Considerations for Using Loaner Instrument Sets: A Collaborative Process

With more than 21 years as an RN and more than 15 of those years spent in the OR, my career has involved what some refer to as the “OR–sterile processing department (SPD)–infection prevention” triangle. It is through working in different roles in the three areas, all centered around safe surgical care, that I have seen the necessity, utility, and challenges associated with inventory loaned to health care facilities for patient use. It is an honor to contribute this guest editorial on considerations for using loaner instrument sets.

I recall several procedures across surgical specialties for which surgeons requested loaner instrument sets. Often these instruments were prepared at the expected surgical time and without any identified quality issues; however, there were several procedures for which the expected loaner instrument sets were not available for clinical use. The reasons for unavailability included quality issues, such as retained soils on instruments, holes or tears in sterilization wrap, and even the occasional wet pack. When loaner instruments were not available—particularly if discovered after surgery had begun—the anxiety and stress in the OR became palpable. Surgeons needed to pivot their plan of care, which triggered a cascade of unplanned and high‐stress events for the entire surgical team (and possibly sterile processing team) to gather additional instruments and supplies to accommodate the change. The surgery and anesthesia times were prolonged during some procedures, which may have increased the patient's risk for development of complications.

LOANER INSTRUMENT SET CHALLENGES

Instead of purchasing certain instrument sets, health care facility leaders may decide to borrow instrument sets from device manufacturers and representatives. The reasons for borrowing instruments may include the cost of purchase, space constraints, and rapidly changing surgical technology.

The accompanying article, “Addressing challenges associated with loaner instrument sets,” ¹ highlights several concerns and gaps in the cycle of processing, using, and reprocessing loaner instrument sets. The authors present consequences of these gaps and potential solutions to address them. Implementing standardized processes and communication strategies, using digital platforms to track and manage loaner instruments, educating personnel, and encouraging strong collaboration between SPD and OR teams are ways to ensure that the correct loaner instrument sets are prepared accurately for the intended patient at the scheduled time and at an optimal cost.

In my experiences as a perioperative and procedural infection preventionist, I have appreciated my partnership with SPD personnel to manage the receipt, processing, delivery, and reprocessing of loaner instrument sets. The work of SPD personnel in preparing loaner instruments accurately and efficiently is critical for patient care. Requirements for instrument processing may vary by manufacturer. In some facilities, SPD personnel may receive new and unfamiliar loaner inventory without proper education provided by the manufacturer or a device representative. Delays and inadequate processing of the loaner instrument sets may result from lack of knowledge about the specific instruments that have been received.

As an infection preventionist, the lack of systematic tracking of loaner instrument sets across health care facilities makes me especially cautious. A device representative may have multiple sets of the same instruments to lend to several health care facilities. If the device manufacturer or representative does not maintain meticulous records on the loaned instrument sets (eg, dates, receiving facilities) or the sets lack unique identifiers, tracing instruments that may be involved in infections or other complications becomes exceptionally challenging for infection preventionists, epidemiologists, and public health professionals.

As a system leader in sterile processing, one of my key responsibilities involved overseeing and managing the policies and workflows that support efficient loaner instrument set management. In some facilities, SPD personnel can receive more than 200 loaner instrument sets in a day for planned or urgent procedures. When factoring in the usual planned reprocessing work to meet existing facility department (eg, OR, labor and delivery, clinic) needs, receipt of loaner instrument sets with the subsequent need to decontaminate, inspect, package, and sterilize them—often without inventory sheets—can be a significant disruptor to the SPD's operations. As a result, SPD and OR leaders are tasked with the responsibility of making decisions on how to reprioritize operations to absorb the extra work.

The quality of loaner instruments can fall short of expectations. I have identified flaws, such as flaking instrument tape, scratches, dents, and adhesive label residue, in some loaner instrument sets. I have seen unsterile loaner instrument sets sitting on parking lot pavement waiting to be delivered to the next facility and processed for the next clinical use. If such sets are delivered a short time before a planned procedure, SPD personnel and leaders are placed in the difficult position of either continuing with the processing of the instruments despite quality concerns or risking delayed patient care by stopping the process until the concern is addressed.

Instruments of subpar quality can be identified before reprocessing or in the OR during the procedure. In either situation, a decision is needed regarding use of the instruments. If the concern is identified before procedures and the decision is made to continue processing instruments of subpar quality, the decision about how to proceed is then passed to the perioperative team. However, if concerns associated with instrument quality are identified in the OR and the surgeon decides to proceed using the subpar instruments, the consequences for the patient could be significant. When subpar quality loaner instrument sets are delivered frequently, or if loaner instruments are not delivered in accordance with established delivery timelines for planned procedures, SPD and perioperative leaders can unify and hold device representatives accountable. This may involve reminding the representatives of quality expectations for instruments reaching their patients and escalating actions to facility leaders should the instrument quality remain below expectation. A collaborative approach may be effective in increasing the quality of instruments received at the facility.

CONCLUSION

The use of loaner instrument sets can be common in perioperative environments, especially where costs, space, and technology are concerns. A variety of gaps, such as differences in reprocessing, lack of set familiarity, and lack of proper training, may affect the ability of SPD personnel to complete tasks associated with loaner instruments in a timely manner. Inadequate tracking of multiple sets of instruments across facilities can impede the ability of infection preventionists, epidemiologists, and public health professionals from identifying common source infections from contaminated loaner instrument sets. Sterile processing department personnel can use a standardized process to prepare loaner instruments for surgery. They also can collaborate with OR personnel when any issues (eg, subpar quality) are identified to determine the next steps to ensure patients receive safe surgical care.

Conflict of interest disclosures:

None reported.

Biography

Rebecca T. Alvino, MS, RN, CNS, CIC, CNOR, CRCST, NEA‐BC, FAPIC, System Director, Hospital Epidemiology and Infection Prevention, UC Davis Health, Sacramento, CA.