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Are Bigger Hospitals Safer? Not When it Comes to Surgical Instrument Reprocessing

There has been a tremendous amount of buzz recently over The New England Journal of Medicine (NEJM) article showing that bigger hospitals do not equal better patient outcomes.

Well, welcome to the party NEJM. Those of us cleaning, sterilizing, and supplying surgical instruments and equipment to Operating Rooms in these large hospitals could have told you that a long time ago.

For a host of reasons listed in other articles like these (here and here), merger and acquisitions of healthcare facilities rarely -- if ever -- have a positive impact on the state of things in a hospital's Sterile Processing department. In reality, as the complexity of services grow (whether that is through new service lines such as Robotics or the addition of associated off-site clinic reprocessing), the existing human and capital resources of these surgical instrument reprocessing departments undergo increased strain, become overwhelmed by poorly planned volume increases, and are often confronted with ethical dilemmas when their technicians feel they might be crossing the line into a process that is no longer safe for patient care.

The public would be astounded to know how many surgical instruments are used on them in major US hospitals every day with visible rust stains, deteriorating marking tape, and general disrepair. News outlets in this country wouldn't have enough minutes in the day to cover all the times someone else's bone ends up on a back table in an orthopedic case...every single day. If most accreditation surveyors actually knew what they were looking for in these departments, we'd see so many cases of immediate jeopardy, you'd think Alex Trebek was taking over CMS (may he rest in peace).

The reality is: No, bigger is not better, safer, or more efficient. But the inverse is just as troublesome. Smaller, specialized facilities do not automatically improve the quality of Sterile Processing services either. All the other arguments for mergers and acquisitions aside, our challenges in device reprocessing have less to do with the size of the basement -- and more to do with the lack of connection that hospital administrators and the public at large make between the resources given to our teams, and the ultimate quality of surgical instruments available for every procedure that books into our Operating Rooms.

"Imposing buildings, modern art sculptures out front, and powerful brand recognition doth not a safe surgery make."

I would say that it is a shame how little patients actually know about the surgical instrument quality issues they may be walking into for their surgeries. But it's more than a shame. It's a damn shame, and there is nothing truly informed about their consent when patients don't know they may go under rusty knives and dirty scopes. No one signs up for that. And yet, it's happening with unbelievable frequency.

Far too often bigger hospitals means bigger potential for the critical needs of Sterile Processing teams to go unmet. And we don't need an article in the NEJM to tell us this. Just take an honest SPD technician out for coffee and ask them what they've seen. Then tell your neighbor...because they deserve to know the truth.

What say you?

Hank Balch

Beyond Clean © 2020

Hank Balch is the Founder and President of Beyond Clean. You can follow him on Instagram @WeFightDirty, and find his Fighting Dirty video series on YouTube. He is an international thought leader and has written over 150 other Sterile Processing articles and commentary, along with published articles in Becker's Hospital Review, Infection Control Today, AAMI News, AAMI BI&T Journal, Outpatient Surgery Magazine, and contributions to Healthcare Purchasing News. Hank's CS/SPD team in Louisville, KY was named the "2016 CS/SPD Department of the Year" by HPN. He has also served as the founding President of the South Texas Association of Sterile Processing Services and President of the Kentuckiana IAHCSMM Chapter, in additional to being nominated for the 2017 President-Elect & 2018 President-Elect of the International Association of Healthcare Central Service Materiel Management.


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