ISSUE: Since late July, 2020 Stanton Territorial Hospital has faced issues with sterilization services leading to a reduction in surgical service capacity at the hospital
Surgical services at Stanton remain reduced with urgent and emergent surgeries going forward with available capacity. Limited elective procedures – cases that use low volumes of instruments or are able to be completed with disposable items – are also being scheduled and going forward. Joint replacements continue to be impacted and are not possible at this time. Current waitlists are being reviewed on a regular basis by each Specialist service.
Most surgeries are triaged on a highest-need basis. In the case of total joint replacements, these will proceed in the order by which they are referred because this is best practice.
Since the beginning of this issue Stanton has completed 318 surgeries. To date 74 of the 124 surgeries that have been cancelled since July 23, 2020 have been either been completed or rebooked. The number of cancelled surgeries has not increased as bookings have been suspended until the sterilization issues have been resolved.
Contingency plans for surgeries to continue have been developed; however, the current COVID 19 pandemic response adds additional challenges. These contingency plans may change in response to the pandemic.
Stanton is coordinating with the Inuvik Regional Hospital to coordinate some less complex surgical procedures that can be completed at that site starting the week of November 30th. Calls to patients are underway to determine who may be able to travel to Inuvik for their procedure.
Stanton continues to work with partners in Alberta to glean their expertise and advice on our reprocessing issues. We have not pursued sending instruments for reprocessing to Alberta as staff would be required to accompany the instruments given the risk with the rise in COVID cases in the province. Alberta Health Services is operating at a reduced capacity for surgeries due to COVID 19. On Oct 23, 2020, Edmonton Zone cancelled 30% of scheduled surgeries. The increasing numbers of COVID 19 cases in southern jurisdictions and the increased risk to travelers is high and therefore this contingency continues to be on hold. More information on elective surgeries in Alberta can be found at: https://www.albertahealthservices.ca/topics/page16997.aspx#changes
A letter was sent to each patient awaiting surgery on November 17, 2020 to update them on the overall sterilization issue. Communication on when a patient’s surgery can proceed will depend on the nature of their surgery and we will continue to communicate with those patients who are currently waiting for surgeries as the sterilization issue evolves.
Anyone who has a change or worsening of their condition should contact their provider or specialist clinic and discuss this with their team.
Wet Packs - The initial issue of moisture in the trays in which the surgical instruments are sterilized has significantly reduced. Stanton has not been able to pinpoint for the change but it is expected that environmental factors, specifically a reduction in relative humidity in the environment, contributed.
Staining on Towels – In the sterilization process, towels are used to wrap equipment. Some of these towels are coming out of the devices with very mild rust-like stains.
Stanton has ruled out several of the most likely causes, and is now focused on the following as potential avenues to resolve the sterilizer issues:
- Water quality: Stanton’s water chemistry consultants have provided a proposal for a water treatment solution. Stanton is currently awaiting for parts which are expected to arrive late November or early December. Once installed, testing will take place and analyzed as quickly as possible.
- Water testing for mineralization: water quality tests at multiple locations have been collected and analyzed. Since the last update additional tests have been sent for laboratory analysis and results are expected in 3-4 weeks. At present none of the samples show a definitive point in the system where mineralization is occurring. All samples have been within the specifications of the manufacturer of the sterilization devices. Stanton continues to consult with the manufacturer and experts on this issue.
- Instruments: Stanton examined the current instrument stock to find out whether new instruments could help fix the sterilizer issues. Stanton sent instrument trays to Calgary’s Foothills Medical Centre (FMC) for reprocessing, where both a tray that was decontaminated at Stanton and sterilized at FMC as well as a tray that was fully decontaminated and sterilized at FMC came out dry and without stains. The testing performed at Stanton and Calgary’s Foothills Medical Centre (FMC) do not indicate that changing the instruments would impact the staining levels.
- Reprocessing of surgical supplies and instruments at other sites. Teams have travelled to Inuvik to reprocess instruments. This has provided limited support for some surgeries; however, larger / heavier equipment used in many surgeries cannot be reprocessed at these locations.
- Any examination of the staining issue will be undertaken through a special risk assessment. While a quantitative risk assessment has not been possible, a qualitative one has been completed, and Stanton was advised that there was ‘very low risk’ from an infection prevention and control perspective of using the stained instruments if all sterilization parameters have been met. We will not be using any material that comes out of the sterilizers with stained towels until we have completed a thorough risk assessment. If this process is determined to be acceptable, all patients would be notified before surgery of any potential risks, no matter how limited they may be.
Previous Status Updates:
- Stanton Sterilization and Surgical Capacity Update - November 4, 2020
- Stanton Surgical Capacity and Medical Device Reprocessing Update – October 5, 2020
- Stanton Medical Device Reprocessing (sterilization) and Surgery Capacity Update.- September 15, 2020
- Stanton Surgical Services Impacted by Sterilization Device Malfunctions – July 24, 2020