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 OR 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 OR. ^[2] One minute of OR time costs up to US$ 37, ^[3] which means that one missing or malfunctioning instrument can cost up to US$ 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 utilization 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 US$ 0.51. ^[2] 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 threat 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, for example when being stocked. When pinholes or tears are detected, the whole set is considered as non-sterile and requires reprocessing. On average, 5% of wrapped instrument sets are reprocessed due to tears. ^[4] Damaged sterile packages can cause OR downtimes and time pressure. Moreover, holes in wraps might appear inconspicuous and could be overlooked. This case represents a serious risk factor for surgical site infections (SSIs).

…how instrument sterilization correlates with surgical site infections?

Instruments that are sterilized 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 orthopedics and ophthalmology wards in an NHS hospital in Glasgow could be traced back to poor handling practices in sterilization. ^[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 ten additional days, causing additional costs of US$ 21,000. ^[9] SSIs not only damage the hospital’s budget but also its reputation.

…how important well-trained staff is?

In some hospitals, reprocessing cycles do not fulfill basic requirements of regulation, expert guidelines or state-of-the-art reprocessing practices. This is mostly due to the lack of training and leads to mistakes concerning the handling of items: For example, not detecting pitting corrosion on time 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

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What can be done to solve the problem in the central sterile supply department?

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 a long lifetime and proper functioning of your instrumentation and thus preserves the value of your surgical sets. Moreover, guaranteeing that functioning devices are always available requires good backup management. This enables surgeries to go ahead as planned while other instruments require repair or maintenance.

Set optimization

Our findings show that set optimization is a highly important and effective measure: Surgical sets are often overloaded. Sets can be optimized and adapted for a variety of surgical procedures. ^[11] Our experts in Set Consulting found that an average reduction by 22% for existing set structures is possible. ^[10] Considering that the reprocessing costs for one instrument amount to roughly US$ 0.51, ^[12] we calculated that the reduction of a 90-piece set to 70 instruments (by 22%) can save costs of up to US$ 408,000 per year. ^[10]

Containerization

In many markets, soft wraps are commonly used to pack sterilized surgical instruments but are very prone to pinholes or tears. Damaged packaging cannot guarantee sterility of the instruments and is a high risk for the patient’s health. By contrast, containerization does not only enable safer storage, but also easier handling as containers can be stacked and different lid colors allow for sorting by disciplines. Containers 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 containerization. ^[14]