4 surgery center leaders on sterilization technology that drives efficiency

Efficiency is the lifeblood of surgery centers. As the outpatient setting grows in popularity, surgery center leaders must ensure the safe, efficient turnover of operating rooms to both compete for additional case volume and keep costs under control, according to the Association of PeriOperative Registered Nurses.

“Efficiency is very important due to the changes in reimbursement, costs of supplies, emphasis on the patient experience, physician satisfaction and employee engagement,” said Susan Bianco, BSN, RN, administrator of Big Creek Surgery Center at Southwest General Health Center in Middleburg Heights, Ohio.

Sterilization is one process that can have a substantial influence on efficiency in the surgical setting despite occurring outside of the operating room, according to numerous studies. In one study published in the journal Hand in 2016, researchers identified proper sterilization as one of the factors that can positively influence OR turnover times.

For Island Eye Surgicenter in Westbury, N.Y., there’s no cutting corners in sterilization processes, according to Nurse Manager Darci Bell, RN. Not before COVID-19, and not now.

“We adhere to the strictest standards,” Ms. Bell said, explaining that universal precautions are followed in the care of all patients.

As a specialty center, Island Eye accommodates a high volume of surgeries — anywhere from 60 to 100 cases a day. A sizable portion of these procedures take no longer than 10-15 minutes. With such quick and proficient turnover, the center’s sterilization processes must be not only effective, but also highly efficient.

Along with operational efficiency, industry consensus is a qualitative measure Island Eye uses to evaluate its sterilization processes. In the summer of 2009, The Joint Commission updated its position on flash sterilization — a term traditionally used to describe steam sterilization cycles involving unwrapped instruments — calling it a “less than full sterilization cycle.”

Then, published in 2011, a host of professional organizations, regulatory agencies and accreditation bodies agreed to a new term: immediate-use steam sterilization (IUSS). “Flash sterilization” was abandoned, and IUSS was instituted as a change in practice. There was clarification on when to use it, as well as the rationale for its use in patient care.

“Flash sterilization is often being used for full sets of instruments, multiple trays, complicated devices ... and loaner instrumentation,” authors wrote in a 2013 article published in the American Journal of Infection Control. “This is well beyond the original intent of the flash sterilization process.”

The leaders at Island Eye were paying attention to these industry changes. Committed to clinical excellence and best practices, they began searching for a way to ensure the center’s surgical instruments could be properly and efficiently sterilized.

After researching products on the market, Island Eye became a loyal user of ONE TRAY® Sealed Sterilization Containers in cataract procedures, corneal transplants, lid lifts and more.

“ONE TRAY® was one of the options we looked at,” said Materials Manager Christina Moylan, LPN. Island Eye also trialed a competing vacuum-sealed container intended to improve turnover. “We found it not to be anywhere near as efficient and time-saving as using the ONE TRAY® system. [The other product] didn’t hold up to the standards that we needed for efficiency.”

Island Eye was far from alone in turning to ONE TRAY® as an alternative to immediate-use steam sterilization.

For Big Creek Surgery Center, a hospital outpatient department offering orthopedics, pain management, ENT, pediatric dentistry and podiatry, ONE TRAY® “provided the opportunity to effectively sterilize instrumentation, decreasing surgical and anesthesia time if a last-minute decision was made during a procedure,” according to Ms. Bianco.

These advantages have only become more pronounced as many surgery centers experience resource constraints in the wake of COVID-19-related shutdowns. In this kind of environment especially, Ms. Bianco said, “the ability to process instrumentation safely and efficiently is needed to achieve effective turnovers.”

‘It’s the technology of it’

So, how does ONE TRAY® work? ONE TRAY® is a sealed rigid container with rectangular vents in the lid and base. Disposable hydrophobic filters cover each vent and are held firmly in place by filter covers. This permits the penetration of steam during the sterilization process and serves as a bacterial and fluid barrier at the conclusion of the sterilization cycle.

The resulting air flow pattern makes for fast, effective sterilization — a key selling point for Island Eye.

“It’s the technology of it. That’s why Mr. [Bob] Nelson, our former executive director, [chose ONE TRAY®],” said Teddy Mathurin, the ASC’s sterile processing department manager. “We used to take 40 minutes to sterilize a tray. ONE TRAY® technology cut it in half to around 20 minutes” – for the sterilization cycle alone.

Throughout the entire reprocessing cycle, which typically includes drying and cooling, the time saved with the use of ONE TRAY® is actually closer to 80 minutes.

With the ONE TRAY® technology, Island Eye staff can have a tray decontaminated and prepared for its next sterilization cycle quicker than they have in the past with other sterilization containers. According to Mr. Mathurin, “it is a far superior alternative and helps prevent surgical delays that waste resources and erode patient satisfaction.”

In other words, ONE TRAY® does its job. By monitoring chemical and biological indicators to determine whether necessary conditions were met to kill a population of resistant microorganisms, Mr. Mathurin said, Island Eye’s sterile processing department has been able to determine that ONE TRAY® is an effective technology.

Mr. Mathurin also shared another telling indication that investment in ONE TRAY® paid off. With the use of ONE TRAY®, there have been 0 patient adverse events reported at the ASC.

“That’s not an easy thing to do,” he said.

Securing buy-in

When Big Creek Surgery Center and Island Eye made their respective transitions to ONE TRAY®, guidance from sales representatives was key. For Island Eye, it was especially important because the ASC was in the process of relocating from a three-OR facility to a six-OR facility, according to Mrs. Moylan. Plus, employees can be hesitant about changes even without a major relocation in the works.

“[ONE TRAY® representatives] were outstanding as far as making themselves available to the staff,” Mrs. Moylan said. “There were a lot of changes going on, and at one period in time, the representatives were present for several days in a row working with staff, introducing them to the system and how it works.”

Along with securing employee buy-in, ONE TRAY®’s guidance served to minimize the potential for human error in sterilization processes. Employees were educated on distinguishing issues from non-issues such as residual

condensation, facilitating a seamless user experience and contributing to excellent patient outcomes, according to Mr. Mathurin.

“My first impression of ONE TRAY® was, ‘Wow, this is so easy,’” he said. “‘This is very user-friendly; this is simple and it gets the job done the right way.’”

With ONE TRAY® in its arsenal, Island Eye is able to continue creating efficiencies through standardization. For ophthalmic cases such as cataract, glaucoma and corneal procedures, Island Eye uses a smaller ONE TRAY® container than it uses for plastic and reconstructive surgeries. The plastics-type cases warrant a larger tray because they involve a lot more instrumentation, Mrs. Moylan explained.

“The larger tray accommodates that quite nicely,” she said. “All of those items we used to separately seal in pouches can now fit in ONE TRAY®, so the surgeon now has everything for the procedure readily available in one tray.”

The future for ASCs

Without ONE TRAY®, staff would have to sterilize and package some instruments separately — and with about 65 surgeons working out of the Island Eye facility, it would cost precious time and money.

“Without ONE TRAY® we’d have to have at least double the number of surgical trays to accommodate the volume of cases we currently perform. Because of ONE TRAY® and its efficient and time-saving sterilization, all that additional instrumentation is not needed. Therefore, this saves us a tremendous expense that we do not have to incur,” Mrs. Moylan said.

Big Creek Surgery Center has also realized cost savings because of ONE TRAY®. The center eliminated “wet” packs and torn wraps. Faster instrument processing saves time in the surgical schedule for more revenue-generating cases.

“ONE TRAY® technology is an asset to any organization,” Ms. Bianco said. “The technology has allowed for the ability to increase surgical case volume with limited instrumentation while continuing to provide quality patient outcomes and control costs.”

ASC leaders considering introducing ONE TRAY® should give it a try, according to Mrs. Moylan. She said any center that does will see results, like Island Eye did.

“It definitely has made a difference for us,” Mrs. Moylan said. “I hope that other centers are willing to give it an opportunity because I believe that it really is the future, as far as making things more efficient in surgery centers.” 

This article is sponsored by One Tray.

More articles on surgery centers:
ASC growth + innovation amid COVID-19 — 5 valuable insights
Separate payment expires for cataract surgery drug in ASCs — 5 things to know
The legacy of COVID-19 on ASCs: Pros and cons


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