The hospital’s Medical Device Reprocessing department performs crucial work.
Every day, dozens of MDR technicians work between 7:00 a.m. and 11:00 p.m. to clean every piece of equipment used in the hospital’s operating rooms (O.R.). They work tirelessly to thoroughly wash, sterilize and bundle thousands of surgical tools to be used again, sometimes within hours.
“Any surgical tool used in the O.R. is reprocessed or cleaned through MDR,” reports Scott Zablocki, manager. “We also clean countless other pieces of equipment from the entire hospital. If you’re in a unit or in surgery and you see something wrapped in a blue wrap, we cleaned it.”
The process is more detailed than the word ‘clean’ suggests, Zablocki says. It’s composed of several stages where equipment is rinsed, washed, inspected, sorted, sterilized and stored.
He says tools, pans and trays, come straight from the O.R. to MDR’s facilities in the basement on a direct elevator. “Everything we receive is first rinsed and washed by hand, before being placed on steel racks and loaded into automatic washers. These are essentially large, industrial dishwashers.”
When the double clean is completed, every piece is inspected by hand to be sure it’s free of ‘organic’ debris. If it’s not, it goes back to the start.
“Then the technicians rebuild the kits,” Zablocki continues, noting this too is a painstaking step in the process. “Every procedure pan or set has its own ‘recipe card’ because every surgeon has their own preferences so the kits are all very different. The various combinations number in the thousands.
“Kits consist of everything from generic equipment to specific tools. They must be placed properly in pans and put together, then labelled with sterile indicators. Once a kit is completed, it’s steam sterilized in the autoclave. We call this part ‘cooking the goods’ and it takes about 90 minutes.”
After being sterilized, Zablocki says equipment is placed on shelves or carts for their next use. “Our turn-around time is anywhere between an two to three hours, depending on the complexity of the kits. The O.R drives this, so there are times when we need to do a ‘quick turn’ – when we know a pan or set of tools is needed again soon. Technicians do their best to get it through.”
Extraordinarily, this process is hand-tracked. Technicians note who and when items were cleaned and what kit they’re in. It’s necessary because if a piece does slip through that isn’t sterile, staff follows the chain to determine if anything else in a kit is affected.
It all happens every hour, 16 hours a day and sometimes longer when there’s a heavy workload.
Or when there’s equipment malfunction. Like the O.R., the strain of constant use wears equipment down, Zablocki reports. “It’s old equipment, too. Much of it was installed when the building opened in 1993. We continually have issues.”
As part of Making O.R. a PriORity, Medical Device Reprocessing is asking for two new autoclaves and for its cart washer to be completely replaced. “We have four autoclaves but one is now permanently out of order, and another is failing regularly,” Zablocki reports. “That leaves us with two working devices at most times and results in a backlog with just two units processing everything in the hospital.”
Zablocki adds that the cart washer – used to clean and sterilize the racks where equipment is transported and stored – is simply aging beyond usefulness. “There’s no back up. When it’s gone, it means carts must be laboriously washed by hand.”
Equipment failure of any degree in MDR has consequences. “If we’re down, we cripple not just the O.R. but also every unit in the hospital. Surgeries will be cancelled. Patients, many of whom travel from out of town, have to go home and come back another day.
“Simply put, if we haven’t been able to do our jobs, no one else can do theirs.”