the students Teacher, the sterile processing program we precept students and so I have a picture of them with the book out on the desk and the teacher says why is the book out? I said, well, I'm just letting them know that if they don't know the answer, find it. So now we've got a lot of these technologies out here that are really helping people to identify. So I think it's really good that they are giving more resources to those who need to learn more or are new to the industry.
Speaker 2:Yeah, and Bill don't ever think old school's going away. Old school's the right school, that's right. That's right, you do things right because it's the right school. Will AI and all that stuff fix these problems? No, because you still need a human in there, you sure do.
Speaker 1:Yeah, even with the automation right. I had RST automation on there and he was showing me amazing technologies where it can do pill packing for you, it can help you with assembly, but you still have to have someone to run the machine. Yes, so AI robots are not taking over the world. We're still here, ladies and gentlemen. We're still here.
Speaker 2:No, this industry is not going away. It's time this industry gets better. It's really quite sad that some people refer to it as the brain drain. The CS manager has been there 35 years. She decides to retire. There goes all her knowledge and experience. We have to keep learning and the days of going to your local chapter meeting and have educators, not salesmen, up there selling their BS.
Speaker 1:Yeah, yeah, it's true. No, it's so true. I think this is really really good. If you could give SPD Tech one habit to adopt tomorrow, today, tomorrow, that would extend instrument life. What would that be you need?
Speaker 2:to teach your eyes to inspect the hinged area or box lock, that's right. Go where the blood and guts are, and your patients will thank you.
Speaker 1:Yeah, that's right Now and then for leaders. What's one practice that could immediately improve general set quality across the department?
Speaker 2:As a department leader. Yeah, yeah, absolutely. Getting back to knowing the names the name game Create a contest. Put 10 hemostats out, have all the employees put a name down, drop it in the hat. They get a Starbucks gift card.
Speaker 1:I love it.
Speaker 2:You got to create fun to learn.
Speaker 1:That's awesome. No, it's actually really great. I love that. And then, looking ahead, how do you see instrument care evolving with all these new technologies that are you know?
Speaker 2:I'm sorry to say it, the technology is only as good as the people. You got to have good people working with and around the technology. There's no other way to say it. Just be the smartest you can be, know your instruments, know where to look. I am not teaching you how to slow down. I teach how to go faster. Mm-hmm.
Speaker 1:Yeah.
Speaker 2:It's that simple.
Speaker 1:Yeah, that's good. It's really true too. It's very good. Well, you know what I really appreciate this episode. It's really really great. So you know, another chance for us to catch Mr Schultz pick his brain. We are just getting started.
Speaker 1:If you thought general surgery sets were the foundation, wait until we step into the heavy hitters. In our next episode, Built to Move, we'll be going over ortho instrument care. We'll dig into the complexity of orthopedic instruments, you know, from bone cutting tools to power equipment, to the critical care of the cannula, drills, saws and the reamers. We'll talk about keeping sharp instruments, preventing rust and why orthopedic sets can challenge even the most experienced SPD tech. So don't miss it. Episode three is built to move and you'll want to be ready. So, rick, we want to thank you once again for sharing your expertise. Thank you for tuning in and once again, join us next time as we keep building from this foundation into the specialty sets to bring their unique challenges. Rick, once again, I just want to thank you for joining us today. It was another great episode. And do you have any parting words for the listeners today?
Speaker 2:I love doing this. You know I can't. I have so much knowledge in my head, I can't grow hair and I'd like to share all that instrument knowledge that's up there. So I'm here to help you.
Speaker 1:No, and this is great. Yeah, because I do know that we didn't get a chance to touch on laparoscopic instruments, which, in a lot of cases, are related to general instruments. But I really would like to add that I know Rick, he's ready. He just sent me the question. He don't even want to know the questions, he's like. He just shows up ready to go. So I love this.
Speaker 2:Lap instruments scare people. You got to know once you get comfortable with them, know how to take them apart, put them together. But once again, you got to teach your eyes where to look on a lap instrument. And it's easy, that's great. No, that's really good.
Speaker 1:So that's awesome. Well, thanks again, rick, and we'll definitely we'll see you in the next episode and stay tuned to Sterilization Station. Please like, comment or subscribe. You can find us on Instagram, sterilization, underscore station 52. We're on LinkedIn wherever you can. You think you can find us. We're there and so make it a.
