With the recent mandate that hospitals eliminate STERIS System 1* (SS1), many facilities are working to make a smooth and rapid switch to alternative reprocessing methods. Advocate Good Samaritan Hospital, a 333-bed Level 1 trauma center serving metropolitan Chicago, is one step ahead. More than five years ago, the hospital eliminated SS1 in the operating suite, replacing it with low-temperature hydrogen peroxide gas plasma sterilization for flexible endoscopes. The impressive results achieved by the hospital include optimized availability of expensive instruments, increased instrument turnover, and decreased instrument repair costs.
“We are fortunate that we were ahead of the curve in eliminating STERIS System 1*,” said Grant Smith, RN, clinical manager operations, surgical services at Good Samaritan. “We know that many SPD [Sterile Processing Department] and OR managers and staff are going to have to quickly educate themselves about alternatives to STERIS System 1*…”
More than 9,000 surgeries are completed annually at Good Samaritan Hospital, and instrument processing plays a vital role in ensuring ready availability of instruments. To meet this demand, the hospital utilizes hydrogen peroxide gas plasma sterilization (STERRAD® Systems, Advanced Sterilization Products) in the sterile processing and surgical environments to provide rapid terminal sterilization for a variety of heat- and moisture-sensitive instruments.
The hospital’s journey to an SS1-free facility included the acquisition of two STERRAD® NX™ Systems in the OR, replacing two STERRAD® 50 Systems. Smith said the transition from the wet SS1 process to a dry sterilization process for flexible endoscopes involved protocol changes and the creation of an equipment “turnover room” in the OR suite to increase efficiency. As an added benefit, the turnover room is staffed by sterile processing personnel, freeing nurses from cleaning and reprocessing surgical instruments. During the transition, the SS1s remained in place, but it took only a short time to convert the OR nurses to the new process.
“After the first month, the use of STERIS System 1* decreased rapidly,” Smith said. “We worked closely with the OR nurses to reinforce the new procedures. Now, instead of cleaning and putting a device in the STERIS System 1*, nurses bring it to the turnover room and leave it to be cleaned and sterilized. They are no longer stressed with reprocessing instruments, allowing them to focus on surgical procedures.”
According to Smith, the changeover to hydrogen peroxide gas plasma sterilization resulted in cost savings due to a reduction in instrument damage associated with SS1. “Endoscope damage was dramatically reduced once we began using the STERRAD® System,” he said. “We completed an analysis of repair costs due to fogged lenses caused by moisture infiltration. In the first year with the STERRAD® System, we saved more than $44,000 in repair costs.”
Smith said costs also were reduced due to the elimination of unnecessary SS1 cycles required in case a device was needed and couldn’t be processed quickly in ethylene oxide. Prior to its use of the STERRAD® System, an average of eight peracetic acid cycles were run per day in the hospital’s three SS1 machines, and four of those cycles were run only in case the equipment was needed—in other words, 50 percent of the cycles were wasted, which in sterilant costs alone totaled more than $10,000 per year. (Savings based on estimated costs of $7 per cycle x 4 cycles per day x 365 days per year.)
Now, after installing its first STERRAD® System in 2003, six units are deployed throughout Good Samaritan, and the systems are used at near capacity. Fast turnaround and a high level of materials compatibility are key benefits, increasing efficiency, reducing instrument damage, and lowering costs. Now, Smith is helping other facilities understand the research they completed to go SS1 free, the processes they implemented, and the resulting benefits. “Based on our long and positive experience with the STERRAD® System, we are in a great position to help.”
To read the full story of Advocate Good Samaritan’s transition from SS1, as well as ethylene oxide, click here.
*STERIS System 1 is a registered trademark of STERIS Corporation.
Key Steps to Follow when Going STERIS System 1* Free
It is critical to understand what instruments currently are being run in STERIS System 1* and what reprocessing alternatives are available. Some instruments cannot be processed in a STERRAD® NX™ System, so you may have to upgrade to a newer instrument model, change to a slightly different model (i.e., larger lumens for pediatric scopes), or find an alternative sterilization method, such as sending instruments to central service for processing in STERRAD® 100S/200/100NX™, or steam, or outsource to EtO).
Understand Workflow Requirements
Moving from a wet process to a dry, terminally sterile method requires changes in processing protocols. For Good Samaritan, creating a turnover room staffed by a Sterile Processing Department technician made it easier to maintain processing standards and allowed OR nurses to focus on surgical procedures.
Understand Capital Requirements
A turnover room, or any other option, will have capital impacts. Moving instruments to CS may require additional inventory of instruments, along with additional sterilizers to handle the increased instrument flow. Additional instrumentation also may need to be purchased. A turnover room will require at minimum a washing basin, washer, sterilizer and an air line for drying.
Understand Behavior Setting
Part of the change process is breaking old habits and building new ones. Proper training, communication, and oversight early in the process will help build a successful transition. Having an SPD staff member oversee process change allows experts in instrument processing to do what they do best and troubleshoot as the new process takes effect.