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1 2005 Surgical Instruments Guide Our 2005 Surgical Instruments Guide was intended to provide our readers with an easy-to-reference source for suppliers of all types of surgical instruments. In addition to our chart of vendors on pages 28 31, this guide includes a selection of tips, strategies and rules of the trade from leading instrument suppliers on the selection of surgical instrument manufacturers and vendors; cleaning, disinfection and sterilization; maintenance and repair; and instrument tracking. We hope you ll hang on to this handy guide and refer to it throughout the year as you make decisions regarding the surgical instruments used in your facility. Cardinal rules on surgical instrument management- Evaluating surgical instrument manufacturers There are many considerations in selecting a surgical instrument manufacturer, based on the individual needs of specific surgeons. Some basic guidelines include: Look for a company that offers a broad line of instruments general, specialty and custom patterns for a wide range of surgical needs, including neurosurgery, microsurgery, cardiovascular, urologic, thoracic, orthopedic, ophthalmic, endoscopic, OB/GYN and ENT/plastic. Select a manufacturer with a long history and commitment to crafting surgical instruments. A company that owns its specifications and processes demonstrates a high level of quality and consistency. Country of origin is important to consider, too. Find a company that meets evolving needs. As technology advances, instrumentation needs to keep pace. Look for a company that adds new product lines, keeps up with current surgical trends and offers flexibility in customization. Guarantees Find a manufacturer that offers lifetime guarantees on its instrumentation. Look for a company that can serve as a single source for instrument needs, including a comprehensive line of surgical instruments, instrument management services such as maintenance, tracking and repairs, and products and services for reprocessing, packaging, storage and maintenance. Choose a company with outstanding service, excellent fill rates and a highly-knowledgeable sales team. Tips on cleaning, disinfection and sterilization Many manufacturer and professional organizations have published guidelines on decontaminating, cleaning, maintaining, handling, storing and sterilizing surgical instruments. While it is impossible to advise on specific instruments, here are some general recommendations: 24 April 2005 HEALTHCARE Purchasing NEWS Surgical instruments should be cleaned, handled and used according to manufacturers instructions. Instruments should be kept free of gross soil during surgical procedures. Instruments should be reprocessed as soon as is reasonably practical. Any instrument opened on the sterile field should be decontaminated, and personal protective equipment should be worn in the process. Cleaning methods should be based on the hospital s policies and manufacturers guidelines. This includes ultrasonic cleaning, washers/sterilizers or manual methods. Instruments should be inspected for proper functioning after cleaning. Check for smooth movement of hinge. Locking mechanisms should be free of nicks and present a continuous edge. Instruments with broken, cracked, chipped or worn parts, or tarnished surfaces should be repaired or replaced immediately. Steam permeable lubricants should be applied to instruments that require it prior to sterilization. Let instruments drip dry for three minutes before wrapping for sterilization. Load instruments in dedicated trays or generalpurpose sterilization trays. Wrap with appropriate methods. Protect jaws and cutting edges from damage. Sterilization may be accomplished by Autoclave or Ethylene Oxide. Time and temperature parameters vary according to type of sterilizer, cycle design and packaging material. After sterilization, instruments should be stored in sterilization wrap or containers in a clean, dry cabinet or storage case. Maintenance and repair of instruments Some manufacturers offer solutions for managing instrument programs, including maintenance, tracking and repairs. Their services include on-site stainless steel instrument repair, mail-in repair programs, endoscopic equipment repair and instrument outsourcing and management programs. In selecting a repair and maintenance program, look for: A company that emphasizes quality and guarantees their service In-service staff training Assistance with instrument/equipment procurement and standardization Dedicated National Repair Centers Loaner and courier services in conjunction with repairs Endoscopic equipment management and repairs Inspection, preventive maintenance and repair history reports Methods of tracking instruments Over the last couple of years, hospitals have begun to adopt software-tracking systems at a fast rate due to the many benefits that can be achieved. Today, there are instrument-tracking systems available from a number of surgical instrument manufacturers and software companies. Some of the tracking technologies include radio frequency identification (RFID) and the use of barcode technology to track surgical instrument sets in real time. Hospitals should: Identify set types and usage for optimum utilization of existing inventory Drive standardization of instrument sets Enhance employee productivity and accountability in set assembly areas, helping reduce errors and minimizing costly OR downtime Track instruments in real time to each location Immediately identify missing or lost items Manage instrument expenditures Track all aspects of instrument repairs Track instrument sterilization history Source: Cardinal Health Inc. V. Mueller Division See SURGICAL INSTRUMENTS on page 26

2 Strategies for evaluating surgical instrument vendors by Rick Schultz and Alex Vrancich Selecting a surgical instrument vendor doesn t involve the decision-making that was required in years past. This is mainly due to the rise of group purchasing organizations (GPOs) and their growing influence on hospital purchasing. Not long ago, the decision to purchase general surgical instruments may have been done on a case by case basis, taking into consideration the specialty or tray, the relationship with a sales representative, price, quality and any other number of factors. Now, a facilities GPO affiliation determines about 80 percent of where and how surgical instruments are purchased. Although GPO affiliations do not guarantee the lowest price, most instrument purchasing is in compliance with the contract. One area where GPOs have not completely transformed purchasing is in the area of surgeon s preference items. These items are defined by a surgeon s specific need or want of an instrument that may lie outside the GPO s vendor. Surgical specialties, including vascular, neurology, urology, and laparoscopy, require highly specialized instrumentation that one vendor may not be able to supply, or a surgeon may require a specific brand of instrument. In these cases, the evaluation of an instrument vendor demands more thought and consideration. The most important component of the vendor evaluation should center on warranty. Most companies offer a lifetime warranty on all surgical grade surgical instrumentation. For the purpose of our discussion, we will concentrate on the warranties of general instruments, including hemostats, scissors, and needle holders. Below is a list of questions to ask to learn more about a company s lifetime warranty. Is lifetime defined in years? If so, how many? Are cracked box locks on all hemostats covered Are cracked box locks on all needle holders covered Are cracked screw hinges on scissors covered Are cracked tungsten carbide blades on scissors covered Are cracked tungsten carbide inserts on needle holders, forceps or rasps covered Is pitting covered Is surface rusting and heavy staining covered Other factors to consider when discussing warranty are the ease-of-use of the warranty. Does the company require you to fill out paperwork or go through bureaucratic red tape to fulfill their warranties, or is it a simple phone call to the representative? Many times during the purchase process the warranty is discussed and promised, but when issues arise, you have to know if the company will be there to support your needs. After warranty, one of the most important factors when considering an instrument vendor is the stability of their representatives. First, it is important to know if the company employs manufacturer s representative or direct employees. A seasoned surgical instrument sales representative brings a tremendous amount of value to the relationship. Experienced sales representatives will be able to provide solutions that will help your facility to care and maintain instruments and extend their useful life. For instance, if you have a staining problem, a good representative will be able to assist you in tracking down the root cause of the problem, and make suggestions to eliminate future problems. In addition, a veteran representative can assist you in making decisions concerning inventory levels, repair and maintenance frequency, and much more. One should never underestimate the importance of a company s representatives when selecting an instrument vendor. Many times it is necessary to cross reference items from a different vendor. For instance, if a pattern is back ordered from your primary vendor or if a pattern is discontinued, a reputable instrument company should have a cross-referencing conversion system in place. Converting another company s catalog number should be a service available to you, so that you aren t wasting valuable time looking through competitive catalogues and Internet web sites to come up with the proper conversion. Another area where evaluation of a surgical instrument vendor comes into play is the availability of alternative quality patterns. Not all instruments purchased have to be German-made surgical grade instruments. For instance, a costsaving alternative may be to purchase a middle line instrument for non-critical patterns such as towel clamps and sponge forceps. Middle line instruments are usually made in Pakistan using higher quality steel than economy or store room instruments, which are made in Pakistan using low-grade Pakistan steel. Economy or store room instruments also have a place within the facility. Many of the instruments used on the floors don t have to be high quality and these semi-disposable instruments are a perfect cost alternative. Economy-grade instruments can usually be purchased at prices ranging from $1 to $4 depending on the pattern. A small number of instrument companies are now offering tracking software systems. Many times these tracking systems are offered to the facility for free. In theory, this sounds like a great deal, but nothing in this world is free. These free tracking systems have been developed, programmed and loaded with only their own instrument patterns and their own catalog numbers. Hospitals simply do not use just one brand of instrument, and although these tracking systems may offer some advantages with respect to count sheet management and tracking, they tend to steer the purchasing of instruments to their own products. The end result of a free tracking system is in reality, an instrument ordering facilitator. The final item for discussion is education. Most instrument companies have a brief instrument care and handling summary located within their catalogue. However, you should expect education from a reputable instrument vendor. By providing CEapproved educational programs for your staff, instrument vendors are accomplishing two things. First, they are providing a value added service to their customer, and second, they are reducing their warranty exposure. By helping to increase staff awareness and teach proper care and handling techniques, the quality and performance of the instruments will improve, thus reducing warranty situations, and lowering the hospitals instrument expenditures. Although the landscape has changed and GPOs make many decisions for us, it is still important to use a patient and analytical approach. Issues concerning warranty, quality, pricing, and value added services must be taken into consideration to ensure that your surgeons have the tools necessary to perform the art of surgery. Rick Schultz is president and CEO and Alex Vrancich is general manager of Spectrum Surgical Instruments, Stow, OH. HEALTHCARE Purchasing NEWS April

3 2005 Surgical Instruments COMPANY 26 April 2005 HEALTHCARE Purchasing NEWS 3Gen, LLC Aesculap Alcon Laboratories Allen Medical Systems American Optisurgical, Inc. Accurate Surgical & Scientific Instruments BD Medical Bulbtronics, Inc. Cardinal Health, V.Mueller Prod & Serv Censis Technologies, Inc. Echo Instruments, Inc. Encision, Inc. Greenwald Surgical Co., Inc. Gyrus Medical Healthmark Industries Co., Inc. Instrument Specialists Karl Storz Endoscopy Kimberly Clark Lawson Software MAHE International, Inc. Materials Management Microsystems Medikmark, Inc. Medline Industries, Inc. Megadyne Millennium Surgical Corporation Miltex, Inc. Mobile Instrument Service & Repair MSI Precision Specialty Instruments Olympus America, Inc. PL Medical Co., LLC Preservation Solutions, Inc. Richard Wolf MIC Riley Medical, Inc. Sandel Medical Industries Scanlan International, Inc. Spectrum Surgical Instruments Corp. SRS Medical Corporation STERIS Corporation Stryker Communications Stryker Endoscopy Valleylab div of Tyco Healthcare World Medical Equipment, Inc. Guide TELEPHONE 949/ / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /323-WOLF 207/ / / / / / / / / / WEB ADDRESS KSRLeads/Circle No

4 Arthroscopic Instruments & Products Biofeedback Instruments Blades/ Blade Removal Systems Brushes Burrs Cardiothoracic Instruments & Products Cautery/Cautery Tips Clamps Cleaners Containers / Container Systems Custom Procedure Trays/Kits/Packs Diagnostic Instruments & Products Dilators Dissectors Drains/Drainage Systems Drills Electrosurgical Instruments & Products Endoscopic Instruments & Products Forceps Holders & Positioning Devices Irrigators Instrument Maintenance/Cleaning HEALTHCARE Purchasing NEWS April

5 2005 Surgical Instruments COMPANY 28 April 2005 HEALTHCARE Purchasing NEWS 3Gen, LLC Aesculap Alcon Laboratories Allen Medical Systems American Optisurgical, Inc. Accurate Surgical & Scientific Instruments BD Medical Bulbtronics, Inc. Cardinal Health, V.Mueller Prod & Serv Censis Technologies, Inc. Echo Instruments, Inc. Encision, Inc. Greenwald Surgical Co., Inc. Gyrus Medical Healthmark Industries Co., Inc. Instrument Specialists Karl Storz Endoscopy Kimberly Clark Lawson Software MAHE International, Inc. Materials Management Microsystems Medikmark, Inc. Medline Industries, Inc. Megadyne Millennium Surgical Corporation Miltex, Inc. Mobile Instrument Service & Repair MSI Precision Specialty Instruments Olympus America, Inc. PL Medical Co., LLC Preservation Solutions, Inc. Richard Wolf MIC Riley Medical, Inc. Sandel Medical Industries Scanlan International, Inc. Spectrum Surgical Instruments Corp. SRS Medical Corporation STERIS Corporation Stryker Communications Stryker Endoscopy Valleylab div of Tyco Healthcare World Medical Equipment, Inc. Guide TELEPHONE 949/ / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /323-WOLF 207/ / / / / / / / / / WEB ADDRESS KSRLeads/Circle No

6 Instrument Repair Instrument - ENT Instrument - Surgical Laparoscopic Instruments & Products Laryngoscopes Light Sources Mallets Needle Holders OB/GYN Instruments & Products Orthopedic Instruments & Products Probes Retractor Systems Saws Scalpels Surgical Scissors Spreaders Suction Tubes Tracking Systems Urological Instruments & Products Other Imaging Phaco Handpiece Instrument Mgmt Eye & Neuro/Spine Inst. Diagnostic Instruments Software for Inst. Mgmt Sterile Irrigation Solutions Diagnostic Instruments Vaginal Weights Video/Voice Integration Video Camera Systems Refurbished Equip HEALTHCARE Purchasing NEWS April

7 Keeping tabs on precious assets Detailed tracking of surgical instruments is not just a good idea, it s absolutely essential to keeping operating room costs in check. Lawson Software s Surgical Instrument Management (SIM) software is a web-based solution designed to reduce surgery delays and control instrument and staff costs. Winthrop-University Hospital (Mineola, NY), is one of a string of hospitals counting on the Lawson system to deliver multiple benefits through automated management of surgical instruments and trays. In fact, said Winthrop s director of central sterile service and materials distribution, Richard Kraft, We expect to achieve our return on investment within eight months. The 591-bed hospital on Long Island has been providing healthcare and medical research for over a century. As part of an initiative to revamp its Sterile Processing Department and bring outsourcing of trays back in house, Winthrop and external consultants from ISH, a firm that provides strategic IT and logistical planning, management and implementation services to the healthcare industry, decided that surgical instrument management software was necessary to attain the best gains in quality and efficiency. After evaluating several systems, Winthrop chose Lawson s SIM. The Lawson system for me was the best of breed. It has touch-screen capability, would be easy for the staff to use and provide the functionality we require, said Kraft. The Lawson system is web-based and can be run on thin clients rather then PC s which is more cost effective, he added. Kraft s immediate plans for SIM, which should be completely installed within the next few months, are to hold Winthrop s database of tray count sheets, sterilization load and biological indicator records and track location of instrument sets. Future plans for the software include staff productivity reports, repair logs and scheduling preventative maintenance of trays and sets. The system will also track tray usage, identifying which trays the facility needs more of, and which trays could be broken down for instrumentation to be used elsewhere. Through the use of Lawson SIM, Winthrop will be in a position to achieve its ultimate goal: We want a correct, ready-to-use, sterile tray in the right place at the right time, said Kraft. Using SIM s visual aids, which provide pictures of completed sets, Winthrop can more easily and effectively train its CSS technicians, again promoting more accurate tray assembly. With first hand knowledge of the efficiencies a tracking system could bring to his department, Kraft led the charge to implement the system, working with Winthrop s assistant vice president of materials management and the operating room director, alongside ISH. Kraft noted that Lawson solicited his opinions of the system and added that he was happy to see that they were working on implementing some of his suggested enhancements, including an equipment racking module. HPN