Like most facilities, we used to follow a schedule for preventive
maintenance. Heavily used trays were sent out monthly, lower movers
maybe every quarter or so. But that approach left us vulnerable. What
if a pair of scissors or a rongeur becomes dull on the first day of that
cycle? You're not going to have it PM'ed for another 28 or 30 days.
Now, there are 2 things to keep in mind here. One is that if you do
a good job of getting instruments repaired before any damage gets
worse, it increases longevity. The second is the X factor. Thankfully,
I've never witnessed anything like this at UPMC, but we've all heard
stories of frustrated surgeons tossing scissors across the room
because they didn't like the way they're cutting. That, to put it mild-
ly, tends to be detrimental to instruments. The simple fact is that
well-maintained instruments help keep tempers in check, and our
approach has generated a lot of really positive feedback from our
surgeons.
How do we do it? The key is that we inspect instruments in sterile
processing as we go through our pick lists and assemble trays. We've
done multiple in-services with the instrument companies, training our
staff on what to look for. So anything that has a really specific func-
tionality — like a scissor or a rongeur or a needle holder — ends up
being inspected once or twice a day, instead of just once a month.
We hold needle holders up to the light and make sure they align per-
fectly. For scissors, we have a clip card on the side of our rigid contain-
ers. They need to be able to make a perfect cut. We'll also test it on a
piece of latex, and if there's the slightest amount of drag, we'll pull it
off the tray, get a backup and send it out for sharpening. Staff also
check at the point of assembly to make sure parts are moving fluidly. If
not, they spray on a little lubricant.
I know what you're thinking. People assume our approach must be
time-consuming. It does take some time to train people and make
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