Healthcare Purchasing News - October 2024 by Endeavor Digital Editions

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CONTENTS > OCTOBER 2024

Sourcing & Logistics

8 > A Value Analysis Team Worth Watching: Cincinnati Children’s Hospital Medical Center

JANETTE WIDER

32 > Taking a Bite out of Climate Change

KAREN CONWAY

Infection Prevention

10 > Infection Preventionist Stresses Importance of Bed and Mattress Maintenance

JANETTE WIDER Departments

4 > Organizational Conundrums

6 > What’s on the Web, Advertiser Index

Sterile Processing

14 > Instrument containment, transport and storage success stories

KARA NADEAU

20 > The Mystery of Bowie & Dick

WILLIAM LEIVA

24 > Conducting Meaningful Performance Reviews in the SPD

DAVID TAYLOR

26 > Policy and Performance: “Walk Your Talk”

STEPHEN M. KOVACH

Special Report

28 > Raising Standards in UV Disinfection with AI

MATT MACKENZIE

Organizational Conundrums

BY JANETTE WIDER, EDITOR-IN-CHIEF

This month, we feature a story on instrument containment, transport, and storage and it got me thinking about … stuff.

On a personal level, I have accumulated a lot of things over the years. That box of fashion scarves (any millennials reading this?) in my closet? Totally need those. My trumpet from my days in the band when I was in school that I haven’t played in 15+ years? Better not throw that out. Several pairs of winter boots and moccasins lined in fur while I live in south Florida? What if it gets below 40 degrees?! I might need those!

Not to mention, my husband and I have a 7-year-old dog, a Shiba Inu, who has an excessive number of toys. Well, we certainly need to keep this old toy shaped like a piece of broccoli from when he was a puppy!

I’ll admit, things tend to get a bit disorganized around the Wider house from time to time. We’re currently renting and looking for a permanent place to call home but, in the meantime, my excessive craft supplies and my husband’s bass

guitars and accompanying accoutrements are getting piled up in the guest bedroom closet with minimal organization.

Clearly, hospitals and health systems cannot be as disorganized as I am (although, as you can see, my problems come from having too many unnecessary items). Particularly when transporting contaminated items. The story is on page 14 and it is very clear that having good containment, transport, and storage solutions is essential.

One part particularly stuck out to me in the article: “The central processing department team at Pennsylvania Hospital in Philadelphia had been struggling with a double wire rack system in its instrument storage space. The racks were challenging for staff members to move and necessitated stacking of sets. The system was on tracks, preventing the team from customizing the racks to meet their needs.”

Certainly, our audience can relate to being frustrated with trying to get a job done and having to work with something that, frankly, just isn’t working. (I’m imagining my cabinet of Tupperware right now; why is it always a challenge to find a lid?!) So, be sure to read the article this month to get your own organizational inspiration! And, of course, feel free to send any storage and containment stories my way at jwider@hpnonline.com.

VP & Market Leader

Healthcare and Dental

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Editor-in-Chief

Janette Wider jwider@hpnonline.com

Associate Editor

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Wolfgang with his excessive toys.

What’s on the Web

University of Oxford Researchers Validate Method to Identify Fake Vaccines

According to a news release from the University of Oxford, a new study shows that researchers have developed and validated a method to distinguish authentic and falsiﬁed vaccines using instruments originally developed for identify bacteria in hospital microbiology laboratories. The global population is increasingly reliant on vaccines to maintain population health with billions of doses used annually. A rise in substandard and falsiﬁed vaccines threatens global public health.

Read on: hpnonline.com/55138025

PODCAST:

Supply Chain Cybersecurity with Richard Staynings

Water-Related Issues Impacting Sterilization Equipment Postpones Surgeries in Colorado

Three hospitals on the University of Colorado’s Anschutz Medical Campus in Aurora, Colo. recently postponed surgeries due to water-related issues impacting sterilization equipment. Children’s Hospital Colorado postponed non-emergent surgeries through Sept. 3. Staﬀ at UCHealth’s University of Colorado Hospital noticed tiny black ﬂecks in some of their washers prior to sterilizing and a er washing medical equipment

Read on: hpnonline.com/55137009

Richard Staynings is currently Chief Security Strategist for Cylera, a medical device and HIoT security organization. He is also author of Cyber Thoughts, a leading healthcare cybersecurity blog, and teaches postgraduate courses in cybersecurity, health informatics and healthcare management at the University of Denver University College. Listen at: hpnonline.com/55134491

Editorial Advisory Board

Jimmy Chung, MD, MBA, FACS, FABQAURP, CMRP, Chief Medical Officer, Advantus Health Partners and Bon Secours Mercy Health, Cincinnati, OH

Joe Colonna, Chief Supply Chain and Project Management Officer, Piedmont Healthcare, Atlanta, GA; Karen Conway, Vice President, Healthcare Value, GHX, Louisville, CO Dee Donatelli, RN, BSN, MBA, Senior Director Spend symplr and Principal Dee Donatelli Consulting LLC, Austin, TX

J. Hudson Garrett Jr., PhD, FNAP, FSHEA, FIDSA, Adjunct Assistant Professor of Medicine, Infectious Diseases, University of Louisville School of Medicine

Melanie Miller, RN, CVAHP, CNOR, CSPDM, Value Analysis Consultant, Healthcare Value Management Experts Inc. (HVME) Los Angeles, CA

Dennis Orthman, Consulting, Braintree, MA

Janet Pate, Nurse Consultant and Educator, Ruhof Corp.

Richard Perrin, CEO, Active Innovations LLC, Annapolis, MD

Jean Sargent, CMRP, FAHRMM, FCS, Principal, Sargent Healthcare Strategies, Port Charlotte, FL

Richard W. Schule, MBA, BS, FAST, CST, FCS, CRCST, CHMMC, CIS, CHL, AGTS, Senior Director Enterprise Reprocessing, Cleveland Clinic, Cleveland, OH

Barbara Strain, MA, CVAHP, Principal, Barbara Strain Consulting LLC, Charlottesville, VA

Deborah Petretich Templeton, RPh, MHA,Chief Administrative Officer (Ret.), System Support Services, Geisinger Health, Danville, PA

Ray Taurasi, Principal, Healthcare CS Solutions, Washington, DC

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A Value Analysis Team Worth Watching: Cincinnati Children’s Hospital Medical Center

Gloria Graham DNP, RN, CVAHP manager, Value Analysis, Contracts & Value Analysis/Supply Chain Management, discusses a recent IV pump project

BY JANETTE WIDER, EDITOR-IN-CHIEF

Value analysis teams are integral parts of the healthcare ecosystem. Although they can be considered “behind the scenes,” these teams and leaders are making everything work with tight budgets, staffing shortages, and all of the other

pressures hospitals and health systems are facing today. No project is too big or too small for successful value analysis teams, as one such leader explains to Healthcare Purchasing News.

Gloria Graham, DNP, RN, CVAHP is the manager of Value Analysis,

Contracts, & Value Analysis/Supply Chain Management at Cincinnati Children’s Hospital Medical Center. Graham said that she started her career in nursing and transitioned into value analysis and supply chain. She’s been in the industry for 35 years.

When asked about what recent successful projects she’s worked on, she said, “The value analysis team [at Cincinnati Children’s], even though it’s me and just two nurses, partner very closely with our sourcing department and the buyers. Anything that we do as a whole, we are successful as a result of that team approach.”

Indeed, “Sourcing can’t work on finding cost saving projects and initiatives without going through us and we can’t identify something without pulling in our sourcing partners, and that’s one thing I really like about our structure, that it’s not just value analysis. We are part of a bigger structure under supply chain that really helps us to be successful.”

“Over the past year,” she continued, “one of the goals we hit is what I think is really great and strong work by our sourcing team. We reached a

goal of $15 million in savings over this past fiscal year. That’s a significant amount of savings for our organization that you know is going to help continue to sustain us and those goals that we have every year that we work toward.”

Graham added, “One of the goals for our department that we’ve worked on was looking at IV pumps for our organization. While it’s not necessarily something as far as a cost savings initiative, these types of projects are so important for value analysis to be involved with and being involved from the very beginning. My perspective is we try to be clinically integrated so that we know when these types of projects are on the radar for the clinical staff and the frontline staff so that we can be involved and help guide and be there as a resource as they’re going through this.”

Graham added that her team set up the very early stages of vendor fairs or supplier fairs for this project. This was to solicit clinicians for their opinions.

“We have to keep in mind the overall cost, but we have to ensure the safety of the pump, the advocacy, the efficiency and how the staff use it,” she notes.

Graham went on to explain that these fairs are set up for larger projects, as well. They’re generally set up in the organization’s auditorium or conference rooms. The value analysis team works with the sourcing team to identify the suppliers that are in the market and, at the time, during the IV pump project, five vendors were brought in and 120 clinicians came in throughout the day. They spent time at each station learning about each pump and what they had to offer.

“We had a score sheet that we set up with them, which is another important aspect to really make sure that objective data is collected

to help drive the decisions that the diagnosis teams along with clinicians are making,” she said.

Graham goes on to explain that the IV pumps were narrowed down to two choices and then those suppliers were brought back on campus where a deeper dive by staff can be done. “We worked on all these different clinical scenarios,” she commented, “that included a lot of different medications unique to their area.”

She continued by saying that after getting that set of score sheets, it is nearing the time when the decision is brought to the executive level.

“When we presented it back to the executive team, at that point, we obviously pulled in the financial piece of it as well too. We had all the analytics around not only what the clinical information was as far as the front-line staff, but then also we had the financials that go along with it.”

Graham then said, “And then in our multi-disciplinary team, we had everyone—environmental services, infection control, clinical engineering, pharmacy, IT, physicians, anesthesia, pain team, as well as all of the different nurses and RT’s. And we even brought in our transporters (they help transport the patients). We had the pumps on IV polls and they actually did a bit of a demo walking through the hospital with each of the different suppliers to see what it is like to get on the elevator, etc.”

She concluded, “So, we were really very methodical in making sure every aspect of how this pump project was, one, the best decision clinically, and secondly, for the money. This is a very expensive project that when you think about the volume of the pumps that we have to bring on board for the next 10 years, we need to make sure that the right decision for the organization, both clinically and finally, is made.” HPN

Infection Preventionist Stresses Importance of Bed and Mattress Maintenance

Isis Lamphier, MPH, CIC, manager, Infection Prevention, Moffitt Cancer Center gives a Q&A style update on the current state of bed and mattress maintenance

BY JANETTE WIDER, EDITOR-IN-CHIEF

In today’s busy healthcare landscape, bed and mattress maintenance is overlooked or, perhaps, sounds like an easy task. Infection preventionists, including Isis Lamphier, MPH, CIC, manager, Infection Prevention, Moffitt Cancer Center, know the true importance of keeping up to speed with bed and mattress maintenance.

Healthcare Purchasing News spoke with Lamphier to get an update on this topic.

Can you give us an overview of bed and mattress maintenance from an infection preventionist standpoint? This is a very big topic and it’s an important one too. One thing that infection preventionists can do is terminal clean—watch terminal cleans being conducted by environmental services (EVS) because one step of the terminal clean process is ensuring

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that the mattress is being cleaned after a patient is discharged. What is used to clean should depend on the instructions for use on the mattress to see what chemicals are compatible and mattresses should be changed after certain periods of time, depending on what the manufacturers recommend. Sometimes it could be after five years. That’s a standard or, perhaps, seven years. They need to see what the manufacturer recommends and what other healthcare organizations recommend, like the CDC, on the standard time mattresses should live in a hospital for and then change it appropriately.

Isis Lamphier

the inpatient stay. But with room turnover, usually it’s environmental services that assists with that. Or it could be the nursing staff. It really depends on the facilities and what their expectations are, but it’s usually those two parties that will help and we need to ensure that we’re changing the sheets appropriately and regularly, especially for that patient.

But the mattress should be changed prior to that if they see that the mattresses are ripped or they have holes in them, because then you’ve created new environments for pathogens to live in. So that’s another thing that infection preventionists should be looking at—making sure that mattresses are replaced as needed and appropriately.

Editor’s note: Guidelines from the CDC can be accessed here: https:// www.cdc.gov/infection-control/hcp/ environmental-control/laundrybedding.html.

You mentioned EVS; can you tell us a little bit about the relationship between infection prevention and EVS as it pertains to this topic?

Infection prevention should always be in constant communication with environmental services. It should be two teams that work very closely together that have a strong working relationship.

Changing the sheets usually is done by two different parties. It could be the nursing staff that change the sheets. Let’s say a patient is there for an extended period of time: then it might be nursing staff changing it every day or periodically throughout

For example, if a patient has a lot of wounds, it might be more appropriate to change the sheets more often, or if they have a lot of bodily fluids or leakage coming from anywhere, it’s probably more appropriate to change the sheets more often so it does depend on the patient’s diagnosis and what’s happening.

We should change the sheets often, also for patients to have central lines, we need to ensure that those are being changed or any other devices are being changed regularly, because those sheets and mattresses can provide another vessel for pathogens to enter the bloodstream or through those devices.

What should organizations look for in a vendor when it comes to sheets?

Definitely something that’s hospital grade and approved to be used in a hospital. Another thing is to look also at the instructions for use, because sometimes companies that make hospital linens might recommend replacing them after a certain period of time. It is also important to have a system in place to track their age.

Additionally, an important aspect for infection preventionists is obtaining sheets that are breathable. One has to take into consideration a large population in a hospital, so you don’t want a fabric that a lot of people are allergic to or that’s uncomfortable or itchy because that can also affect the patients’ quality of care.

If it’s itchy and uncomfortable and causing rashes, that’s something to keep in mind. You want a fabric that is going to be comfortable for all patients and that won’t cause them to have any skin irritation because their skin is their first line of defense. So it’s important that they have something that’s good quality and that won’t provide them any skin discomfort because, a lot of times, patients are laying on those sheets for a long time, especially if they’re bed bound, and that can increase their risk of infection or any issues with skin integrity.

What about bedframes themselves?

Bedframes are monitored by a hospital’s biomedical department and to ensure that they’re working properly, they should be serviced based on what the manufacturer’s instructions are and the hospital’s policy. Typically, biomed will inspect bedframes at least once a year, and that should be instilled in the hospital.

Additionally, frames should be wipeable and wiped daily, because that is a high touch area and an area that is also frequently prone to contamination because patients might get food on it, they could get bodily fluids on it, they’re resting on it, etc. And sometimes you even see patients hang urinals on them. So, the bed rails are definitely one of the areas in the room that are at most risk for contamination.

Any final thoughts?

Tracking mattresses is important! If the instructions say that they have to be changed by a certain time, I think it’s helpful to have a system in place to ensure that those mattresses are being changed as required by the instructions for use. Additionally, infection preventionists should be looking to see if their facility might have a committee, like a biomedical committee or committee on linens, that they can join to put in their input. HPN

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Instrument Containment, Transport and Storage Success Stories

And product solutions designed for efficacy, safety and efficiency

BY KARA NADEAU, SENIOR CONTRIBUTING EDITOR

Effectively and safely containing, storing, and transporting instruments, devices, and supplies involves collaboration among many stakeholders, from sterile processing (SP) professionals to end user clinicians and everyone in between.

HPN presents two stories of healthcare organizations that made improvements in these processes, including why and how they did it and the resulting benefits. We also include some of the latest product innovations aimed at containment, storage, and transport success.

A health system wide standardized approach to transport

“Transportation of contaminated items is one of the most important factors to consider when working to eliminate the potential risk for cross contamination for visitors, patients, and workers in the healthcare setting,” said Randalyn Harreld, clinical education manager, Belimed, who led a process improvement initiative that tackled this exact issue.

The subject of the initiative was a health system located in the Southern U.S. with three hospitals, three ambulatory surgery centers (ASC), and 78 clinics. Couriers and end users were complaining of untimely delivery of items and case delays stemming from issues in the delivery process.

The investigation and findings

Harreld and team, in collaboration with the health system’s infection control team, began an inspection of the clinic courier process, including the carts, transport bins, and vehicles. They rode along in the vehicles to observe the courier process, conducted assessments of every end user, including the clinics, and spent hours in decontamination receiving.

After visiting just 12 of the 76 clinics and noticing not one was compliant with internal policies and procedures and U.S. Occupational Safety and Health Administration (OSHA)

regulations, they had enough justification to move forward with a systemwide transport standardization project.

“We found a mix of clean and dirty items were being transported right next to each other in the same vehicles with things sliding around, including dietary items,” Harreld explained. “The safety risk and lack of compliance was enough justification for me to ask the organization, ‘Can we launch a project to dive into this?’”

The scope

They secured approval and funding for the project and dove into it. They found the internal operating rooms (OR) were not affected because transport of contaminated items was performed with enclosed case carts and a dedicated lift. In Harreld’s words, “This project was really a focus on everyone else.”

“That’s pretty much any patient care area in any organization using some form of device that must be transported, whether it is carried to an on-site soiled utility room for high level disinfection (HLD) or transported from off-site via courier to the main hospital’s SP department,” she stated.

Because the scope of required transport improvements was so wide reaching, engaging all impacted stakeholders was critical to the project’s success. This included the infection control team, clinical leadership, SP leaders, and the director of logistics who oversaw the couriers.

The initiative

The resulting system-wide standardized policy and procedure for transport included new processes, new products, new courier pathways, new logistical tracking, and in-depth education and training for all acute and non-acute care site teams and couriers.

“We implemented the use of dedicated courier vehicles so that items that had previously been transported in one vehicle, including dietary items

and equipment, were transitioned to separate clean and dirty vehicles,” said Harreld. “We also incorporated soak bins for many ortho items and HLD items and purchased red biohazard OSHA approved leak proof bins for clinics and outside customers.”

Continued on page 18 

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State of Healthcare Procurement: Part 2

Mastering the 3 ‘P’s of Post-Pandemic

Procurement Efficiency: Price, Process, Product

BY DELANEY REBERNIK

Editor’s note: This article is the second part in a three-part series exploring the challenges and opportunities facing healthcare procurement leaders as outlined in the 2024 Healthcare Procurement and AI playbook from Healthcare Purchasing News (HPN) and Staples Business Advantage (SBA). Respondents’ comments have been lightly edited for length and clarity.

The Post-Pandemic Procurement Landscape

As the healthcare industry recovers from the pandemic’s peak, procurement leaders continue to face uncertain economic conditions, stubborn supply shortages, and a proliferation of new settings in their purview, among other aftershocks.

To overcome these challenges, a relentless focus on efficiency is crucial. According to the 170+ leaders surveyed for HPN and SBA’s 2024 Healthcare Procurement and AI report, efficiency is one of the three key mandates (alongside quality and innovation) shaping the future of procurement. In fact, six of the top 10 priorities identified by respondents center on streamlining core aspects of operation (see Figure 1).

being asked to save the organization money,” explains Jack Koczela, director of analytics and transformation, supply chain, at Froedtert Health, a Wisconsin-based system with 10 hospitals and more than 45 health centers and clinics. “If we’re trying to pay our folks more to keep up with wage inflation, that money has to come from somewhere, and a lot of people are turning to non-labor spend.”

Although important, cost containment initiatives shouldn’t compromise safety and security, warns Daniel Uzupis, CHCIO, CDH-E, CISSP, chief information and information security officer at Union Community Care, a federally qualified health center with nearly 20 locations throughout Pennsylvania.

According to McKinsey & Company, highperforming healthcare supply chains prioritize investments in strong data analytics, collaboration with frontline clinicians, and talent development.1

Process

Beyond cost reduction, streamlining procurement processes can yield substantial benefits. This explains why procurement leaders are laser-focused on:

• Optimizing the ordering process (82%)

• Increasing procurement efficiency (81%)

• Accurately forecasting demand (74%)

The Three Pillars of Efficiency: Price, Process, and Product Price

The top priority for most procurement leaders (83%) is reducing the overall cost of supplies; 76% of leaders aim to control rogue spending. Achieving these goals, however, can be difficult due to tightening budgets, rising costs, and lack of pricing clarity. “The greatest challenge is the transparency of pricing,” one respondent notes. “It’s being able to clearly understand the costs to assess the budget.”

To weather this perfect storm, experts recommend thinking outside the box. “In the days of very slim margins or negative margins, we are

Implementing these improvements can be challenging due to external factors like ”fluctuating market conditions, complex vendor management, regulatory compliance, and balancing cost-effectiveness with quality standards,” one respondent notes.

Leaders can address these intricacies by identifying areas for simplification. One respondent explains, “There are too many repetitive tasks that consume time and elongate the procurement cycle.” Another emphasizes the importance of building capabilities in areas challenged by “disorganized purchasing, limited visibility, and risk of fraud and human errors.”

To create a more resilient supply chain, McKinsey recommends2 improving transparency and alignment. Internally, this could involve consolidating inventory data across locations,

enhancing inventory systems, and building dashboards for a comprehensive view of organizational performance. Externally, collaborating with GPOs and distributors can also be beneficial. Contracts stipulating daily updates on inventory levels across all distribution centers can help anticipate and mitigate disruptions.

Product

Nearly 80% of procurement leaders are prioritizing the elimination of product waste as part of their optimization efforts. Technology plays a crucial role in achieving this goal. Jack Koczela emphasizes the value of data analysis. “We have to dig through a lot of data” to analyze and reduce waste, Koczela explains. If, however, an AI or machine learning model is trained on that information, it could “surface great results very quickly.”

Another key focus area for leaders is ensuring the timely availability of the right products. This helps to avoid situations where organizations must resort to using alternative options while waiting for backordered items. To address this challenge, McKinsey advises leaders to create contingency plans for their organization’s most critical items. These plans should consider factors like the life-saving potential of the product, availability of substitutes, frequency of use, and potential financial impact.

In conclusion, efficiency is the backbone of a healthy and resilient healthcare supply chain. By understanding the factors that can hinder or accelerate efficiency gains, procurement leaders can make informed decisions and navigate the current challenges successfully.

Staples Business Advantage is a trusted partner for procurement leaders at thousands of healthcare organizations nationwide. Partnerships with top GPOs enable clients to achieve significant cost savings while streamlining purchasing across multiple product categories, including EVS, furniture, breakroom, office supplies, and more. Learn more 

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1. https://www.mckinsey.com/industries/healthcare/our-insights/ optimizing-health-system-supply-chain-performance

2. https://www.mckinsey.com/industries/healthcare/our-insights/ bolstering-health-system-supply-chain-resilience-to-reduce-risk

It also encompassed instrument vendors, including a standardized process for transporting loaner trays on a dedicated pathway, a specific room/area where they could label the trays and identify them, as well as a soiled area for point of use (POU) care.

The results

A final audit revealed zero non-compliance fi ndings related to transport throughout the health system.

“It was a massive win from an infection control perspective,” said Harreld.

In addition to the safety and compliance improvements, the initiative also improved instrument traceability.

Prior to the project, couriers would use paper and pen on a clipboard to document when items were picked up and dropped off.

“Many items were being transported in biohazard bags with no labeling,” Harreld explained. “The traceability was lost, and instruments were getting dropped off at the wrong locations.”

Implementation of instrument tracking software replaced piecemeal manual documentation with end-toend electronic traceability.

While pre-treatment at the POU was not a primary aim of the project, the team’s work served to improve this process as well. During the inspection process, they found 60 out of 78 clinics had no POU pre-treatment spray. In Harreld’s words, “They didn’t know what they were supposed to use or how to order it.”

Alongside delivery of the new transport containers to the clinics, Harreld and team provided bottles of pre-treatment spray. They conducted in-servicing on both the containers and the spray, so clinic staff members understood the importance of POU treatment, how to use the spray, and how to procure more.

Advice to others

Faced with a project of this scope, which required the purchase of new containers among other items, other

healthcare organizations are likely to question how they can secure the budget to perform a similar transport turnaround. Harreld offered this advice:

“In order to secure appropriate budget, you must gain the support of all stakeholders. Don’t expect all the funds to be allocated from the SP department. In our case, I separated the cost out for every clinic in an Excel spreadsheet and sent each clinic director the amount they were required to pay. With all clinics on board, I was able to secure bulk discounts for better pricing. Therefore, my advice is to push the clinical departments and locations to help with project funding.”

Pennsylvania Hospital’s

“best

practice” storage solution

The central processing department team at Pennsylvania Hospital in Philadelphia had been struggling with a double wire rack system in its instrument storage space. The racks were challenging for staff members to move and necessitated stacking of sets. The system was on tracks,

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preventing the team from customizing the racks to meet their needs.

“Our storeroom is very old, and we have no room to expand,”

Pennsylvania Hospital Central Processing Department Associate Director, Ryan R. Cashman, CRCST explained. “We wanted the flexibility to easily change the layout and maximize the space we had to work with.”

A scalable solution Cashman and team turned to DSI for a solution and selected the company’s Sterileshelf clean storage technology.

“DSI checked all the boxes for us, and they were very detailed, giving us multiple options,” said Cashman. “With the Sterileshelf system, we could adjust the shelf to what is needed for each set, allowing us to put more sets in each row. They are also on wheels so we can easily move them at any time.”

The results

Cashman commented on the benefits his department has derived from the Sterileshelf system:

“We noticed a reduction in holes in wrapped sets. And in our most recent accreditation survey, the surveyor commented on how clean and organized everything was. She said, ‘now this is best practice.’”

Advice to others

When asked to offer his advice to other sterile processing leaders planning to optimize their storage space, Cashman stated:

“In hindsight, we should have phased in the install. It was a big undertaking to do our entire storeroom in one weekend. I recommend breaking it up into smaller sections as it does take time to get the initial setup just right. For us we had to have all old racks removed, relocate the instruments temporarily, then move them to their new location. It’s a lot of work for one weekend, but once it is done it’s well worth it.”HPN

See the industries top storage solutions spotlighted online at https://www.hpnonline.com/55137016

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DSI Sterileshelf clean storage technology at Pennsylvania Hospital

The Mystery of Bowie & Dick

Alterations in the Vacuum on Your Sterilizer Throughout the Year

BY WILLIAM LEIVA, SENIOR PROGRAM MANAGER FOR STERILE REPROCESSING, MEDTRONIC

Intro and first learning objective: Understand the rationale of the porous load test pack. If you were to read about one John Herbertston Bowie or one James Dick, most of us would never connect their names to steam sterilization. However, if you were to read about Bowie & Dick, your thoughts would lean toward one of the most commonly used tools by SPD Professionals. Doctor Bowie, a British Bacteriologist, conducted many studies in the United Kingdom between 1949 and 1955, and concluded that most hospital sterilization systems (steam was the only method used in the United Kingdom at that time)

Learning Objectives

1. Understand the rationale of the porous load test pack.

2. Describe the current Bowie & Dick test package technologies and the information they provide.

3. Understand air removal systems and performance changes over the year.

The Mystery of Bowie & Dick

October 2024

This lesson was developed by Solventum. Lessons are administered by Endeavor Business Media.

Earn CEUs

After careful study of the lesson, complete the examination online at educationhub.hpnonline.com. You must have a passing score of 80% or higher to receive a certiﬁcate of completion.

Certification

The Certification Board for Sterile Processing and Distribution has preapproved this in-service unit for one (1) contact hour for a period of five (5) years from the date of original publication. Successful completion of the lesson and post-test must be documented by facility management and those records maintained by the individual until recertification is required. DO NOT SEND LESSON OR TEST TO CBSPD. www.cbspd.net.

Healthcare Sterile Processing Association, myhspa.org, has pre-approved this in-service for 1.0 Continuing Education Credits for a period of three years, until August 24, 2027.

For more information, direct any questions to Healthcare Purchasing News editor@hpnonline.com.

information on the intensity of the color change or on the residual air or noncondensable gases.

A newer technology was recently approved by the FDA in their De-Novo4 program, which was identified as a digital physical and chemical sterilization process sensor. This new technology offers the ability to detect air removal and steam penetration while delivering the result in an unequivocal way by the use of an autoreader. This technology may have the ability to address issues of B&D sheet interpretation with the potential to deliver quantitative results for residual air.

Third learning objective: Understand air removal systems and performance changes over the year. We know that steam sterilization is achieved through the condensation of saturated steam on medical devices, which enables energy transfer and delivers sterility. However, to cause this condensation of steam, the sterilizer chamber must be free of residual air. Now, where is this air coming from? And what do we really mean when we talk about air removal?

As air is everywhere, it can be found inside packs, trapped within lumen devices, and inside the sterilizer chamber before closing the door. However, air is part of a broader group of gases called non-condensable gases (NCGs). The NCG can

enter the sterilizer chamber through the steam supply from door seals and from faulty valves through the multiple systems operating the sterilizer. When coming from the steam supply, it is often generated during the water treatment process, where CO2 can be generated during reverse osmosis and carried through the steam supply. When these NCGs reach the chamber, they lead to negative consequences because, as their name implies, they do not condensate under the normal operating conditions of a steam sterilizer. Due to the complex behavior of gases under pressure, these gases move to the colder spots within the chamber, which often is next to the instruments and inside containers, and act as thermal insulation, preventing steam from reaching every spot within the sterilizer, containers, and instruments. Even smaller amounts of NCG can lead to sterilization failure, leading to positive biological indicators or internal chemical indicators without adequate change. This emphasizes the importance of the daily air removal test, which will ensure that the sterilizer is effectively removing air from the chamber.

Modern sterilizers used in hospital and healthcare settings use dynamic air removal, which is usually composed of an air removal system and multiple valves and electronic or electromechanical components that control operation. Air removal itself

Table 1: water temperature and pump performance.

Water Temperature Pump Performance

Cold (<16 °C / 60 ° F) Optimal

Tepid (16 - 38 ° C / 60 - 100 ° F)

Warm (38 - 45 ° C / 100 - 113 ° F)

Hot (45 - 49 ° C / 100 - 113 ° F)

Above 49 ° C / 120 ° F

Source: ANSI/AAMI ST 108:2023.

occurs through either the use of water ejectors, also known as Venturi systems, or the use of a liquid ring pump. Since both systems use water to enable or create vacuum, looking into the characteristics of water is not only important but imperative. More specifically, the temperature of the water affects its density, which in turn affects the performance of the air removal systems. In very broad terms, the higher the water temperature, the lower the air removal effectiveness; however, we do not often account for the seasonal changes that affect the water temperature. Although this has been known for years in the scientific community, it has been overlooked in many SPDs. To address this, under the leadership of AAMI, the standards development community works on the development of the standard ANSI/ AAMI ST 108: 2023 ‘Water for the Processing of Medical Devices’. This standard, in its Annex B.2., includes a reference on the temperature of the water and its impact on pump performance (Table 1), which provides great information for SPD and support personnel to understand the implications of the temperature of the source water and the efficiency of the vacuum system. With many health care facilities located in areas with significant temperature variations, the temperature of the water changes throughout the year. These changes in water

Decreased pumping speed

Greatly decreased pumping speed.

Not recommended

temperature may occur due to water distribution systems, water storage, and exposure of the piping system throughout the health facility infrastructure. In turn, this may affect the water temperature enough to create alterations in the performance of the vacuum system.

Conclusions

Although we have seen significant improvements in vacuum system technology and in the configuration of prevacuum cycles, the concept of a porous pack is simple and effective: the Bowie & Dick test pack remains a critical tool for SPD professionals in their daily routine, providing reliable information, assessing the sterilizer, and evidencing problems with air removal, steam diff usion, or vacuum system failures.

There are two downsides to this technology: the need to interpret

the color change of the ink sheet that may lead to the need for a ‘second opinion’, and the lack of data to help assess the cause of a failure of a B&D test.

A failure on the B&D test does help SPD professionals to prevent the use of the sterilizer with airremoval problems, which in turn enhance patient safety; however, there is a need to acquire additional data from this test, specifically quantitative data, to ascertain the amount of residual noncondensable gases on the vessel. This would greatly benefi t the assessment of the equipment, enable trend analysis, and provide better predictive and preventive maintenance on vacuum systems. HPN

References:

1. EN 285 Sterilization - Steam sterilizers - large sterilizers. 2015. Revised in 2021.

The Mystery of Bowie & Dick - Practice Quiz

Alterations in the Vacuum on Your Sterilizer Throughout the Year

1. The Bowie & Dick test was developed to assess the effectiveness of the _________ system.

A. Air removal

B. Steam penetration

C. High-vacuum

D. Gravity

2. The Bowie & Dick test is usually conducted at:

A. 250 ° F (121 °C), for 15 minutes.

B. 250 ° F (121 °C), for 6 minutes.

C. 273 ° F (134 °C), for 3.5 minutes

D. 270 ° F (132 °C), for 5 minutes

3. Current Bowie & Dick packs detect air removal by:

A. Air detection

B. Steam diffusion

4. Current Bowie & Dick packs provide:

A. Qualitative information

B. Quantitative information

5. Residual air can be present as a result of the following:

A. Water treatment

B. Air present in lumens

C. Air trapped in the packs

D. All of the above

All CEU quizzes must be taken online at: educationhub.hpnonline.com The cost to take the quiz is $10.

2. ANSI/AAMI ST 108:2023 ‘ Water for the processing of medical devices’

3. ANSI/AAMI/ISO 11140-5:2007 Sterilization of Health Care Products - Chemical Indicators - Part 5: Class 2 Indicators for Bowie and Dick-Type Air Removal Tests

4. FDA de novo program. https://www.fda.gov/medicaldevices/premarket-submissions-selecting-and-preparingcorrect-submission/de-novo-classification-request

William Leiva is currently a Subject Matter Expert on Medical Devices Sterilization and Reprocessing and is currently the Senior Program Manager for Sterile Reprocessing with Medtronic.

He holds undergraduate degrees in physics and engineering and master’s degrees in business administration and public health, where he focused his research on infection prevention strategies involving medical device reprocessing. He is currently a candidate for a Ph.D. in Cybernetics and Econometrics, researching around the economic impact of the burden of premature mortality. He has published peer review articles on the application of 3D printing technologies for medical devices and for austere environments.

6. A critical input for vacuum systems is:

A. Water ejectors

B. Water

C. Liquid ring pumps

D. Electrical valves

7. Vacuum performance improves with lower water temperature.

A. True

B. False

8. Water temperature may change due to the following:

A. Seasonal effects

B. Storage

C. Distribution

D. All of the above

Conducting Meaningful Performance Reviews in the SPD

BY DAVID TAYLOR, PRINCIPAL, RESOLUTE ADVISORY GROUP LLC

Performance evaluations measure the contributions an employee makes to an organization over a set period— annually, at least, and as needed. Well-implemented evaluations gauge an employee’s work performance, help align organizational goals, identify professional growth opportunities, and allow achievements and challenges to be formally recognized and addressed. Further, evaluations should be objective and transparent— but they often feel anything but. In fact, performance reviews often create needless stress for leaders and employees alike, as Sterile Processing (SP) professionals can often attest.

One problem is annual evaluations often sneak up on employees and managers, leaving them unprepared to adequately evaluate and address performance. This can be further complicated when employees work off-shifts and weekends, making it difficult for the departmental leader and staff to interact regularly. Instead of dreading the performance review, however, leaders should embrace it and help their employees do the same. Properly executed annual performance reviews can offer numerous benefits for employees, managers and supervisors, and the organization.

Laying the foundation for success

The annual review process can be stressful, and employees may feel the process and outcomes are unfair.

Biases, for example, can contribute to challenging, ineffective, and unfair reviews. To eliminate bias, SP leaders should prepare well in advance of the review and ensure that their employees know how to prepare as well. Managers should never show partiality or favoritism, and always recognize accomplishments and improvement opportunities for all.

Employees want objective feedback. To make the annual review process beneficial and meaningful, leaders must take adequate time to review pertinent documents such as job descriptions, skills competency, quarterly check-in results, employee self-assessments, and outcomes from the previous year’s performance evaluation. They should also ask employees to assess their own performance. Some organizations take employee self-assessment a step further by including reviews from the employees’ peers and colleagues, other company leaders and, in some cases, customer feedback. Broader assessments can bring to light key accomplishments, progress and goal attainment, areas of exceptional performance, additional responsibilities assumed, and areas where more knowledge and skills development are needed or desired.

Ongoing evaluations essential

Utilizing a performance management system is essential for ensuring employees can manage their critical

tasks effectively, safely, and according to standards, guidelines, regulations, instructions for use, and policies and procedures. Such systems are not just comprised of the annual employee evaluation but also should include routine employee check-ins and brief informal and formal meetings to drive performance improvement and identify challenges. Through this process, employees can be challenged to grow and engage in other professional activities and tasks throughout the year. It is essential that SP leaders meet with their employees regularly to strengthen connections and communication, oversee progress and barriers, and improve employees’ overall performance in their roles. Leaders who withhold reviews and communication until the annual performance review miss opportunities to identify and address problems proactively. Equally troublesome is that employees may feel that their challenges and contributions aren’t being recognized, which can lead to poor job satisfaction.

Leaders should engage in focused, intentional feedback, and they should also ensure that employees feel comfortable providing it. Doing so helps create a culture of transparency, teamwork, and openness that all staff members, regardless of title and tenure, will appreciate. HPN

Article conclusion and references can be found at hpnonline.com/55136999.

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Policy and Performance: “Walk Your Talk”

BY STEPHEN M. KOVACH, CLINICAL EDUCATOR EMERITUS, HEALTHMARK, A GETINGE COMPANY.

Q“In a recent review of the department I work in, a surveyor cited us after finding some old ‘degraded/worn out instruments’ they felt should not be in use. Can you give me some insight on a possible reply?”

AI was always told to “walk your talk,” or, “If you cannot speak to your practice, you don’t have a policy that supports your practice.” Do you have a policy that deals with the degradation of medical instruments within your SPD, MDRD, CSSD, etc.? This would be found in your inspection policy.

As to “a possible reply,” I have to say, “No,” because the surveyor cited you based on your inability to answer.

A well-defined, robust standard policy and trained staff on inspection and maintenance is critical to ensuring optimal performance and compliance with 42 CFR 482.41(d)(2), which states, “Facilities, supplies, and equipment must be maintained to ensure an acceptable level of safety and quality.”1 Thus, devices and instruments that are worn or in default after usage will not get put back into service.

I suggest establishing a regular time frame with your repair company for refurbishing instruments and keeping an activity log of instruments taken out of service. Share this log should you ever be audited. If your department uses an electronic count sheet/ instrument tracking system, showcase to the surveyor (before a tray gets sterilized) the various tasks required by the staff to help ensure damaged, worn, non-functioning, and

unclean instruments are removed from service.

Industry guidelines and IFUs include forms of inspection and maintenance as standard practice, though some only give limited details. Medical facilities should follow a maintenance strategy determined by partnering with their various manufacturers and use evidence-based observations and clinically relevant products to accomplish this goal of providing clean and functional medical devices.

To summarize, each department must ensure all medical instruments and devices are a) clean and functional; b) damaged instruments are not placed back into service; and c) they have a simple SOP statement to cover all situations in an ever-changing environment. Here is my suggestion for a policy with basic wording that should cover all medical devices and allow you to be able to adjust as you learn more information to document the “Why?” in your SOP.

All medical devices will be visually (e.g., using various methods like magnifying glass, microscope, borescope, etc.) checked to be clean (e.g., using various methods like protein, blood, and ATP testing) and functional (i.e., testing devices specifically when possible) before being sterilized

To accomplish this task, the department will review each medical device, the IFUs, standards, guidelines, and various technical literature on what material should be used to test the various medical devices within our department for cleanliness and functionality of those devices

and frequencies. Testing results will be documented within the assembly record. This will help ensure all medical devices are clean and functional before sterilization and damaged instruments are not placed back into service.

A routine refurbishing practice will be established with the proper vendors to be included in our inspection program ensuring damaged instruments are not placed back into service. When possible, examples of faulty instruments (pictures) will be used to help ensure we have a robust inspection process. Various methods will be used to identify instruments that need to be reviewed/ repaired/taken out of service (using repair tags).

Implementation of any quality improvement or risk-based program does not always prevent incidents; however, it helps reduce and understand them better if they do occur. Consider the example in your question (i.e., the auditor found some “old” instruments). It happens. Research the incident, look at the data, and work on improving your process.

My answer is to have: a robust quality program and policy (as described on inspecting instruments), all staff properly trained, and (if any surveyor asks) you have the documentation that can back up what you do—“Walk your talk.” HPN

Reference:

1. Dept. of Health and Human Services. Code of Federal Regulations: Condition of participation: Physical environment. Title 42 [Public Health], Standard No. CFR 482.41(d)(2): Facilities HHS. https://www.ecfr.gov/current/title-42/part-482/section482.41#p-482.41(d)

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Raising Standards in UV Disinfection with AI

Using AI-enhanced devices to determine the surfaces in a room that need to be disinfected can drive effective surface disinfection

BY MATT MACKENZIE, ASSOCIATE EDITOR

Artificial intelligence (AI) has great potential to improve how healthcare workers can assist their patients and prevent the worst outcomes from coming true.

There has been great progress made on the clinician side with AI, but its applications go far beyond that, into the world of sterile processing. New technologies enhanced by AI could provide sterile processing departments with the tools to more precisely and thoroughly sanitize surfaces, objects, and rooms.

One company in the business of AI-enhanced technology is Shyld AI, whose Shyld AI Autonomous UV-C Sanitizer is helping to pave new trails in ultraviolet (UV) disinfection by identifying spaces within rooms in hospitals that

are most likely to be carrying pathogens and then focusing their energies on those higher-risk spots. Healthcare Purchasing News was able to speak with Mohammad Noshad, Shyld AI’s co-founder and CEO, about the advances they are making in the space and more broad questions of how AI can potentially prove useful in healthcare settings.

In what spaces is AI technology particularly useful in a healthcare setting?

AI technology can be an engine for accelerated workflow and efficiency, which is most valuable in time-sensitive procedural areas, especially the operating room, where speed of care impacts patient outcomes and every minute gained impacts the bottom line. The Shyld AI Autonomous

Mohammad Noshad

UV-C Sanitizer is independently proven to inactivate pathogens like MRSA in 10 seconds from 6.5 feet away, which enables faster care by supporting rapid room sanitization and turnover in as little as five minutes and even UV-C sanitization between surgeries.

What do AI technologies offer in infection prevention that previous technologies/methods lack?

AI can enable healthcare professionals to identify and target potential risks in real time by delivering precision care and treatment. In the case of environmental hygiene, surfaces, objects, and equipment in dynamic healthcare facilities are sources of continuous contamination and transmission, while current cleaning and disinfection methods are point-in-time and more episodic in application. In addition, as it’s impossible to visually see and identify the presence of high-risk pathogens, current environmental hygiene practices focus on disinfecting all surfaces that may pose a risk, which of course takes additional time and resources and may not even compliantly address the present risk. With AI technology, we can enable a precision and targeted approach to identify and inactivate pathogens on surfaces rapidly before they spread. The Shyld AI Autonomous UV-C Sanitizer is equipped with AI technology that monitors the activity in a specific room, identifies contaminated surfaces, then autonomously sanitizes them in seconds without utilizing manual labor.

How does AI enhance UV sanitization?

Specific to UV sanitization, at Shyld AI we’re applying advanced AI technology and fully autonomous operation for enhanced efficiency, speed, and effectiveness. First and foremost, with AI and full autonomy, we can eliminate

the manual labor required for UV device operation startto-finish, from finding devices to transporting them and positioning them in rooms. Given the ongoing labor strain healthcare facilities face, this is a fundamental leap forward that frees up busy Environmental Services professionals to focus on the many other tasks of their day. Second, Shyld AI’s device enables targeted UV sanitization of highrisk surfaces by utilizing AI technology to fi rst identify specific surfaces and then focus a high-performance UV-C LED beam to sanitize them in as little as 10 seconds. Third, another valuable benefit for healthcare professionals is the Shyld AI device’s real-time measurement of the UV-C dose delivered to targeted surfaces. A common question often posed when it comes to UV is, “because UV is invisible, how do I know if it’s really working?” With AI technology and advanced sensors, Shyld AI can verify how much UV-C dose has reached any surface in a room, whether at distance or slope to the device. This provides healthcare professionals with real-time assurance the job has been done without guesswork or manual confirmation practices.

What aspects of UV sanitization can still be improved with future AI implementation?

The future is really bright and we’re just truly at the edge of realizing what is possible with AI. One future innovation that is very exciting is the ability to apply autonomous UV sanitization in occupied spaces, which will be possible with AI technology advancements and even more precise, collimated UV-C beams. Another area of great potential is to integrate many products and services that provide high-performance, effectiveness, and convenience while saving time and labor. Just as we are moving from costly, standalone, isolated devices into integrated devices and assistance at home, the promise of advanced efficiency into healthcare settings is real too.

Has AI eliminated any particularly problematic aspects of UV sanitization?

The most impactful benefit is the elimination of manual labor from UV sanitization. UV devices are extremely valuable and key elements of UV sanitization, yet they can be challenging and time-consuming to operate, limiting their daily use and application. With a fixed, wall-mounted device equipped with AI and advanced sensor technology, Shyld AI powers on and off autonomously, without the need for remote controls, mobile tablets, or smart phone apps. This can enable greater efficiency by freeing up laborstretched teams to perform essential aspects of patient care. We’re proud to be part of the next generation of innovation that is realizing the promise of Smart healthcare facilities. The future is bright! HPN

Shyld AI Autonomous UV-C Sanitizer in use

Taking a Bite out of Climate Change

BY KAREN CONWAY, CEO, VALUEWORKS

Maybe it’s the change of seasons, or the fact that Thanksgiving is right around the corner, but I decided to focus October’s column on one of my favorite topics: Food! October is also the start of the annual Health Care Culinary Contest designed to promote more plant-forward meals being served at hospitals and healthcare facilities. The reason is simple: serving such meals to patients and employees can lower the risk of heart disease, type 2 diabetes, and obesity. Plant-forward diets are also good for the environment by reducing the consumption of red meat, which requires far more energy to produce than plant-based food sources. And finally, as we discuss in this column, it’s an area where supply chain can play an important role in delivering value for people and the planet.

The Health Care Culinary Contest is sponsored by Healthcare without Harm, Practice Greenhealth and Menus of Change. Each year, healthcare system chefs from across the country enter plant-forward recipes that they have served in their facilities. In such recipes, legumes, whole grains, local and seasonal vegetables,

and other plant-based foods make up the majority of the meal. You can find out more about the contest, including how to enter (now through November 30), and view prior award-winning recipes at us.noharm.org.

In the meantime, here are some things you can do as a supply chain leader to reduce food-related carbon emissions in your institution while also supporting the health and economic well-being of your local community.

1. Minimize food waste and find alternatives to throwing excess food in landfills.

• Start by tracking the causes of food waste, which can range from inefficient food preparation to buying, making, and/or serving too much food.

• Reduce the amount of food waste going to landfills by donating leftover edible food to local food banks and other community organizations and composting nonedible food.

2. Seek out local, sustainable, and equitable food sources in your community.

• By purchasing locally, especially from diverse businesses, you

can support local job creation, which is one of the most powerful ways to reduce health inequities and improve health for at-risk populations.

• Purchasing local food sources also reduces the carbon emissions associated with food distribution and minimizes supply continuity risks.

3. Collaborate with those responsible for food purchasing decisions in your institution.

• Whether it’s an in-house food and nutrition services director, an outsourced food service company, or a combination of both, make sure the executive chef in charge and those making sourcing decisions know about the culinary contest and the online resources referenced above.

Bottom line: Make sure the CFO knows about the economic benefits of these activities. For example:

• Beyond lowering initial acquisition costs for food, reducing the amount of waste can lower the amount spent on its removal.

• Better nutrition can support improved outcomes and lower the risks and costs associated with patient care.

• Supporting local, diverse businesses and ensuring healthier food choices for patients and employees are factors that bond rating agencies may consider when evaluating how a health system addresses ESG (environmental, social, and governance). Better bond ratings can lower the cost of capital, help with employee recruitment and retention, and support joint ventures. HPN