Central service then and now: the case of Boone Hospital Center

Healthcare Purchasing News, August, 2005 by Betty Vaughn, Jay Honey

Boone Hospital Center is a 375-bed full service hospital that is located in Columbia, MO, and managed by BJC HealthCare of St. Louis, MO. Boone Hospital Center specializes in cardiology, neurology, oncology, surgical services, and obstetrical services. The hospital maintains a 24-hour emergency center with hospital-based ambulance service and a helipad for emergency air transportation.

Boone Hospital Center's Central Service (CS) department provides hospital-wide processing of patient care equipment and instrumentation, and is operational twenty four hours a day, seven days a week. The department is staffed by a CS director, a CS manager, a day supervisor, an evening and night supervisor, and a support staff of 22.5 full-time employees.

Past and present central services

When Betty Vaughn was hired as a CS attendant at Boone Hospital Center in 1974, the department was primarily responsible for sterilization and linen packing. The department had one Amsco steam sterilizer and one Amsco ETO sterilizer, and both were manually operated.

In response to the increasing complexity of surgical instruments and demand for instrument processing, in 1987 the CS department moved into a new building designed to provide an effective workflow and improve productivity. As part of the upgrade, the hospital purchased additional state-of-the-art Amsco sterilization equipment.

In 1995 a new CS director was hired to manage Boone's CS department. The new CS director encouraged the purchase of cutting edge technology. Outdated equipment was replaced with the latest Amsco equipment, which was reliable and efficient and was supported by what was considered to be excellent technical service.

The future of CS at Boone: planning for efficiency, safety, and productivity

In order to keep up with ever-changing demands from the surgical department and to continue their commitment to excellence, Boone Hospital Center's CS department will be moving into a four-story, 57,000 square foot addition to the hospital in 2005. This addition will centralize and improve access to the hospital's outpatient services and provide 6,242 square feet of space for the CS department.

Designing a new department is a challenge that many never have the opportunity to experience. The Boone CS staff has been working with the architects and their STERIS representative to create a department that will fully support the processing of current and future instruments and equipment.

In preparing for projected reprocessing needs, Boone's facility planners have considered a number of factors, including:

* Employee and environmental safety: protecting personnel from current and emerging microorganisms by replacing manual cleaning methods with automated processes

* Distance, time, and logistics: optimizing workflow to reduce wasted labor

* Current and projected numbers of surgical cases and volume of instruments

* Types of devices and their reprocessing requirements: providing sufficient equipment flexibility for a variety of device designs and decontamination methods

* Instrument tracking: to avoid loss of instruments and unintended use of damaged instruments

Technology for total instrument management

Boone's CS functions will be fully optimized through the use of the latest in equipment and instrument tracking software. The department will improve its instrument management system and process by doubling the number of computers. All CS and surgical instrument count sheets will be maintained and updated through the instrument management system.

The department is purchasing instrument management software that will interface with its sterilizers and disinfection systems. Instrument trays will be scanned through all work stations, providing real time tracking. Comprehensive reporting options will allow critical business decisions to be based on accurate, real time data. This will ensure that Boone can optimize instrument usage and avoid unnecessary costs.

Two existing medium steam sterilizers will be relocated from the old CS department to the new one. A small steam sterilizer will also be relocated to process fast-track requests from the operating room. An Amsco 3017 ETO sterilizer and Eagle EO monitor will also be relocated, along with two STERRAD 100 sterilizers.

A new Amsco Century prevacuum steam sterilizer with a sixty inch chamber will be added to increase the department's productivity. The deeper and wider chamber will allow Boone's CS department to significantly increase the number of instruments they are able to process per load, compared to their current Eagle systems. One Hamo LS-2000 Washer/ Disinfector will replace the existing Hamo unit that is over twenty years old. The plan is to process delicate surgical instruments in this new washer. Planners axe investigating the possibility of adding a STERRAD 200 system as well, for heat and moisture-sensitive items.

A cannulated instrument cleaning system will also complement the decontamination area. This unit is equipped with pulsed sonic irrigation for cleaning inside and outside of all cannulated and small-lumen surgical instruments. An Amsco Sonic Energy Console with rinsing and drying systems will also be added for surgical instrument cleaning, to remove soil from difficult-to-reach places that washers and manual cleaning may not remove.