(This article was written by guest contributor Bob Baker, owner of Back of House Logistics. He has nearly thirty years of experience providing consulting and project planning services, focusing on multi-discipline construction projects in healthcare, corporate headquarters/campuses, higher education, mixed-use retail properties and large venues. Bob is also certified in Lean/DFSS Green Belt.)
Offsite sterile processing centers aimed at supplementing or replacing hospital based sterile processing departments are on the rise. Among many other things, a well-planned offsite operation must of course address the handling of clean and soiled case carts. Case carts might be case specific, or they may transport bulk instrumentation to sterile stores for case picking. Hermetically sealed case carts are a given, but even then, we must work to ensure the highest level of aseptic control during transport.
Clean case cart workflows are transitioning from dedicated clean elevators connecting sterile stores directly with the surgical core, to case carts rolling across the loading dock. Loading docks are hubs of activity. Even the clean side of the loading dock presents aseptic challenges. Pallets, cardboard, dust, and related debris are common.
Clean Case Carts
Clean case carts arrive at the hospital throughout the day depending on case volumes, surgical schedule, and the production schedule of the offsite facility. Carts are usually dropped off at the loading dock and are staged or are transported one or two at a time from the truck to the SPD or a staging room close to surgery. Providing a staging room near the incoming dock bay expedites truck departures.
A dedicated staging room should be a clean and secure temperature/humidity-controlled space having positive air pressure. The room should be sized to provide individual access to case carts so that specific cases or instrumentation may be pulled without shuffling carts around. The ideal transport path from this room exits the loading dock directly rather than maneuvering through dock activity areas. Traveling through soiled dock areas must be avoided.
Soiled Case Carts
It’s important to have a means to visually distinguish soiled case carts from clean carts. Some carts have a permanent label that toggles clean/soiled. Others use magnets or similar methods. The available soiled carts are picked up after clean carts are dropped off, ideally from a different dock bay than was used for clean drop off.
It’s critical to remove soiled case carts on a regular schedule for two primary reasons. To mitigate dried bioburden on instruments and to provide a continuous workflow to the off-site center for reprocessing. Effective pre-cleaning and packaging of soiled instruments is more important than ever.
Trucks
Trucks might be owned or leased, or a third party may provide the trucking service. Either way, temperature controlled, refrigerated box trucks with capacities ranging from 15-24 case carts are often used. We recommend temperature and humidity monitoring systems that sense conditions in the truck box and report anomalies that might affect instrumentation and consumables. It’s a good idea to provide a means to power the refrigeration unit that doesn’t require running the engine while the truck is docked. Especially if the truck bays are uncovered and exposed to the sun.
Cleaning the truck between uses is another topic for discussion.
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The big takeaway?
Providing an efficient workflow, a clean pathway, and protecting clean case carts from contamination are critical aspects of a successful off-site SPD workflow.
For more SPD design questions, you can connect with Bob Baker directly on Linkedin.