Loss Of Instrumentation

[Lynn McKinney]

Can anyone tell me if the use any type of medical loss prevention detectors on their surgical waste at their facility to try and recover instruments being disposed of and do you feel they are worth the investment?

[charlotte williams]

We used instrument detector for awhile it worked great.Then
It was report to state on the issue of searching through bags for instruments
not a good practice

[djw]

This was a very interesting topic at our facility for quite some time. We went through our garbage (including red bags) for years. We went to Infection Control about this awhile back and they eliminated us going through red bags. Then everyone discovered what should have been obvious right away- the instr., when they were actually thrown away, were of course going into the red bags because anything with fluid went into a red bag-almost everything at the end of a case. We quit going through trash just a few months ago, with this discovery. We have on rare occassion had radiology come over with a c-arm and picture bags if-IF-something that is missing is VERY expensive. Like micro artery clips, custom instr. that doc's have brought, things like that. Interestingly enough, when we did go through trash and/or linen, we rarely recovered instr. Where did they go? Who knows, and it was not worth the risk we were taking.

[sonny1388]

Well, we continue to go through trash as a last resort. We will of course look through the instrument wash, cart wash, on the elevators, in the rooms, and in the flash machines before going through the trash (all places where instruments have been found). Generally speaking most of our lost instruments are wrapped up on the back table, or clipped to one of the drapes. Very rarely do we lose something that isn't recovered. Red trash is the very last thing we look through, and it is understood that if there is more risk in going through the trash than the instrument is worse (i.e. C-Section trash = very bloody), then the instrument will be replaced. I have been trying to get a detector for quite a while to cut back on how many bags we have to go through, but it is still going through the budget process. I think that as long as going through the trash is done properly (Full PPE), and trash is put in the right place (no sharps in bags), then there is no more risk in searching for an instrument than there is in washing one, and it is a huge expendature saver.

[djw]

Going through trash was always the last resort. Our concerns (and infection control also) with going through trash is you are assuming the OR is throwing things where they should. Most of our exposure from"sticks" we have had in the last 13 years resulted from going through garbage. PPE cannot save you from a guidewires or k-wires or anything similar, since it was going into the sharps anyway, and what were the odds anyone would know, staff in the OR just bent it in half and threw it in there. We can only be responsible for ourselves, and hope other staff are also. I agree that systems should be in place that put your staff at the least chance of an exposure.

[sonny1388]

I agree also, but I think there is a line we must draw between letting stuff go to reduce responsibility, and keeping our staff safe. In the last 10 years, we have not had one "stick" from going through trash. In fact, the only two that we have had have been in reassembly while putting k-wire sets back together. Perhaps that it is because we have very consciencious OR staff who do not put sharps in the trash (which is true, for the most part), or because the crew going through the trash do not go digging blindly, but look at what they are going through. Perhaps it is because we are a smaller hospital where time is not always at a critical level. Who knows. What I do know, is that it would sure be nice to find a way to keep instrumentation out of the trash all together!

[debbie]

We are responsible for everything that we do. Initials are on every item we touch from the sterilizer log book to the final product.
I use to fight with the OR until one day I asked, "where is the accountability on there end.
If they put it in the trash why are we going through it. One day we were missing an entire micro saw set. They refused to go through the trash. The Tech said he had a witness to say he did not throw it out.
OK I said this is the deal, if I go through the trash and find it from this point forward you will go through the trash when something is missing. YEAP I put my neck right out there.
Result.... we have disposable basins and someone put a basin with lap sponges on top of the basin with the power. There it was for all to see.

I am not saying going through the garbage is a good thing and THEY do not always find the items there, but they have to be accountable as well. I will save the garbage until the next day if I have to. This has reduced the instrument budget and the number of times THEY have to look. No easy answer on this one.

[sonny1388]

Well, I can tell that we have touched upon a very interesting topic here. Debbie, I think you may have also touched on a problem we are having in our hospital. Accountability. Our C.S. crew is acoountable any time there is a screw missing from a set, or a scissor is dull in a soft tissue. Why is it, then, that they are also accountable on the other end, when the trays are coming back down? We have in the past threatened to make the O.R. staff responsible for going through the trash, but have never really enforced it. Part of this is that some of the time, the instrument turns up in the instrument wash, in the cart wash, in the cart, etc. Part of it is that we are not patient enough to leave a set down and wait for the person to be available to come down and look. But if we don't, how do we make them accountable? Will have to re-open that chapter, and perhaps re-implement that policy, and enforce it.

[New SPD Manager]

OR accountability is a huge issue in just about every facility I'll bet. I know that it is always them pointing the finger at SPD when it comes to the question of why there are "missing" stickers on so many trays. And asking why SPD loses so many instruments. I know this is a big problem at our facility. I've pointed out to OR management that there are far fewer ways for us to lose intruments. We don't handle the disposable waste from the rooms so we don't have the opportunity to throw them away. Also the trays come back from surgery in such disarray that it takes extra time to sort the instruments into the trays they belong. Answer? I haven't found one yet. I know we are looking into the metal detector idea but I haven't heard that they are going to actually get that.

[doc7592]

Do you have the OR restring the instruments after a case or do they just put loose in the pan?

[Lynn McKinney]

I have had the OR team leaders assigned to come work a day in decontamination. It helped a great deal. After them seeing the case carts coming down in a mess and dealing with it things have improved some.