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CPT Medical

Monthly Archives: July 2016


Different Types of Custom Surgical Trays

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If you are attempting to do any sort of surgery or even if you just want to hold onto your items and tools, then you absolutely need to think about the best possible surgical trays you can use. Instead of just using medical stock models, then you should be thinking about the following items and possibly using custom trays for your specific operation and practice.

Single Use Procedure Trays

Anyone who needs to use any medical kits on the go or outside of the operating room will quickly come to appreciate any sort of custom trays that can be used and then disposed of. While people may not always want to be in the field, the fact of the matter is accidents and incidents do not show a specific time or place that they occur. Disasters and problems can happen at any given time, and that’s exactly why you should have the single use custom trays available so you can be prepared on the go.

On The Go Kits

When it truly pays to be ready, the custom trays of minor tools are not just something you can use quickly, but they are also something you can conveniently have with you at any time. Custom trays are not just important because they have basic medical kits, they are important because when the time comes for anyone to be able to have immediate medical attention (even if minor), then you want to have a custom set of tools on a surgical tray that are also guaranteed to be sanitary.

Surgical Trays With Stands

While some of the world will use basic trays as they see fit, one of the best options you can actually have on your side is using custom trays with the stands built right in. If you are ever going to be operating on the ground or in an awkward position then you should be fine without one. However, when it comes to the surgical custom trays you can use in an actual operating room, you will most likely be standing and you need to have tools that are supporting with the stands as well.

Perforated Instrument Tray

By having custom trays that not only are instantly accessible but that also have perforations right within the tray, the ability to allow air to breath up and into the tools is one thing, but the ability for any drainage or fluids to exit and fall out of the tray will also help. The last thing you want to do is have a wet surgical instrument, so when you are going to clean surgical equipment you need to have a place for the water and cleaning solution to run to.

Covered and Stackable Trays

Because you want to have many trays available long before the procedure ever even begins (after all, who knows how many trays you will end up using at any given time), you need to have trays that are strong and durable. This strength in your custom trays not only helps you to protect the tools themselves from any sort of debris or contaminants, but the sturdiness will also allow you to stack the custom trays so that they can be protected prior to any given surgery.

At the end of the day, the most important thing you do is choose the right custom trays as well as the right tools for any given surgery. It’s not only important to be prepared for ideal locations, but you also have to deal with the reality that is problems do in fact occur when you least expect them to.

 

Different types of sterilizations for surgical trays


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Methods Of Sterilization


One of the reasons custom trays have become so popular in medicine is because they can be used immediately; they’re pre-packaged and pre-sterilized exactly for this purpose. The world is not always ideal, though; and the proper means of sterilization can be complicated and must be thorough. Meanwhile, custom trays definitely have a high quotient of convenience, and have quickly become a preferred option by a ubiquity of practices. Beyond this method of maintaining operational equipment, the CDC specifies two primary means by which trays become sterilized:

  • Steam Sterilization
  • Flash Sterilization

This writing will give a quick exposition of both sterilization methods, then look at how sterilization in conjunction with custom trays may actually provide the best possible scenario for continuous operations. What good are custom trays if you run out and no shipment is available for a month? Custom trays are convenient and life saving, but unless there is some additional means of support, they can actually end up being a crippling agent in the end.

Steam Sterilization


In a nutshell, steam sterilization is the preferred method. It is environmentally sustainable, clean, and effective. Heat is one of the most trustworthy means of sterilization. Since the heat is moist with steam, it also helps preserve equipment while sterilization is taking place. There’s nothing toxic about steam sterilization, and it is relatively inexpensive considering. Additionally, it kills bad micro-organisms very quickly, and is also able to end spores from molds or fungi. This method also penetrates fabrics without destroying them, and can allow for their sterilization. The only downside is that the process has a history of causing some corrosion as well as lubricant combustion; especially as regards hand pieces used in dental work. It can also reduce light output on some devices, like laryngoscopes. Steam sterilization is accomplished through direct exposure of items requiring sterilization to steam of a requisite temperature to be properly threatening to microbial life. Four main things define this method: pressure, temperature, time, and the steam itself.

Flash Sterilization


Flash sterilization is temperature and pressure. It’s original definition was that an item which has been unwrapped should be kept at one hundred and thirty-two degrees celsius three minutes at between twenty-seven and twenty-eight pounds of pressure. This requires what’s called a gravity displacement sterilizer. Depending on the caliber of sterilizer purchased, and the item being sterilized, time will fluctuate. This process can be very effective, but is complicated and definitely has costs involved which may make custom trays all the more recommendable.

Why Combining All Three Is The Best Approach


Custom trays, steam sterilization and flash sterilization are all great methods of ensuring that your practice remains clean. But if you only have one method or another, you don’t have any kind of protection should the worst come to the worst. What if you don’t use custom trays, and the steam machine breaks? Well, then you’ve got flash sterilization. But what if both machines go on the fritz the same day due to a power surge which causes a fuse shortage that nobody can hunt down for half the day? You could lose lives in such a scenario. That said, if you’ve got custom trays somewhere on the premises, then there’s no issue. But too, you can’t trust solely in custom trays; what if you fun out, or a shipment is late? So, in an ideal world, a medical practice performing surgery is going to use a combination of custom trays, steam sterilization procedures, and flash sterilization procedures. This will allow for the greatest financial retention while incorporating secondary means of necessary support

 

How to create a custom surgical tray

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Considerations

A surgeon’s tray is one of his or her most important tools in operation. Several questions should be asked before you decide on even the proper family of trays you’ll need. This is why custom trays are so popular today. Before customizing yours, ask yourself:

  • What kind of operations is this tray for?
  • What kind of tools are required?
  • Does the tray need to be suspended?
  • What kind of budget are you working with?
  • What sterilization measures are necessary/available?
  • Utility–how comfortable/awkward is the tray? It can’t delay necessary action.

Tray Characteristics

Generally, surgeons are looking for trays that are:

  • Easy to Sterilize: Sometimes surgery must happen extremely fast, and a tray that’s hard to sterilize can lose a life. Ideally, sterilization procedure should be very fast, and very straightforward. Custom trays are more likely to be designed this way than some non-custom options.
  • Sturdy: Custom trays should be strong enough to handle the load of necessary equipment for the operations they’ll be supporting. Whether that load be suspended or lifted up, the tray should accommodate without difficulty.
  • Effective at Consolidating Time: A tray’s weight, dimensions, and features will all help save time. Time is life in medical operations; and without life, there is no money.
  • Well-Manufactured: Whether the tray is a disposable one, or meant for continual reuse, it should be built to withstand not just procedural necessity, but the unpredictable.
  • Disposable Options: Procedure packs and customizable disposable trays have, for quite a while now, been used in surgical proceedings. What these amount to is packages of necessary operation equipment that can be bought in bulk already-sterilized and ready for operation. Both trays and equipment can be acquired this way, saving time and energy in operational preparation and performance. Again, when time is life, expense is tertiary. Though disposable customizable options may be more costly, they will definitely be more effective at helping speedy operations that may save lives.

Dependability of Manufacture and Shipping

When ordering custom trays, be sure to get them from a source which has a solid history of steady, accurate delivery. Medicine is an endlessly necessary function of modern society. As such, the needs of medical facilities increase as the population does. Though shipping, purchasing, and reprisal occur in a cyclic way, there are perpetual demands for equipment; especially of the disposable sterilized variety. As a result, it is not uncommon for custom procedural packs or custom trays to become lost, or mixed up, during shipment. Sometimes custom trays are purchased in bulk, and individually wrapped in a sterilized way containing all necessary operational equipment. But when the first custom trays are opened from the shipment, it is found the items inside do not correspond to the items requisitioned. Such mix-ups are going to be more common among manufacturers who are new to the market, or are perhaps overloaded with clientele. To avoid this, you should order custom trays in dual shipments and keep firm records of contents when they arrive. The better organizations will certainly ship the right items without additional expense to the surgical practice in question. Such errors should not happen, but they are subject to human imperfection, and so they cannot be curtailed; only recognized and planned for.

Reusable Custom Trays

While it is possible to find custom trays that are reusable, and so won’t ever ship with the wrong contents, sterilization can be difficult on-the-fly, and unless some unique system be devised by your practice, will not be something that can be accomplished as quickly as simply opening a pre-sterilized pack. Still, some delicate procedures may require direct reusable customization.

Why is it important to sterilize custom surgical trays

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Saving Lives, Not Losing Them

When surgery is conducted, one of the most important items in maintaining universal sterility is a tray which can be speedily sterilized and utilized. There are several ways to do this, but custom trays are definitely the most recommendable option. Custom trays have the advantage of individualization to match personal procedural ethic, whereas trays that have not been custom-designed may require adjustment, taking time. Time is life in medicine, so this is surely intolerable. Many of the most important medical advancements of the twentieth and twenty-first century involved means of proper sterilization which quantifiable yielded increases in recovery. Custom trays have become increasingly popular, and their effectiveness at facilitating success in operation has been scientifically proven.

The Disposable Option

Sterilizing a tray can be time consuming. Even if there is a process of sterilization which rotates trays on a regular basis such that a steady supply is available, maintaining that sterilization can be a nightmare. It is much easier to sterilize a group of custom trays in a professional manufacturing setting, including all the necessary pieces of equipment the trays will be used to support, and send those trays in bulk to the surgeons that require them. The only downside is expense; but without life, there can be no money. Anything that saves time, and therefore life, will ultimately yield greater monetary support. It may seem an overtly clinical way of examining the situation, but it is nonetheless accurate. Taking too long on a delicate procedure can end a person’s life, just as going to quickly about your business can. When a tray is unreliable, it can increase awkwardness in use, which may be lethal.

Trays Offer Dependable Sterilized Solutions, But Do Have Limitations

Statistically, it is impossible for any operation to operate with one hundred percent accuracy and efficiency. Any statistic, projection, or computer that says otherwise is itself the one percent error hidden from the figure, as there are always existential exigencies that cannot be ignored. With custom trays, sometimes manufacturing companies will send out the wrong items, and the wrong trays. While there are a great variety of medical procedures requiring sterilization and custom trays (read: pretty much all of them), many of those custom trays end up looking the same, and being about the same size. This can lead to confusion on the operating table. Imagine an emergency where a patient is rushed in, you get scrubbed down for surgery, grab your custom tray–and find that it got switched for some dentist’s order one block north of you. It has happened before. The way to guard against this is to order in duplicate, and to ensure your custom trays have been verified in their size, shape, sterilization, and contents before stocking them in your operating areas. The more high-profile the agency producing the custom trays is, the more likely they will deliver shipments without making a mistake. But again, no organization anywhere operates at true one hundred percent efficiency. That said, when a more high-profile maker of custom trays mistakenly delivers the wrong product, they will replace it with the right one free of charge. This is an integral question to ask before you make any bulk orders of custom trays. It doesn’t matter how well-sterilized your operating theater is if you’ve been given the wrong tools to perform a procedure.

Sterility Maintains Vitality

The human body can fight off a number of things, but in a delicate operation, it shouldn’t have to. Get custom trays pre-sterilized and pre-packaged for maximum time retention and applicability, yielding quantifiable success in operation.

What are the guidelines to sterilization in surgical trays?

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Find The Right Sterilization Cycle

A process and cycle of sterilization is integral to preserving ready-to-operate, clean equipment on a perpetual basis. Though custom trays which come pre-packaged are one of the best options for the ensuring of proper sterilization, they can be more expensive; and sometimes a clinic may not be able to absorb the cost, or may have an environmental putsch. As a result, such clinics will usually result to a cyclical procedure of sterilizing those custom trays on the premises which may not be of the disposable variety. Before this cycle is implemented, it must be verified by a vetted agency.

Types of Sterilization

There are several popular types of sterilization procedure employed in the operating theatre.

  • Steam
  • ETO (Ethylene Oxide)
  • Low-Temperature Sterilizers

Custom trays that have been ordered to specification have already been tested before they come to you, but if you are reusing the custom trays you have, you are going to need both chemical and biological indicators to be professionally applied at your installation by an agency designed for the purpose. This usually involves three different “empty” steam cycles wherein both indicators are used to test trays. All cycles used in sterilization receive separate testing.

Facilities of On-Site Sterilization

According to the authorities, there are three primary sections you should have your operating area divided into when it comes to sterilized equipment and custom trays.

  • Decontamination
  • Packaging
  • Sterilization and Storage

The Decontamination Area

This area should be near, but separate. Especially with the decontamination area, this separation should be acute; walls separating it from other areas. Airflow of the decontamination area should direct contaminants away from operating sectors. Recommendations are that air in a decontamination area be changed about every ten minutes, or six times an hour.

The Packaging Area

Next there’s the packaging area. Before a tray is repackaged, it must be properly cleaned with properly treated water that has been verified to ensure sterilized equipment. The same goes for the trays. There are a number of different machines available to help facilitate proper cleaning, and they should also be inspected. Custom trays that can be reused are useless if the machines cleaning them aren’t doing any good. Be sure to leave no stone unturned in this area. Investigators are keen to examine cleaning effectiveness to the microscopic level. They’ve found that even when an implement appears clean on the outside, it may very likely contain hidden microbial life liable to contaminate.

Those Who Clean

Personnel that are working in decontaminating reusable custom trays should also dress appropriately, wearing proper gloves, face masks, attire and goggles. This isn’t just a safety measure for patients that will come “under the knife”, as the expression goes, at a later date. Personnel involved may find they’re in contact with some contagions spoiling for a host. If they’re doing a good job, they will most certainly get some contaminated biological material on them. Without proper protection, it’s likely that an infection will occur.

Sterilized Storage

Custom trays should be contained in rigid boxes according to AAMI guidelines, and those of other professionally-vetted organizations. Any equipment with moving parts should be disassembled during its storage. There are a number of choices in methods of sterility retention, also. They include

  • Rigid Containers
  • Peel-Open Pouches
  • Roll Stock/Reels
  • Sterilization Wraps

When using custom trays that require your own method of sterilized packing, be sure to include:

  • Sterilant Penetration Allowance
  • Contamination Protection During Handling
  • Microbial Penetration Barriers
  • Sterility Retention Post-Sterilization

Ideally, such solutions are easy to use as well. Following these guidelines is a great way to ensure sterility in your practice.

What are the steps to sterilization for surgical trays

According to the Centers for Disease Control and Prevention (CDC), there are four main steps that must be taken to ensure the disinfection and sterilization of surgical instruments and trays.  It is important that these steps be taken in separate and controlled areas designated for each activity by professionals who thoroughly understand the process.

  1. Decontamination: All instruments and trays must be pre-cleaned using water mixed with either detergent or specialized cleaning solution to remove foreign materials before placing them into a mechanical cleaning machine to be washed and dried.  Items should be inspected both visually and microscopically for cleanliness before passing them on to packaging.
  2. Packaging: Once cleaned, items must be packaged in plastic, hard containers, or placed in a surgical tray to maintain the sterilization.
  3. Storage: Instruments and trays should be stored far enough away from the ceiling, floor, and walls to allow for adequate air circulation and ease of monitoring and cleaning.  Items should never be placed in an area where they may become wet as this can contaminate the item or tray with microorganisms from the air or surfaces.
  4. Monitoring: Sterilization should be monitored periodically to test for contamination or failure of sterilization.  This may be accomplished through mechanical monitors like temperature or pressure, chemical indicators sensitive to heat or chemical presence attached to the outside of packaging, or biological indicators that monitor how lethal the sterilization process was to certain spores and infectious materials.