Yellowknife (October 5, 2020) – The NTHSSA continues to face issues with medical device reprocessing services at Stanton. The team at Stanton continues work to fix the issue but have not yet reached a final resolution.
The sterilization devices at Stanton are outputting sterile equipment. We know this because we have tools to measure the biological and chemical efficiency of the sterilization process and the devices continue to pass these tests. The issue is moisture in some of the packs when they come out of the devices. Packs with moisture present – or wet packs - cannot be stored for future use because moisture can attract bacteria. In general, heavier and larger instrument packs are coming out of the sterilizer still wet. In a normal situation Stanton would be continually cleaning and sterilizing all surgical instruments to maintain an inventory of surgical supplies ready for use, which allows for a full capacity of surgeries to take place. The wet pack issue is preventing full capacity surgical services at Stanton leading to delays in elective surgeries.
Below you will find an update on the latest status and information on what steps have been taken to date.
What is Stanton doing now to address the issue?
At this point Stanton is currently focused on:
- Steam and water quality test results.
- Steam quality tests were completed that measure the temperature and dryness of the steam. These results were in line with expected parameters.
- Further water quality testing was completed and is being analyzed by a specialist lab in Ontario. These results are pending.
- Continued daily trials of sterilizer devices to determine what combination of factors (wraps, trays, weight/density of loads) are performing as expected and outputting dry sterilized packs that can be stored for use. Stanton has found some success in sterilizing smaller/lower weight instruments; larger volume and weight instruments are still presenting challenges.
- Developing contingency plans that will be put into place if the reductions to elective surgeries continue. These plans include determining if some surgical procedures can take place at other sites within the NWT and whether instruments could be reprocessed in other NWT locations or in other locations within Canada. More definitive plans will be shared when final.
What has been done to date?
The sterilization process in a hospital setting is complex and has many interrelated systems including
- sterilization devices themselves,
- steam generation equipment,
- supply lines/exhaust systems,
- water supply
- processes related to putting equipment through the devices (how they are packaged, the weight/density/material of equipment in machines at any given time, drying time settings on machines, etc.
Moisture and staining issues related to the sterilization process at Stanton started suddenly and at the same time in all three sterilizer devices. No definitive cause has been found to date. Identifying the underlying cause requires a systematic process of elimination, changing one factor at a time to determine its' impact. Each of these steps is time consuming, which has led to a prolonged period of investigation.
For more information on other steps Stanton has taken to address this issue see our update issued on September 14, 2020.
How many surgeries have been delayed?
From a patient impact standpoint, urgent and emergency surgeries continue. To date there have been 124 elective or non-urgent surgeries that were cancelled and will be rescheduled at a future date.
What capacity does Stanton retain for surgery?
At this time Stanton’s capacity for surgery has been limited but not eliminated.
Stanton’s surgical and medical device reprocessing teams work together weekly to determine what surgeries can go forward. All urgent and emergent (see chart below) surgeries are continuing. In some cases, certain types of elective procedures have been able to be completed depending on the surgery type and available equipment. The goal is to limit patient impact and use the available resources to complete surgeries that are possible now, allowing for reduced future volume so we can prioritize those who experienced a cancellation or delay.
For example, an elective joint replacement is not possible at this time because the equipment needed is heavier and the volume larger. Results to date on sterilization of these types of equipment are showing that the equipment is consistently coming out of the devices with moisture present. There are no disposable options for some of the types of equipment needed for joint surgeries. Surgeries like tonsillectomies or cataracts are going forward in certain cases because there are disposable equipment options and where sterilization is required, the volume and type of instruments are small. These types of instruments are able to be sterilized and stored or replacement disposables are able to be used.
Currently Stanton can continue with high priority (urgent and emergent) surgeries that require larger or heavier equipment by processing instruments for on-demand usage. This is a labour-intensive process because it does not allow for storage and building an inventory of sterilized instruments and limits the number of surgeries we can complete.
Stanton Territorial Hospital has the following definitions for prioritizing patients waiting for surgery:
|Surgery category||Target time for Surgery|
|Priority A – Emergent||
1A: within 0-2 hours
1B: within 2-8 hours
|Priority A – Urgent||
1C: within 8-48 hours1D: within 2-7 days
|Priority B – Semi-Elective||within 4 weeks|
|Priority C – Elective Surgery||within 12 weeks|
|Priority D – Elective Surgery||within 6 months|
Semi-elective surgery is a surgery that must be done to preserve the patient's life, but does not need to be performed immediately. (Stanton B)
Urgent surgery is one that can wait until the patient is medically stable, but should generally be done within 7 days. (Stanton A: 1C & 1D)
Emergency surgery is one that must be performed without delay; the patient has no choice other than immediate surgery if permanent disability or death is to be avoided. (Stanton A: 1A & 1B)
From the time Stanton began experiencing issues with the sterilizers until September 25, 2020, 175 surgeries have been completed at Stanton. These surgeries have primarily been in the Priority A and B categories.