Reduce Spend: Implement an Instrument
Preventative Maintenance Program
Spend pennies vs. dollars by Matt Rudolph
ith hospital budgets continuing to shrink and Patient Safety
W instrument purchases put on hold, the imple-
mentation of a surgical instrument preventative
maintenance program will allow managers to spend pennies
Well-maintained surgical instruments result in increased
patient safety. By putting a sharp scissor in the hand of the
surgeon, the procedure will be faster and smoother resulting in
versus dollars. This program involves identifying the high- less anesthesia time. Sharp instruments will also result in
volume, high-usage sets in your facility. For example, if your increased surgeon satisfaction.
facility specializes in orthopedics, it is important to focus on The repair vendor plays an important role in patient safety.
servicing these sets first. To accomplish this, the repair vendor Cracked instruments must be identified and immediately replaced.
should offer seven day per week availability. If the vendor only Cracked instruments should never be welded, as this will increase
shows up at the hospital once a month at their convenience, patient risk.
the sets may be in use. Weekend service should also be offered
without paying a premium. Risk Reduction
The process starts with inspection of the instruments. Implementing a preventative maintenance program will
This should be a team effort between the sterile processing reduce possible infections. The repair vendor must partner
department and your repair vendor. This program should pay with the sterile processing department in identifying and
special attention to the sharps (scissors, osteotomes, rongeurs) removing baked-on debris and bioburden on the instruments
as well as needleholders. In addition, specialty instruments such as Kerrison rongeurs and laparoscopic instruments.
must be targeted. Inspection will prevent costly purchases for By utilizing cleaning brushes, ultrasonic cleaning, and
replacements. For example, a new Kerrison rongeur can cost preventative maintenance with complete refurbishment, the
the hospital $400 to $600 while the repair cost is only $8. instruments can be restored while improving patient safety
Similarly, to replace a laparoscopic grasper will cost $450 to and reducing hospital liability. If the instrument is not clean it
$700 while most repairs will run approximately $35. is not sterile.
Preventative maintenance, such as removing bioburden on instruments such as Kerrison rongeurs, will reduce
56 MANAGING INFECTION CONTROL July 2009
Preventative Maintenance Program
Frequency of Service
(Varies depending on number of sets and number of procedures)
Set Minimum Frequency
Orthopedic sets 2-3 times per year
Osteotome sets 4 times per year
Curettes/Gouges 4 times per year
Arthroscopy 3 times per year
D/C trays 3 times per year
C-section 4 times per year
Use of cleaning brushes helps to restore instru-
ments and improve patient safety. Cardiac sets 3 times per year
Neuro sets 3 times per year
Plastic sets 4 times per year
With a comprehensive preventative maintenance
Comparison of Replacement Costs vs. Repair Costs
(PM) program, instrument problems and issues can
be identified and eliminated before they occur. Item Repair Cost Replacement Cost
Examples of programs include: Scissor sharpening $2.95 $25 - $140
Double-action Rongeur $6.50 $250 - $400
Stainless Steel PM Programs
The repair vendor should track the service dates Kerrison Rongeur $8.00 $350 - $600
of the most frequently used sets. The trays are put on Osteotome sharpening $3.95 $40 - $110
a rotating repair schedule so that instrument issues
Lap instrument rebuild $145.00 $400 - $650
are caught before they reach the operating room.
Laparoscopic PM Programs Average Preventative Costs vs. Major Repair Costs
The repair vendor should have the capability to
inspect and test the laparoscopic sets for functionality Item Replacement Average PM Cost
Cost Repair Cost
and damaged insulation. A continuity tester will
detect torn and punctured insulation. This evaluation Pneumatic microdrill $4,000 $700 $200
and repair should be performed quarterly on location Electric power system $5,000 $650 $300
to prevent down time.
Battery-powered drill $7,000 $995 $275
Power Equipment PM Programs
Powered handpieces must be sent out to be After implementing a preventative maintenance program, it is
disassembled and cleaned at least once a year. imperative that the sterile processing staff and the operating room staff
Pneumatic, battery, and electric equipment can accu- continue learning by taking advantage of vendor educational programs.
mulate moisture and bioburden which can damage A reputable repair vendor can assist with these programs by offering
vital components. If build up occurs, the handpiece them free of charge. The staff will learn critical areas of instrument
could possibly stop functioning during surgery. inspection such as identifying cracks, dull scissors and worn-out needle-
holders. The goal of this program is to have a basic understanding of all
Flexible Scope PM Programs instrument categories. This knowledge will add to the value of the
This component of the program involves preventative maintenance program. ✛
conducting a comprehensive inventory of the flexible
scopes. Serial numbers are recorded along with a
report reviewing the overall condition. Angulation, Matt Rudolph is corporate trainer and senior sales representative
control knobs and image quality also need to at Spectrum Surgical Instruments Corp. For more information visit
be evaluated. the company’s Web site at www.spectrumsurgical.com.
58 MANAGING INFECTION CONTROL July 2009