How to Deal With Instrument Trays from Outside off Your Facility (Part II) In Part I of this blog we discussed the fact that when it comes to new surgical instrumentation, not every hospital or healthcare facility can afford the large investment required to continually purchase the ‘latest and greatest’ in new surgical instrument technology. This is leading to more ‘sharing’ of complex, expensive instrumentation between hospitals and healthcare facilities within a given geographical area. While the sharing of instruments can be more cost effective than purchasing new instruments, the practice of transporting sterile trays to different facilities and locations raises a host of issues. Additionally, the problem of how to deal with contaminated trays coming from outside of your facility raises a number of issues as well. This important topic recently generated a lot of questions, comments, observations and suggestions on AAMI’s Members Discussion Group. Part I of this blog dealt with the issues created when using trays that were sterilized at another hospital. In Part II of this blog we will look at some of the additional issues created by this practice. One of the first issues to be addressed came from a member named Tim: “We have been challenged with supporting our local system hospitals and off campus clinics due to the transportation of hospital sterilized instruments while maintaining temperature and humidity.  Finding a trucking service that can accomplish this is the challenge.  I have not found any supporting information on this as well. Additionally, we support clinics that do not have SPD and must wash their instruments for the return trip which may be considered and issue with DOT. Has anyone found standards for this that a transport service would be able to follow?”   Tim, Director – CSPD Program¹ Tim’s question prompted this response from Stacey: “I implemented a transport system within the facility I currently work at. It allows the surgery centers the ability to acquire sterile instruments from the hospital and use them the same day.  If a system is put in place, where you can validate the cleaning and sterilization process, using sterile instruments from another facility is not uncommon.  There are hospitals that are connected to other facilities that have implemented an instrument transportation system, transport sterile instruments to the facility and they were able to use the instruments without any issue, these facilities were miles away. You just have to have the proper system in place.   If there isn't a process in place, by all means do not use the instruments and reprocess them, if there is something in place then you can use those instruments.” Stacey, Sterile Processing Coordinator² The most important point that Stacey made was that you must be able to validate the cleaning and sterilization process! Failure to validate these processes places your patients at risk of an infection caused by a contaminated instrument. Stacey’s excellent comments raised these questions from Eddie: “Do you use dust covers, bins or closed case cart to transport to the other locations? How do you handle the temp and humidity requirements from the time they leave your control environment? Are dirty sets returning to you in the same transport car that the sterile ones were sent?” Eddie, Manager CSR³ Eddie’s questions generated this informative response from Donnie: “A policy can be implemented for hospitals, Ambulatory Surgery Centers and physician clinics to use instrumentation between each other, within the same health system as your practices should be standardized across your system, provided that all of those facilities follow the AAMI, AORN, OSHA and DOT guidelines for transportation of instrumentation (with respect to sterile and contaminated instrument transport).  I would not recommend the use of instrument sets from facilities/vendors outside of my own health system for many reasons that have been stated in this thread.  ​I'm also glad to see that the general consensus is unanimous as this challenge is ubiquitous throughout the country.” Donnie, Director, Medical Equipment Reprocessing-QA⁴ In this two-part blog series there were many good issues raised concerning the ‘sharing’ of instrumentation and trays between hospitals and healthcare facilities. The transporting of sterile product and trays can be safely carried out between facilities provided you have these key things in place:

1. Standardized processes for all aspects of the program, including the use of recommendations from the CDC, JACHO, AAMI and the
2. Risk Assessment for those processes to include sterilization and transport.
3. Evaluation and auditing of the process.
4. Strong communication among all participants.
5. Flexibility to evaluate the processes and make changes as needed/identified.

If your facility is looking at setting up such a transport system between one or more facilities, you must remember that the number one goal is to maintain and protect the packaging material from being compromised during transport. Sterilized instrument trays must be protectively packaged and transported in a manner that maintains the integrity of the packaging material and prevents contamination from any source, both human and environmental.

1. “AAMI Members Discussion Group” March 1, 2019
2. “AAMI Members Discussion Group” March 11, 2019
3. “AAMI Members Discussion Group” March 14, 2019
4. “AAMI Members Discussion Group” March 18, 2019