Hospital Sterile Processing - What You Need to Know and How it May Effect Device Performance - Part 1
Nestor Hernandez, CRCST, CHL has 40 years of sterile processing experience in 5 hospital systems, and is the Director of Operation Sterile Processing (SPD) at Lee Health in Fort Myers Florida. Nestor is active in education within SPD community and also consults with medical device companies on issues related to sterile processing. In this episode Nestor shares how he entered SPD, a detailed description of what SPD does, teamwork within the hospital and educating hospital staff, and how to manage hospital acquired infection. This is part 1 of a 2-part conversation.
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Episode Transcript
This transcript was generated using an automated transcription service and is minimally edited. Please forgive the mistakes contained within it.
Patrick Kothe 00:31
Welcome! The hospital Sterile Processing Department or SPD is critical to minimizing hospital acquired infections or HAIs. But many of us who have single use devices don't know anything about it. But But again, some of us work with them daily because our products can actually be used multiple times, I think, surgical instruments. Regardless, the performance of our products are intertwined with the ability of the hospital to provide an environment that discourages infection. One of the risk factors for HAI is his surgical procedures, where exposure to viral bacterial or fungal pathogens can lead to catastrophic consequences. And the SPD plays a crucial role in limiting these pathogens because the medical devices they clean and sterilize directly touched the patient. I think you're really going to enjoy hearing from my guest today Nestor Hernandez, because in addition to his 40 years of sterile processing, department experience and five hospital systems, Nestor is also a great storyteller. And you're going to hear his passion about his profession, and also about personal growth and empowerment. Nestor is the Director of Operations, sterile processing at Lee Health in Fort Myers, Florida. And he's also active in education within the SPD community. And he consults with medical device companies on issues related to sterile processing. This conversation covers a lot of ground so it's broken up into two parts. In his first part, we discuss how he entered SPD. And I think you're really going to enjoy this. And then a detailed description of what SPD does teamwork within the hospital, and the best way to educate the hospital staff and what that means. And then how to manage hospital acquired infection. Here's part one of our conversation. Nestor, welcome to the podcast. So glad you're able to join us.
Nestor Hernandez 02:57
Hi, Pat, how are you? Thank you for the opportunity.
Patrick Kothe 03:00
So Nesta, you've got a really long background in sterile processing, and done a lot of things. But can you take us back to the early days and how you entered into sterile processing,
Nestor Hernandez 03:12
I was around 18 years old, I lived in New York City. And I had this ambition, this dream that when I turned 18, I wanted to leave New York City and I wanted to explore and do something different. I guess like any 18 year old, you know, either you get kicked out of the house by the parents or you make the decision to leave the house, you know, and I had this ambition, this dream. And I think a lot had to do because of the roots of like my mom, my mom was a registered nurse and my aunt so I was surrounded by healthcare professionals. But I didn't know anything about health care profession, you know, you drive by a hospital and you see a beautiful big building and all you think about is nurse, okay, you got to be a nurse to work there or, or you have to be a doctor to work there. But we don't. We don't think about all of those other departments that work together for the success of that organization. And I did exactly that. I packed my bags and say goodbye and I am moved to the state of Florida and had some money saved up but I knew that I needed to get a job. I didn't have a driver's license. I didn't know how to drive at 18. Um, I lived in New York. And living in New York means you get on the bus you get on the train. So then I realized that I needed to learn how to drive a car, but I couldn't afford it. So I got me a bicycle. And I went to the nearest hospital it was like 15 miles away. I saw an ad in the paper that said that we're hiring for the warehouse. And I got dressed up and I made it to the hospital and actually got the bicycle from a Salvation Army made it to the HR department and I remember remember the young lady's face and her name Her name was we're gonna say Gloria and I remember approaching this young lady and telling her I'm here to apply for a position. And I'm in the warehouse and, and it was how she looked at me and, and she kind of moved herself from her desk and kind of brushed me with her hands and told me, We don't have a job for you. So I got back on my bike and, and little did I know that in Florida, it rains all the time, you know, I got soaking wet. And on my way home, I started questioning myself and, and one of the questions was, did I make a mistake? Should I have stayed back home, and listen to my parents. And you know why. And we all go through that in our lives where when something doesn't go the way that we thought, we quickly start questioning our abilities of whether or not I was doing the right thing. The next morning I woke up, and and I still felt like, it was like something was pushing me pushing me and telling me you got to go back. So I didn't have a plan. I didn't have a how to get a sterile processing job for dummies. I didn't have anything like that. All I had was just my mother's voice in my head, you know, come back home, come back home, went back to the Salvation Army. And I got myself a suit I got dressed up. Why was I doing it? I don't know. I was following my instincts. You know, sometimes in life, we got to follow our instincts, because they're not going to lead you wrong. I saw my instinct was telling me go good dress, get back on that bike, take two large trash bags, and take some duct tape, you know, and it wasn't like I wasn't gonna do anything to the young lady in HR. So Pat, I don't want you to think that I was planning to go back and put her in one of those bags. That wasn't my intention. I was just saying, if it rains again, I'm going to create a raincoat.
Patrick Kothe 06:53
By the way, you're 18 years old. What year is this? 1980.
Nestor Hernandez 06:57
So I get on my bike. When I get to the hospital. I started questioning myself. So what are you going to do? I got to talk to somebody. I went inside and I started walking around the lobby. And in the lobby, there was a directory. And I looked at the directory. And it gave me a name of an individual who was the Vice President of Human Resources. And his office was on the fourth floor of this building. And I'm like, wait a minute, that's that young lady's boss, HR HR. So I go up to the fourth floor mind you, and that I was studying to be I was studying mechanical engineering in high school. Before I finished high school, my ambition was I wanted to be an architect. And I had that all in my head. You know, I could look at a room and could tell you the square footage and I could, you know lay out a room and move furniture and tell you it'll fit here to fit there and not all came with my training. So as I'm walking the fourth floor looking for this individual, there's a nameplate with his name on it. Today I don't have a nameplate by the way out of my I'm front of my office in case somebody crazy like me is looking for me. I always say that No, no nameplates in my outside my office. I walked by and I stopped by looked inside and I saw, you know, regular you know, 10 by 12 with a secretary sitting inside and there was an L shaped desk and to the right of the L shape of her desk. There was another entrance that led to an office. So as I'm walking the hallways, I could tell that that was maybe his office. So now I'm preparing myself and I'm telling myself Okay, who is this guy? Is he there? Well, he talked to me what he listened to me what I got arrested today. What am I gonna do? And my instinct told me, he must hear what you have to say. And how you felt yesterday. walked in. As I approached the desk, front of the desk, the young lady looked at me she goes, Hi. How are you? May I help you? And as I would say that half of me the left side of me is having a conversation with her. The right side of me is calculating the square footage the distance between where I'm standing and the entrance to his door. How many steps do I have to take to make it there? And because the L shape right the L shape of her desk, what's going to stop her from stopping me getting in the office.
Patrick Kothe 09:24
But the other part of you? What were you feeling? I mean, this you're an 18 year old kid who are gonna be nervous,
Nestor Hernandez 09:32
not at all. Wow, I grew up being very reserved person, not well spoken kid. I had low self esteem of myself. But to be able to do that and act on that. I kind of felt that it wasn't me. It was that inner voice within me that was ready to speak ready to you know, call out what belong to him, right? So the lady asked me my name. I gave him my name. And she asked me if I had an appointment. Before I even answer I took the seven and a half steps. When I took the seven and a half steps, I was right by the time she went around her desk, she wasn't able to stop me and the VP was in his office, I stepped in. And she said, this gentleman does not. And before she said one word, I took two steps in the office, I introduced myself, I called them by his name appropriately, with a professional tone of voice. And I told them, sir, I'm sorry, but I'm here because I feel that I've been discriminated against the color of my skin. And when he heard me say that, he said, What are you talking about son, and he calls me he called me son. He didn't know my story is that I didn't grow up with a father. Last time I saw my father was five years old. And then when I turned 17, my father shows up to ask for forgiveness. Six months later, my father dies. He drowns. So I never had or, or a thought or heard his voice calling me son for now, here's his VP calling me son, automatically, I felt a connection. He went into his 80s computers, and he looked it up. He goes, You know what, there is a position in the warehouse. Come with me, son, calls me son twice. Now, I want you to think about this scene. You know, the Vice President of HR, you know, what a really nice suit, Nestor Hernandez with a suit from the Salvation Army. You know, I kept thinking, hey, whoever died that donated this suit. Thank you, because I look really good today. That's what I kept saying. And as we're walking through the hallways, you know, and people are saying good morning to him. You know, I'm also saying good morning to these people. I felt like, there was a connection that that was, where everything was going to begin. Well, you could only imagine the face of the young lady when she saw me walking in with her boss. Seven days later, I got the job. I was the happiest person in the world. $3.65 an hour, believe it or not, but I was happy. I was happy on my bike, go to 15 miles one way, 15 miles the other way. And I was content, I was happy. Until one day my boss asked me to deliver parcels toward department call the sterile processing department. I remember walking into that department. And the feeling was like that feeling when you're searching for a home. And you looked at 20 different homes and you walk into this home and you know, this is the house, that was the feeling or the feeling when you're searching for a vehicle, right, and you test drive for five different vehicle. And when you sit in that car and the way it smells the way, the way that chair that seat just wraps around you and you feel like this is the car. That's how I felt about about walking into sterile processing, you know, and I still get emotional about it. Because in my head and in my heart, I go through those emotions of rejections, those those emotions and feelings of not trusting my gut feeling, right? Wanting to give up wanting to say, you know, I'm gonna go based on what others are saying about me, but I fought it. And when I walked into that department, it was like something told me that same voice that was pushing me told me, this is where it all going to begin for you. That's 40 something years ago, there was a job opening and I apply for the sterile processing department. And all of my colleagues were like, You're crazy. You don't want to work for that lady, the manager of the department, she is tough, she is tough, you know, you're not going to do well. I trusted my instinct, and I got the job. And I believe that today because of the following those instincts, and and in going under her wings, I owe it all to her. Right. And to that supernatural power that just motivated me. And then I started growing within the organization. I started like getting thirsty and saying, wait a minute, there's more to this. But besides being a technicians, I could be a lead technician, I get certified. Yeah, I'm gonna get certified as well. Supervisor educator and but then I became the manager of the department. I was there for 17 plus years. And I remember the the VP came to my I call a retirement because I was leaving but he came down he shook my hand and he goes I will never forget that day that you crashed my office. He goes in here you are today. So successful, I wish you the best of luck and, and I moved back to Allentown, Pennsylvania because my mom had moved to Allentown from New York. And my mom was very sick. And I got a job right away in Allentown. And I worked for some amazing companies, St. Luke's Hospital in Allentown, I went to Morristown Memorial and jersey, I went to university hospital, I could tell you a lot of stories about UMDNJ. But all all of those challenges, there, were just there to make me who I am today. And my mom, you know, I thought we were going to lose our mom and my mom this month, we just celebrated her 83rd birthday. Pretty amazing. And here I am today, working for an amazing organization. And it's going very, very well. So to close that circle of life, the organization that I'm working with right now is the same organization that I started my career back in 1980.
Patrick Kothe 16:11
What a what a fantastic story, a story of it's just a story of purpose of resilience. Exactly. resilience, and, and drive. And so you mentioned that this is make you the man you are today. Who are you today, what is what is the man you are today
Nestor Hernandez 16:32
when it comes to my profession, so I'm a director of operation of sterile processing. For a large organization here in Fort Myers, Florida. I have two children. My daughter is 40 years old, and she has a 22 year old grandson, I, my son is 37 years old, and I got three grandchildren, I'm just surrounded by my beautiful children and my grandchildren, I have a passion for what I do. And that is my drive. There's two main reasons why I am driven within this organization, especially when we talk about medical devices, how important those medical devices are, and how important what we do is for the outcome of our patients, because if we don't go through every single process correctly, and tests all of those processes, then we'll have someone like my daughter, 40 years old today fully on disability, she's has had nine surgical procedures in her belly. Some of them did not go well due to medical devices not being clean or use correctly. Okay, then you have my mom at three years old, Mom has had a total of I hope you're ready for this pattern in your audience. A total of 10, right? Total Knee on the same right knee 10 Not one, not two, not three, pretend. Today, Mom, I'm at three still walks around with crutches. And she still has an infection in the metal. And she's been told that as long as the infection doesn't go into her bloodstream. She'll be okay. So what went wrong? Right? What went wrong? Did we cause that the sterile processing department? Did we not examine that instrument correctly? For my daughter, for my mom, for your daughter, for your mom for your uncle's for your significant other than make it to all of these operating room, right with the with the hope that they're going to fully recover with no issues. And here is my mom 50 plus years later, my mom hasn't recover? What has gone wrong. My mom has seen the best of the best in New York City. And Lancaster. I brought her here to Florida. And the best of the best they are saying there's nothing we could do now. Because of osteoporosis. Because of your age. Maybe we should amputate. So what went wrong? What goes wrong? So just when I thought that I want to retire and just when I thought that, you know, maybe I come to Florida in a year or two, just open up a landscaping business and cut some grass because everybody else is doing it. I don't think it's gonna happen Pat because I'm still thinking about somebody is mom like my mom was somebody's daughter, like my daughter, you know,
Patrick Kothe 19:47
unless you're let's let's talk about sterile processing because a lot of people in the audience know that there's some something that happens in the hospital to re sterilize instruments in ER, but they don't understand the breadth of What, what is done in sterile processing, and all of the different places that it touches? So can you explain to us what sterile processing is? What a sterile processing department? Sure.
Nestor Hernandez 20:11
And I think the best way to really understand the sterile processing as let's go into a house, so this is the architect and me, right? Let's go into the house and a house has, you know, has one roof, but under that roof, there's different rooms. So we talked about the operating room procedure ends when the procedure and at point of use, right, this is in the O R, with the O RS staff, that's where sterile processing really begins, right? Removing a bioburden, removing of any fragment bones, maintaining those instruments,
Patrick Kothe 20:50
go back for a second, what is bioburden.
Nestor Hernandez 20:53
So bioburden, could be blood, it could be tissue that's on the instrumentation, it could be bone that's on the instrumentation, micro organism that we can even see it's on the instrumentation. So I point of views during the procedure, when they hand that instrument with physician hands that instrument back to the person who is the scrub tech, you know, that person should be wiping that instrument down, right? With sterile water, nothing else but sterile water. We don't want to use hydrogen peroxide, we don't want to use because that will corrode the stainless steel, the instrumentation, and these instruments are very, very expensive. So sterile water on that back table to maintain those instruments free right from the bioburden or allowing the blood to dry on the instrumentation.
Patrick Kothe 21:45
And why is that important that it's done at that point in time and not just let it kick on and get to start processing?
Nestor Hernandez 21:52
Good question. So just think about if you have 24 operating rooms, and all 24 rooms break at the same time, that's 24 case cards, with probably an average five to seven trays of instruments. And in each tray, it's probably an average of 15 instruments 15 instruments to probably 125 instruments. So now I'm in the decontamination room. That is room number one in my house, right? It's the decontamination room, these instruments, then these case cards come to my room, I could only work one card at a time. And if there's two technicians, we got 24 cards come in. All right, let's just say half, let's say 50. That's a 12 cards come in, I could only work one card at a time. Right, the other technician works one I work the other one, we got 10 case cards left with an average of seven trays in each. By the time I get to probably the fourth car cart. If the Oh war did not start the point of views cleaning and or spraying them with an enzymatic spray to keep the instruments moist. Or they could take a towel, soak it in sterile water and place the towel right over the instrumentation. If they don't do that par By the time I get to that case card that blood is drying. So now it's gonna take me longer soaking time to breathe so that the enzyme and my detergent could start dislodging right the micro organism that now it's attached to that instrument and attacking the stainless steel. It's not the whole total different world that we don't see, but it exists. And that blood could actually damage the instrumentation. corroding right, creating crevices what micro organism organism bacteria is going to live. Anything that's serrated, you know, now it's going to take more time for me to brush brush, brush, brush brush. So on a normal day when I get a trade in deaqon and by that time I do my soaking, socking brushing, that's all hand washing. before it goes through a mechanical washer. Then the mechanical work now we got to open every single instrument so that every part of that instrument gets cleaned. If they're suctions Fraser suction, yank our suction, anything that it's open we have to with a syringe flush flush, manually flush to make sure that we're removing whatever's inside of the instrument. Then it goes through a mechanical washer. From there we go to the My next room, which is tray assembly and inspection. In that room that technician Grab that tray and begin to inspect every single tray for want to make sure there's no blood, make sure there's no tissue, make sure it's functioning, make sure the scissors are sharp, make sure your Karason run doors are working correctly. Everything works out fine. Then we set up our tray for sterilization.
Patrick Kothe 25:23
So Nesta, when you say a tray, about how many instruments are in a tray, depending
Nestor Hernandez 25:29
so it could be if it's an ancillary cause we also serve as our number one customers the operating room, but we also service 3040 50 other ancillary department like radiology, the emergency room, the ER could have a laceration tray with six instruments in it. But the O ARCU have a vascular trio a craniotomy tray, with 150 200 instruments in there, every single instrument has to be touch inspected, make sure that they are again, a functioning opening closed that the Ratchet is holding, and then inspect anything like the suctions to make sure that they're clean.
Patrick Kothe 26:12
So these trays, if you've got however many 150 however many pieces that are in there, they're not individually wrapped. Those are those are in a tray in a tray, that tray is wrapped.
Nestor Hernandez 26:26
That's correct, they're in a basket, and then that basket goes inside of a container for sterilization. Okay, or it gets wrapped with a CS blue wrap, right, which is a two ply RAM. Now we go to the next room in the next room is the sterilization room. In that room, there's two methods that we commonly use, we use steam, right, it's the cheapest way to kill micro organism, as long as you can hold that temperature for the amount of minutes of exposure. And your standard is 270 degrees Fahrenheit, right for four minutes exposure and 3040 or 50 minutes dry time. It all depends on the IFU. Alright, and we all talk about IFU. And I'm gonna be very honest with you, you know, some if fuse. If we go back to the first room, the decontamination room like when we talking about and robotic and Da Vinci robotic instrumentation in just a hand washing part alone before it goes into the Sonic, that's 10 steps in the IFU that you have to follow. Soak it for 30 minutes. Brush if for so much time, you know and so on and so on. So I'm trying to at the end, give view a on a standard everything is going smoothly. How long is it going to take from the moment that tray arrives in deaqon to the moment is ready to be used again. Right? So let's go back to room three, right that is the sterilization. There the technician is trained to know, do I put this tray and an autoclave and you steam to kill the micro organism? Or do I take this tray and put it in a low temperature sterilizer because not everything could go in an autoclave. So when you think about a collana scope, when you think about a flask of flexible scope, you can put that in an autoclave, because that's $25,000 damage. So, how do we get the same result at the end of the sterilization process the IFU says you can put it in a sterile unit right a low temperature sterilizer. So we have to differentiate while packing the tray the into indicators, right we put indicator strips and side of the tray. So for low temperatures a different integrator than it is for the steam, right. So the technician is trained to understand all of that when the process is fully fully completed for Steam, when the process is done, the items are still hot, sometimes 110 degrees Fahrenheit, we have to allow it to cool and every site is very different depending on air circulation depending on you know high vac systems in the department. For us, we don't release it until it reaches 73 degrees Fahrenheit and how do we know well we have a temperature gun, right and for Ray light and tells us the temperature. So from let's not say the point of views but by the time that tray makes it to Deacon and goes through all those steps, tray assembling and goes through all of those steps sterilization And then cooldown time, we're talking at least four hours for one training. So when the O R says I need this turn around right away, please stat, this, it's important that we sterile processing, share this knowledge with the operating room because they have no idea what it takes for us to turn around, you know, a tray and have it available for them that has met all of those criterias you can't release a when it's hot. Because when the moment they take that hot tray and take it to the operating room, and they put it on the back table, that it's not like 60 degrees, condensation right away. Right? It gets wet. And if there's water, you can use it, that the sign that there may be some bacteria. They're
Patrick Kothe 30:53
such a detailed process. And it's one that companies I'm sure don't understand. But also people within the hospital don't understand, like you said, stat, you know, I need I need my instruments. I've got a I've got a patient that's that's on the table here. I need it. Don't you have? Don't you have some spare stock up there? You know, can't you just processes? Can't you just just, you know, flash this and get it down here? Right, right. So imagine you're getting that question constantly. So yeah, how? How do you educate? Let's say stay within the hospital? How do you educate the hospital staff?
Nestor Hernandez 31:28
Good? Good. I love that question. Because we know back in the 80s, it's like, we couldn't figure out how to educate because we were learning ourselves. But one of the things that I initiated up north was share the knowledge, share the knowledge. So I work with the director of the operating room, and I was willing to share the knowledge. So every new nurse, and certainly new surgical tech that works, that that's gonna start in the operating room part of the orientation as I need them for three days in sterile processing. That became a really big positive turning around the expectation of what they thought they knew. And then on top of that, we also started connecting with the director, Medical Director, you know, to have the physicians, I want the physicians to give me one hour of their time. And, and the chief was a good friend of mine, my daughter actually worked for him for many years. And we had a great relationship. So when he became the chief, I made an appointment with him, and I needed for him to stop by and he did, and he gave me an hour and a half of his time. And I what I do is they spend time in the con, when it's an O R employee, they'll spend an entire day in T con. So they go understand our frustration, why is it important that when you're done a point of view that you do your job number one, and that you unlock all of those instruments, because otherwise I'm gonna have to add to those four hours, maybe another hour and a half if I have to unlock all of those instruments. So with with the staff, they spent an entire day in deaqon. And then they spent an entire day in Tray assembly and then they spend another day in sterilization. With the physicians, what we did was just give me an hour, an hour and a half. And it's just walking through the department explaining detail by detail how we do our job. By the time whether as an employer as a colleague or a physician, at the end, they all looked at each other and they all said the same thing. I just walked in the O R and everything was in there, already set up. Had no idea that you guys had to do all of this. In the operating room. surgical tech that was hired for surgical tech had to come and work in sterile processing for at least three to six months before they could step into their role as a surgical tech and I put together a really nice PowerPoint presentation call that you know sharing the knowledge understanding especially micro organism and how it works understanding when we do sterile a sterilization running biologicals. You know, why do we because the question was, but how do you know that this stuff is clean? How do you know that the machines are doing their job? How do you know that the sterilized Okay, so the external indicator change colors. When I opened it, the internal indicated the little strip that changes colors, change colors, but how do we know that the micro organism, it's dead? So and that was a great opportunity for teaching. So we run with every load. It's not a recommendation, or it's not a standard mandated that you run a biological with every load but we run it with every load and what it's a biological biologically, it's like a deck of cards, and sandwiched inside of that deck of cards. It's a spore inside of a plastic tube, right. And that spore is geo Brasilia stereo thermophilus. Right? Very difficult to kill. The sport is so intelligent, that when it detects heat, it creates a shield around itself doesn't want to be eliminated. So when we put this pack that is wrapped in the sterilizer, with all of those instruments, the steam has to penetrate through the deck of cards, the steam has to penetrate through an internal integrator, and then penetrate through the plastic, get through the shield of the sport to eliminate the sport. It's pretty amazing. So now when the load is done, we removed the pack, open the pack, let it cool down for 10 minutes, take the spore and then crush it, put it in the incubator. And nowadays, thank god to technology in 24 minutes, we have a result, if there is a growth in the bacteria, or did we kill the bacteria or the spore, if there's growth, then that load, it doesn't get released that load then the process has to start all over again. We test our washers as well. So in the mornings, with every luck with the first load of the day, every rack we put test strips in there, what are we testing temperature, we're testing to make sure that the spindles right are working, they're not clock that the enzyme mix pH levels are correct. We test the Sonics as well to make sure that the Sonics are work. So every piece of equipment in a sterile processing department, there are tests out there for us to make to ensure that our equipment is functionable.
Patrick Kothe 37:05
So Nestor, you talked about the tragedy that infections can play your mother, your daughter, just some some tragic situations. But infections can be caused a lot of different things when you're in surgery or in the hospital, it could be surgical technique, it could be something that happened on the surgical field and or could be, could be the instrument. So the the purpose, I believe, of the sterile processing department is to ultimately decrease
Nestor Hernandez 37:34
infection. That is correct. That is correct.
Patrick Kothe 37:37
So how do you measure success in the department, when you have other factors that are that are contributing to infection? So I'm assuming an infection happens and the the finger gets pointed at the surgeon? And the surgeon has to determine what it is? How do you how do you as a department play within that, to assure that you're being measured correctly, and your portion of the puzzles, so to speak is correct.
Nestor Hernandez 38:12
So what we do is so one of the things that I've learned in my Korea is to create a relationship with the infection prevention department. They understand that better than I do, they really do understand, you know, the, the world of micro organism and bacterias and spores and how do they survive? And what environment so we bring them in their expertise them, right to help us understand that. So when we have a situation where, you know, someone got an infection, they get involved, and they assess everything, they assess the patient. And sometimes we discovered that the patient came in with that infection. And it's not necessarily that the patient got the infection when they were on the back table, or because of an instrument but we look at everything. We look at EBS and their process, right environmental services and their process. Are we cleaning the rooms, are we turning them around? Are we turning them too quick and we're skipping certain steps. So they look at that they look at air flows in the operating room, they look at temperatures. So they do all of these assessments. You know are there is there on the back table was that back table clean? They look at the anesthesia card you know, are we taping you know signs that are not laminated so because the tape go harbor bacteria and so on and so on and then we come to sterile processing. They spend a lot more time in sterile processing and then what they do and all the other departments they Also look at the unit where the patient came from, at the unit the patient went to. But when they come to sterile processing, they really spend a lot of time. So we're looking at the IFU. Are we following the iFuse? We have to show them proof of sterile, that the product was sterilized. So how do we know that the product was sterilized? Well, we know about the printout, the printer will tell you if we met the parameters. Number one, we look at the results of the biological, we look at the external and internal integrators did they change. So now what we doing the, the company where I'm working at right now, what we're doing is we're actually doing quality testing. So we're using a swab tests. To test to verify right, it's called verify, actually from stairs. And, and we're doing workstations we're doing keyboard, we are doing robotic instrumentation, doing protein check, robotic instrumentation, and we're monitoring 30 per month, the rubber mats, instrumentation handles, I mean, you name it. So we collect all of this data. And when we have a situation like that, we're able to demonstrate that, at least on our part, we cover all our bases. And if we discovered that something went wrong, so it becomes a learning experience, and then new processes would have to be implemented.
Patrick Kothe 41:41
I told you, you're gonna enjoy this one. Nestor really has a gift for taking inside his world, and explaining not only what they do in that world, but more importantly, why a few of my takeaways, first of all nesters Why, what's his why? When you listen to him, explain how he got into the business. And then the experience that is that he had with his mother and his daughter, and how that is impacted their lives, and how he's personalized that into the SPD department. That's a pretty strong why. And it's really impressive that he has dedicated his career to being able to do this correctly, to protect not only his family, but ours as well. Then there's the how, and he clearly understands his craft, when you listen to everything that he talks about, and how he educates people that his 40 years of experience really comes through and he's dedicated himself to this. And he really understands the how you do this properly, and how it what what they do impacts the total patient patient experience when a patient comes into the hospital. And then the last thing is his passion. So his Why is how and his passion. And it's clear that he's passionate about this business, it's clear that he understands what his role is, and how it can impact patient care. So he's like, he's really passionate about this. And you also heard it right from the start, when he identified as he said, what's rightfully his, and going after it. That's the intensity. That's the passion. And that's what's carried him through all of these 40 years. So make sure that you listen to part two of this, this interview, where we're going to get into what companies can do to help make sterile processing better, what reps should and shouldn't do when working with SPD and if you're a rep, make sure you tune in for this one, and also the future of sterile process. Thank you for listening. Make sure you get episodes downloaded to your device automatically by liking or subscribing to the mastering medical device podcast wherever you get your podcasts. Also, please spread the word and tell a friend or two to listen to the mastering medical device podcast as interviews like today's can help you become a more effective medical device leader. Work hard. Be kind
