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Neil Rehburg takes the lid off a metal pan full of instruments that have just been used to remove somebody’s gall bladder.
The operation - called a laparoscopic cholecystectomy or lap chole - is a common minimally invasive procedure. The surgeon uses graspers, tubes (cannula), clips, a tiny camera and other devices to remove the gall bladder through small incisions in the right upper abdomen.
Rehburg took the container - called a Genesis pan - to an elaborate set of sinks in the medical device reprocessing department in a new wing of the Dartmouth General Hospital.
“You have to take everything apart,” said the MDR technician, who was dressed in protective clothing and gloves, as he quickly dismantled the cannula and washed off blood and other fluids.
The hand-washing station is the first of a complex process that makes up a loop of use, sterilization and reuse between the MDR department and the operating rooms at DGH.
The lap chole equipment will also be run through an ultrasonic cleaner, which uses rapid changes in liquid pressure to remove contaminants, as well as a decontamination washer that makes the equipment safe for MDR staff to handle during the repackaging phase.
More sensitive equipment, such as the laparoscopic cameras, will be sterilized with a low-temperature hydrogen peroxide system.
Thousands of devices
Dale LeBlanc, the hospital’s MDR supervisor who has worked in the field for 28 years, oversees about 20 MDR technicians and other staff in the new state-of-the-art facility that is part of the Neville J. Gilfoy wing that officially opened on Dec. 3.
LeBlanc said these rigorous reprocessing protocols are crucial for patient safety, particularly the prevention of infections related to bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile.
Each year, about 8,000 Canadians die from hospital-acquired infections and 220,000 others get infected, according to the Canadian Patient Safety Institute.
The rates of MRSA and C. difficile are below national rates in Nova Scotia Hospitals, according to the provincial Health Department's public reporting website.
“Any one single instrument is just as important as a set that has like 100 implants in it,” LeBlanc said while giving a visitor a tour of the new MDR facility.
The MDR staff deal with thousands of different types of devices and equipment that are used in the orthopedic and endoscopic operating rooms in the new three-storey wing.
For example, a surgeon doing a single hip replacement will use three case carts filled with Genesis pans, just one of which could contain up to 400 instruments and implants, LeBlanc said.
“So there's a lot that goes into preparing a set (of equipment) for patients,” she said.
Checks and balances
A crucial part of that process is keeping track of exactly what’s been done to every piece of equipment. As she led visitors through the different sections of the MDR department, LeBlanc pointed out the “checks and balances” that are incorporated into the system.
For example, test packets are regularly sent through the reprocessing system. Some have specialized tape that changes colour to indicate the level of sterilization. Other packets are embedded with live spores which, if all is working as it should, will be dead by the end of the reprocessing test.
As for the new MDR facility itself, LeBlanc’s enthusiasm for its design and facilities was hard to miss. There are two elevators - one that is used only for transporting “soiled” equipment from the operating rooms to the MDR and another that is dedicated to taking the repackaged sterile equipment back to the ORs.
There's the “picking” room, where staff select and package equipment based on the particular needs of that day’s surgeries. The room is filled with laden metal shelves that have wheels for easy movement. The sinks, computer desks and other stations are ergonomically designed with features such as height-adjustable fixtures.
“Another big thing we always talk about, which seems so minute but it's huge to the staff, are the windows,” LeBlanc said, which line the back wall of the department. “We don't normally get to have natural light in MDR because sometimes we're in the basement.”
Back in her office, after she and her visitors took off the protective gowns and blue slippers worn during the tour, LeBlanc acknowledged people might be surprised at the depth and breadth of the work that goes into what might appear to be a simple task - keeping medical equipment clean.
“We’re very lucky to have a lot of the public come through the new MDR, they ask a lot of great questions and it’s a real eye-opener. They’ll be like, wow, this is how my instrument gets processed and they’re so pleased we do all this rigorous testing and how in-depth it is.”