Of the many questions a patient scheduled for surgery may ask, how the medical equipment is cleaned and sterilized is most likely not one of them. Yet it’s vital to a successful outcome.
At Sunnybrook, the Medical Devices Reprocessing Centre (MDRC) is at the heart of preparing and organizing all reusable medical tools, devices and accessories.
“Reprocessing involves cleaning, decontamination, packaging, assembling and then you sterilize,” says Abdool Karim, who has been the MDRC’s manager for 10 years. “What [MDRC staff are] doing is providing devices that are functional and sterile and free of any infectious agents – 100 per cent of the time.”
In Sunnybrook’s operating rooms – there are 21 at the Bayview site – the equipment ranges from small instruments such as those used for ear procedures to larger scalpels, forceps and retractors (which prop open everything from the mouth to the abdomen while the surgeon works), and metal bowls, spoons and trays.
Not all equipment is reusable; for example, saw blades for orthopaedic surgery are used once and discarded, while retractors can withstand hundreds of uses.
Here’s an in-depth look at the MDRC, which handles about 2,000 pieces of medical equipment daily:
1. The dirty work
Equipment is first soaked in a special enzymatic solution that loosens and breaks up blood, bodily fluids and contaminants. Technicians sort and place 90 per cent of the equipment, usually made of metal (flimsier items like endoscopes are cleaned separately in special solutions), on carts that are pushed into one of the three state-of-the-art Getinge 88 Turbo washing/disinfecting machines.
Sunnybrook was the first hospital in North America to install the 88 Turbos, which resemble large industrial dishwashers, and are now the gold standard for all hospitals. the machines whip around extremely hot water for 20 to 45 minutes (10 times faster than a car wash), spraying the equipment with powerful cleaning solutions. A lubricant, added during the final rinse, coats the instruments to keep them in top working condition.
2. Sorting and Packaging
Technicians organize the Turbo-washed equipment according to the tools needed by surgeons for specific procedures. Certain pieces are “packaged” – put in a rigid (metal) container or wrapped in special paper – and placed on a tray, which is then bar-coded, as part of a system to ensure each surgeon gets all required tools for each procedure.
The bar-coded trays are put on carts and placed into one of four industrial steaming units for final sterilization, at a temperature of up to 274° F.
4. Checks and balances
Certain “challenge tests” are done during the processes, says Karim. For instance, a little vial containing spores is in each sterilization unit. If the spores have been destroyed by the steam, any contaminants on the equipment have also been killed.
5. Ready for use
The bar-coded trays are wheeled on sterile carts to the operating rooms. a content sheet accompanies each tray, tracking each piece of equipment, so everything that leaves the MDRC is returned there for the next round of disinfecting, packaging and sterilizing.
All photography by Doug Nicholson