Black box CSSD

Let’s talk about some facts 

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…how high the costs for a single missing or malfunctioning surgical instrument can be?

Delays are the most common type of disruption in the operating theatre and the main cause (55.2-57.9%) of delays is equipment failure, including missing or malfunctioning instruments. ^[1]

When a new tray has to be ordered during surgery, it takes approximately seven minutes until it arrives in the operating theatre. ^[2] One minute of operating theatre time costs up to $37, ^[3] which means that one missing or malfunctioning instrument can cost up to $259 only due to the delay it is causing – in addition there are the costs for the waiting surgeons and nurses.

…that many instruments within a set are never used during surgery?

The instrument utilisation rate often is as low as 13% due to overloading of sets. ^[2] After surgery, all devices should be reprocessed, even if they were not used.

This causes significant unnecessary costs for health institutions, considering that the total reprocessing costs per instrument exceed $0.51. ^[2a] The reprocessing not only costs money and personnel resources, but also shortens the lifespan of the device. Another problem of overloaded sets is that the rate of broken, and thus unusable, instruments increases with the number per set. ^[3]

…that pinholes in soft wraps threaten the hospital’s finances and patient’s health?

Surgical instruments and sets are often packed in soft wraps, which are prone to pinholes if they are not handled appropriately. When pinholes or tears are detected, the whole set is considered as non-sterile and requires reprocessing. In a study in 2022, 12% of sets were rejected due to holes/tears in the wrapping.^[4] Damaged sterile packages can cause operating theatre downtimes and time pressure. Moreover, holes in wraps might appear inconspicuous and could be overlooked, leading to risks of surgical site infections (SSIs).

…how instrument sterilisation correlates with surgical site infections?

Instruments that are sterilised insufficiently can lead to SSIs. 2-5% of all patients undergoing surgery develop this kind of infection ^[5] – for abdominal surgeries, the percentage is even five times as high. ^[6] A study showed that a sudden increase of the SSI rate in the orthopaedics and ophthalmology wards in an NHS hospital in Glasgow could be traced back to poor handling practices in sterilisation. ^[7] In 3% of all SSI cases, this complication leads to the death of a patient. ^[8]

On average, a patient suffering from an SSI has to stay in the hospital for 14 additional days, causing additional costs of £10,523. ^[9] SSIs not only damage the hospital’s budget but also its reputation.

…how important well-trained staff are?

In some hospitals, maintaining optimal reprocessing cycles is challenging. One reason is the lack of training which can lead to mistakes concerning the handling of items. For example, not detecting pitting corrosion during care and maintenance leads to a systematic corrosion affecting not only the instrument sets but also the whole reprocessing cycle including the equipment.

Black box CSSD – a potential cost saver

Discover your saving opportunities 

Solutions for the CSSD

Value preservation & backup stock management

Ensuring the optimal functionality and availability of surgical equipment allows operations to go ahead as planned, avoiding delays, stress and costs. A professional high-quality repair management and a technical service that is reliable and always available when needed can help you to achieve long term functionality of your instrumentation and thus preserves the value of your surgical sets. Ensuring that functioning devices are always available requires good backup management. This enables surgeries to go ahead as planned while other instruments undergo repair or maintenance.

Set optimisation

Surgical sets are often overloaded however they can be optimised and adapted for surgical procedures, bringing wide ranging benefits for the operating theatre and CSSD. ^[11] Our Set Consulting Team found that, on average, reductions of 22% for existing set structures is possible. ^[10] Considering that the reprocessing costs for one instrument amounts to approximately $0.51 ^[2a] we calculated that the reduction of a 90 piece set to 70 instruments (by 22%) can save up to $408,000 per year. ^[10]

Containerisation

In many CSSDs, soft wraps are commonly used to pack sterilised surgical instruments but are very prone to pinholes or tears. Damaged packaging effects the sterility of the instruments and is a high risk for the patient’s health. By contrast, containerisation does not only enable sterile storage, but also easier handling as containers can be stacked and different lid or faceplate colours allow for sorting by disciplines. Containers help prevent contamination of sets and maintain sterility for at least 360 days. ^[13] One case study found that – compared to soft wrap packaging – on average US$ 190,000 can be saved per year by containerisation. ^[14]