CSSD on the edge of overload?

Does infrastructure meet requirements?

Does this sound familiar? 

If so, you probably know about the difficulties.

Overloaded instrument sets lead to unnecessary reprocessing

In some hospitals, one surgical set can contain up to 120 instruments and often not even half of them are used during surgery. ^{[1], [2]} These overloaded and most often unstandardised sets are very heavy and difficult to handle for the CSSD staff and the nurses in the operating theatre. The overloading leads to unnecessary reprocessing of unused components. Clearly, this increases the costly use of personnel resources and reduces the life span of the instruments and devices, which in turn leads to a higher purchasing rate of new instruments. ^{[3], [4]}

Insufficient backup of surgical instruments makes the completion of sets impossible

If instruments need repair or must be substituted, CSSD often can be difficult to provide appropriate replacements. As a consequence, incomplete sets go into the operating theatre and cause time consuming delays. Hospitals may not have an outright backup stock. In addition, hospitals may not have sufficient organised storage space or appropriate inventory management systems. This leads to not having an overview of what is available and also might result in incorrectly packed sets because items cannot be found or are not available in the amount needed. A digital solution however, could help achieve an efficient and transparent system, assisting with restocking, for example when items must be reordered, or with tracking items under repair.

Incomplete or incorrectly packed instrument sets

Although many sets are overloaded, they often do not include what is needed by the surgeon, or even contain the wrong instruments. For example, gynecological instruments are sometimes packed by mistake into trays for orthopaedic operations. ^[5] Such mistakes can happen when the CSSD is understaffed and there are time pressures. Another factor might be suboptimal instrument management, often based on bulky paper files, so required items can quickly be overlooked or cannot be identified properly.

More than half of the instruments can be in bad condition and unusable

On average, only 18% of instruments on sets are in  good condition for use. The remainder need either replacing (33%), repairing (31%) or require surface treatment (18%) ^[6].

Missing the reliability of a high quality Technical Service?  

Hospitals require an efficient, quality-assured service to enable broken instruments to be repaired promptly and to high standards however, the funding, contracting and organisation of routine repairs can be missing or incomplete. This can lead to varying response times making planning very difficult, or the use of service providers who are unable to provide a high quality repair and maintain the performance of the instrument. 

Soft wrap packaging is prone to pinholes

The instruments are often packed in soft wraps, which are prone to pinholes if they are not handled appropriately, for example during stocking. When this happens and pinholes are detected, the whole set is considered as non-sterile and requires reprocessing, thereby negatively affecting the workload in the CSSD. Even worse, regarding patient safety, 18% of pinholes are not detected by the medical personnel ^[8] increasing the risk of surgical site infections (SSIs).

Daily challenges in the CSSD – how can they be solved?

Discover your opportunities for improvements 

What can be done to solve the problem?

Set optimisation

Our findings show that set optimisation is an important and effective measure: Surgical sets are often overloaded, but can be optimised and adapted for a variety of surgical procedures. Our experts found that an average set reduction of 22% for existing set structures is possible, in one case study 90 instruments could be reduced to 70 instruments per set. ^[9] In this way, reprocessing and wear of unused devices can be reduced, and lighter weight sets make handling and transport much easier.

With standardised packing lists overloading and the placing of wrong instruments on sets is avoided. 

Optimised backup stock

Ensuring functioning and complete sets is a vital task for an efficient and reliable operating theatre process. Transparency of your inventory, in particular of your trays and contents, alongside reliable tracking of tray usage (according to operating theatre needs) are the key elements for identifying optimal backup stock, no matter whether your CSSD already has some items available or start from scratch.

Establishing a well-defined backup stock with the right instrument-mix ensures that any set is fit for use in the operating theatre, because the CSSD is always in the position to replenish, while instruments are under repair or new purchases are being made. A properly organised backup stock helps you avoid incomplete sets. The reserve is built to an appropriate stock level to suit your surgical routines and in such an organised manner that CSSD staff can quickly refill any gaps.

In combination with an efficient digital solution, the handling of the backup stock becomes significantly faster and easier. An app enables CSSD staff to identify instruments, deposit or find them at defined locations. At the same time the system simplifies the overall management of the backup stock including features such as an alarm if items fall behind a minimum stock level, or lists that allow timely orders of out-of-stock items. Another benefit is the management of items under repair, as well as optimised restock functions. In addition, powerful analytic features show options where item handling can be optimised.

Digital instrument management system

The trend of digitalisation is a driver of automation and efficiency. Recent advances offer a clear benefit for the CSSD: Modern digital tray organisation solutions reduce assembling errors and workload in an easy and smart way. The digital organisation of your trays generates, collects and analyses all relevant data and creates updated set lists to assist you in performing everyday processes such as packing, tracking, documenting and reporting.

Depending on your need and/or legal requirements, the implementation of an instrument management system (IMS) will optimise reprocessing by providing necessary information on the whole sterile goods supply, including the entire documentation of the reprocessing cycle, SOP and cost transparency. Interfaces allow the complementary use of different solutions such as backup stock and repair management within the IMS.

Value preservation

Ensuring the optimal functionality and availability of surgical equipment allows operations to go ahead as planned, avoiding delays, complaints and stress. Professional high-quality repair management and a technical service that is reliable and always available when needed, can help you achieve longer working lives and proper functioning of your instrumentation, thus preserving the value of your surgical assets.

Containerisation

Soft wraps are commonly used to pack sterilised surgical instruments, but are very prone to pinholes. Damaged packaging cannot keep the contents sterile and is a high risk for the patient’s health. By contrast, containerisation does not only enable safer storage, but also easier handling as containers can be stacked and sorted by disciplines due to different lid or faceplate colours. 

Provide the right set, at the right place, at the right time and in the right condition?

What could make the difference in your CSSD?