Hospital Sterile Processing - What You Need to Know and How it May Effect Device Performance with Nestor Hernandez - Part 2
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 who works in the SPD, what training, education and certifications are required, what devices should and shouldn’t be processed though SPD, what vendors should do to build a relationship, what the best reps do that others don’t, how to communicate with an upset surgeon who is in surgery, and the future of SPD. This is part 2 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! This is a second part of my conversation with Nestor Hernandez. What we're talking about is understanding the hospital sterile processing department and how we in medical device can best help and support them, and also work alongside them to assure optimal patient care. If you haven't listened to part one, make sure you do so as it contains detailed information on what SPD is all about. And what they do and what happens if they don't do it well, to review, Nestor has been in sterile processing for over 40 years and has experienced in five hospital systems. He's currently Director of Operations, sterile processing at Lee health in Fort Myers, Florida. In the second part of our conversation, we discuss who works in the SPD, what training education and certifications are required, what devices shouldn't shouldn't be processed through SPD, what vendors should do to build a relationship, what the best reps do, and others don't in relation to SPD. How to communicate with upset surgeon who's in surgery. And then we get to the future of SPD. Here's part two of our conversation. That's it, let's let's talk about the people and as well as the department. So in 40 years, I'm sure you've seen things evolve, but 40 years ago is probably the department's down the basement and nobody knew anybody that worked there. And it was kind of a black hole for people within the hospital. And but I think that that's has been changing over over the years. So talk to me a little bit about where the departments are, why it's important to be where they are, and and what type of people are working in the department. So Nestor Hernandez 02:39 back me at the bar was very low of who's sterile processing department is. And you know, you always wonder why is it the sterile processing is done in the basement? Why you always ask yourself that question, why are we oh, how come we're not up there on the seventh floor next to the operating room is because of the steam line, the boilers are down in the basement. Right? So those lines is a lot cheaper to run those line to sterile processing right than to have to run a map seven a flies by the time he gets up there, you lose of the quality right of that steam, right? So back in the days, you know, sterile processing was just, there was really no no knowledge, people had no idea of who we were, what were we doing. But today is totally different. Today, there's we've worked so hard, especially with the two organizations that certify our technicians cbspd. And now it was called ation before and now it's healthcare that we're processing association. So January 1, you know, pick us up organizations like these, that have made the education piece of it available to all of us, and are raising the bar. So the bar was here back in the 80s. The bar is high, the standard too high. People now have an idea of the importance of what we do. And I think the respect that we deserve as an as an organ as a department within an organization. It's finally where it needs to be we now have and I say this, you know, jokingly, we now have colors on our walls. You know, I am one manager then when I get to a new hospital, they always have you know, black and white color was you know, I like to splash colors on the walls, put some blue, put yellow, put orange, splash some colors on the wall. And let's invite so how do we do that? Where are we today? Right with sterile processing. And how do we raise that bar? How do we share that knowledge? The RingCentral service we one of the things that I did in the past was open the department up to my clients. Right we have back home we have 40 people as ancillary departments, we will send invitations out during the second week of October, which is center service we and have an open house, have them come have them kind of tour that department so that they know exactly, you know, what is it that we do, every time that we will put a trade together for ancillary department, we will put a little thank you card with a picture of our staff saying thank you for entrusting us to take care of your instrumentation. And and then we got a little smarter one year and we set up we did like a mock TiECon mock assembly and a mock sterilization area. And we set up right outside of the cafeteria. And in the hospital, where I work, it was huge. And and we just had the employees or gown up and PPE put catch up on the instrumentation, so people could understand what is it that we do you know, I remember this one kid, you know, brings open for the public to to see. And this one kid came by and oh my god and Martin the mom goes like, is that blood? And the kid goes nah, Mom, that's ketchup, can you smell it? That's how you share, share the knowledge and today we have technicians that are are certifying, you know, we encourage certification. I myself, I've been teaching the prep course for CRC st technician for the last nine years. And I'm considering you know, coming back to doing that, because I want to empower these folks, some of these folks come with no experience right out of high school. Some people just want a career change. They've been working for company X for so many years, and they want something different. So they come to our department, we hire them with no experience. And they start as a non certified technician. And then we provide all of the experience orientation is around a good 10 to 15 weeks before you feel comfortable and understand. Because again, they have to go through every room, right of our house of sterile processing every single room and understand step by step. And then once they at least complete 400 hours of clinical hours. And then we get them the books. And if they want to do a sit in a classroom setting, we do that as well and prepare them to sit and take the the their exam, the CRC st, which is a certified register center service technician. Patrick Kothe 07:43 Well, it's great to see the knowledge really increase in that area. Because obviously it's a it's a critical area for performance of, of surgery, performance of patient care. So most of our listeners work in the medical device industry and and they're very interested in doing things properly as well. So let's talk you mentioned about I refuse, so instructions for use for different devices. So let's kind of start with which devices are good candidates for sterile processing, and which ones are bad. And I'll give you just an example. Back Back in the 80s, I was selling cardiac catheters, coronary catheters for for for coronary catheterization. And these these were 15 $20 devices. And I remember I was shocked when a 15 $20 device that was getting reprocessed at one of the largest cardiac centers in the world. And I walked in, I go, Wait a second, you got this 15 $20 device and you're processing it, it doesn't make it doesn't it doesn't sound like a good deal here. So in today's in today's environment, what's a good candidate for a device? And what's a bad candidate for a device? Nestor Hernandez 09:00 Ah, ah, I don't know that I could answer that question without putting out a name. You know. Let me just say if the item is single use, it should be single use. So I get a lot of people like my ancillary departments that want us to continue reprocessing Pakistan and instruments. And I totally refuse to reprocess Pakistan and instruments, you know, don't be because Patrick Kothe 09:30 because they're labeling says it's a single, Nestor Hernandez 09:33 single use device. And it's a single use device and it's a single use device. I worked for a company for a hospital that wanted us to sterilize our combs. You can't sterilize come up, but we've been doing it for so many years, but you can. I had a physician that wanted me to sterilize X rays. He was doing wound care. So what he would do is he would take the x ray He will have it cut out, give it to us, and then want us to clean it, peel pouches sterilize it, and have a ready for him for his next case, you can do that. feeding tubes, right, they wanted us to, you know, reprocess feeding tube stop being cheap, you know, spend the money, because at the end of the day, you know, we cannot reprocess feeding tubes. So those are the really, really bad bad ones that there's organizations there that are still doing that, because it's all about saving money, they're not thinking about the final outcome of the patient, Patrick Kothe 10:35 and are you really saving money when it takes four hours from exactly start to Nestor Hernandez 10:39 finish, you're not saving money, because if that patient ends up having an infection, right, and we can come back and prove that it was that instrument that was reprocessed, and we should not have reprocess it, you're done, your lawsuit is going to cost you a lot more than to buy combs that are already sterilized. The other thing was practice swabs in GYN. They wanted us to sterilize the practice, you can sterilize practice, just by them already sterilized an orthopedic, ace bandages, you can sterilize the ace bandages. So that's, those are the really bad, bad example. But today, we still see that I do some consultants on the side, and I would go into a hospital and I was like, I can't believe you guys are sterilizing, you know, so then my recommendation was, here's the manufacturer number for you to buy this product already sterile instead of reprocessing instrument. And then we have these instruments, that according to the IFU, we can reprocess, you know, 1520 times my personal opinion, when we follow the IFU. For this specific product, they need to simplify this a little bit more. Because right now we're having to post up on the wall step by step, but there's no way that we're going to remember, you know, 30,000 different IFU. So now we're having to put workstations with computers in the decontamination room with the IFU is there for you already. So when you get the tray, you scan the tray, click on the iFuse. And now you got to read the IFU, to make sure that you're following those IFU step by step, because they are all so different. So on, some of them have 1520 25 different steps. So the manufacturer of this medical devices, my advice, before you start manufacturing, or creating this great idea of this product, spend some time in sterile processing, connect with us, you know, especially if they don't have any experience in relation to what sterile processing is, they're only looking at it from a functional standpoint, at the point of views, but not thinking about the turnaround time to clean these instruments to inspect these instruments. So give us a call talk to us, if you got this great idea, bring us into a round table so that we could give you some advice. I'm working with a few companies right now that are creating some really exciting new devices that are coming. And they're from Germany. And they flown down from Germany, Germany several times for the last three years, just to spend two hours to bring the product. Okay, this is what we did test it. Why don't we try this, let's change this. They go back home a year later. It's been three years in the making, and they're still working on that same device. See, that's a company that really wants to be able to release a product that's going to meet everybody's need. Patrick Kothe 13:52 Everybody's needs not just patients, not just the RN, but everyone. Everyone's very interesting. So the other thing that I was curious about is so you've got an instrument that has an IFU that has cleaning instructions and reprocessing and instructions for it, but it's the same instrument that's an instrument that's in the same tray. How do you deal with that? I mean, because you know, one, one may say, you follow this process and other may say follow that process. Nestor Hernandez 14:23 So what's very important from a sterile processing standpoint, when creating this department, right? And when putting together these trays, stick to one vendor, when you have a tray that has a mix of different vendors, you have Jared you have escalada you have V Mueller, and you have all of these instruments mixing this pan and they all have for the most part the IFU as far as sterilization, it's the same is really isn't that complicated, but those specialty instruments that are in there, you know, require extra attention. And if you have no knowledge of that IFU, you're going to damage those instrumentation or process them incorrectly. The other thing that we do Pat, as we bring the vendors in, so we spoke about physicians, we spoke about new hires, I also worked with the vendors, I asked the vendors to come in, I asked your vendors, you know, don't just come in here and sell me something, let's create a relationship that it's so important. So for those vendors, right, that are listening, they're trying to move this medical devices, it's all about creating a relationship with the sterile processing department, those two organizations that I mentioned, right, the H s. P A, right, we used to be a sham, and CBS, they have a certification just for vendors as well. So my recommendation is get on board, right, be at our level, you know, take the course get certified, you know, come into sterile processing and do the clinical hours, create a relationship with that department, not just with the physician, not just with the operating staff, but also with us to sterile processing department, and by you spending time with us. And yes, we love donut. Yes, their incentive service week, you know, acknowledge what we do. You know, and I gotta say this, but during Nurses Week, these vendors go all out. Physicians go all out when a center servers, we got a bag, hey, can you sponsor us, we got a bag, that means you haven't spent enough time to create a relationship with us. But you know that you need us, the O R needs us. It's like a carpenter, or carpenters not able to do his or her job, unless they have the right tools. And they in their hand, you go to Home Depot, and you go to the hardware, you're going to find seven 810, probably more different hammers, why they all serve a different purpose. They get handled differently. But if I don't put that right hammer on the hands of that carpenter for the job that he or she is doing, they're not going to be successful. So I think about the same way with instrumentation, we're not going to have all our running ords was shut down. If I didn't say to take 20 for my employee, and let's just shut it down and boycott this place. Yeah, don't get, you know, people to come in there, before a week or two weeks, you're gonna lose a lot of money, right? Because we need each other to be successful. Patrick Kothe 17:50 Well, there's another group that is also needed. And relationships are extremely important as well. And that sales representatives, especially our sales representatives, who may have Orthopaedics products that have trays that need to be sterilized, and in many instances, you know, the hospital doesn't own these trays, there's the company owns the trays, and the trays get moved around from place to place to place, and then you need to come in for the surgery. So the sales rep will need to interface with with you as well. So talk to me about how that works, and how it works well. And when it doesn't work. Well, why, Nestor Hernandez 18:34 again, it starts with the relationship establishing relationship, right? It starts with a good policy, right, creating a policy and procedure for vendor trays, right? Not, not trades that are on consignment that live on our show, we don't owe them but they live on our show. But vendor trade, like you say, Pat that come in just for a specific case. And it's fully all the instruments are there. And we want to make sure that when they come and pick them up, if they come and pick them up, that all of their instrumentation is there. So it started with a good policy and procedure to hold them accountable. 48 hours before the case those instruments must come in when the instrument arrived. That's a lot of different technical ways to take pictures of the trays, create, you know a list of what you received and put up the different processes you can put in place. But the vendor has to be part of that process. And then there's different ways of identifying that those trays or vendor trays. When the trays are done, the trays get clean, the trays get picked up and then we give them 24 hours to pick them up. You don't pick them up within 24 hours according to the policy. We put them in a FedEx box and put a sticker Return to Sender at your expense and we ship it right back to you. But for that that has to be managed right? You have to really Create positions, employees who just deal with that, because that is a full time job, especially if you're doing a lot of orthopedics, we had a physician, no joking, that he will bring in 75 Plus trays just for one procedure, he had a backup for a backup for backup. One day, he had 126 trays for just one procedure, a backup for a backup for a backup. Patrick Kothe 20:30 And I imagine, in his trays, he had, you know, maybe had 5050 devices on there, and he probably only use three. Nestor Hernandez 20:37 Exactly. So out of the I remember that one data 75 He used 12 Out of the 126, he probably use 15. So when you think about a price that you put per tray, and I did an entire investigation, we were looking at almost $107 per tray. So what I wanted to do was to charge back to the O R or to the vendor, you know, per tray that was not used. But you made us go through all of that work. And then before they left, they pop every single wrap, remove all our towels, we pay six to nine cents per towel. And every indicator integrator that was between, you know, three to four cents to nine cents if they had the extender was nine cents. So I will collect all that stuff and then start putting together a PowerPoint to start to bring awareness of the expenses, you know, has a change. It's gotten better, but we're not there yet. 100%. Patrick Kothe 21:45 So what are the what are the good sales reps do and what are the bad sales reps, do Nestor Hernandez 21:50 the good ones, they're buyers donors they supported me now the good one, they spend time in our department, they show interest when especially trays that I have implants, you know, at the end of the procedure, they restock their own trays. So now when the tray comes through the washer, the tray is fully stocked, oh, they'll say wash it, let us sit and then we'll come down and we'll inspect the entire tray to make sure that everything is in there because it's your trade. Those are the good guys that really spend time the the ones that really acknowledge your efforts and not necessarily were doughnuts and all that stuff because nowadays, you know, they do that they get in trouble we all get in trouble unless it's an in service you know, we can bring your doughnuts unless we have an in service right and I totally understand that right. But they spend time just words of affirmation, you know, just acknowledging and saying thank you or being available when we need them right being available all of a sudden now the doctor's calling procedures change the doctors calling for different tray calling them I'll be there and X amount of time or sharing the knowledge and saying hey you know what Nestor tell the physician that he could use this tray, this tray in that tray, combining those three trades, you'll have everything that that we that we need for the case, right being part of the team decision critical thinking because they're the ones who have that knowledge not us. All right. Another thing that I really appreciate with some of our vendors as the end services that they provide to our employees, or they fly them to their company so our employees could see the manufacturing of these instruments and and how they work right. Bringing us picture so those are the good good sales rep. You know, do a good vendor that spend time the ones that I don't want to use the word bad as the ones that do the total opposite of the good guys you know, I don't have time or you know, hours go by and the instrument is still sitting there and you call them they don't answer the phones where are they? Oh, I had to go to another hospital leave those trays sitting there come back tonight in the morning you come in the trades are still sitting there and now all of a sudden we have an add on and I have to give an explanation. Why Dr. So and So who did a case yesterday eight o'clock in the morning and not today. The next day at two o'clock the trades are still sitting downstairs not sterile. Patrick Kothe 24:39 And I imagine there's some blame game that goes on as well. And I imagine the the poor representatives are saying Geez You know like yeah, maybe maybe I didn't deliver it on time but he's gonna blame sterile processing for not not doing it Nestor Hernandez 24:53 and most of the time you know, I get the phone call nesto Dr. So and So wants to see you in the room. Okay, so I go in my room. In the room, and I stand there where I know I need to stand. That is not the place for you to argue with a physician or to justify why that tray is I learned that, trust me at the beginning, I will stand there. And I will say, Well, we did talk to the sales rep, blah, blah, he doesn't want to hear that I had a doctor throw a scissor at me because I spoke back to him. And it was like The Matrix. You know, I mean, this matte scissor was coming straight at me straight to my face. And I saw it in slow motion. And I just ducked the scissor, hit the hit hit the wall, it broke into little pieces. And I told him, are you done? I told him, we'll talk about this later. For right now, please take care of the patient. And I learned I learned to not respond what was justifiable at that time, the doctor does not want to hear that. And so I've learned to walk in. And yes, sir, may I help you listen to what he has to say. And then tell them that you will look into it, and you will follow even though you know the answer, but that's not the time to share that answer. And then later on, send an email and say, based on our conversation, apologize on our behalf, and then give them the details, right, of what really occur. And I've learned that that's how you also establish relationship with physicians, and within with your sales rep, it's a learning experience, you know, Patrick Kothe 26:19 the whole thing is, we're all part of this process, we're all part of the result of the surgery and dealing with patients. It's the surgeon, it's the staff that's in the ER, it's the sterile processing department, it's it's the company with with the product and the IFU is it's a sales reps, we all have a piece of this in delivering good patient care. Mm hmm. So Nestor, thank you so much for enlightening us on what goes on within sterile processing and the importance of sterile processing, kind of look into the future. What do you see being the future of sterile processing and where it needs to go in relation to medical device and delivering great patient care? Nestor Hernandez 27:10 Wow, that's, that's a really good question. I think the future of sterile processing has to revolve with better patient outcome. And how do we get there? With get there by continuing to establish a better relationship between sterile processing in the operating room. equipment that can provide the same outcome, but faster. So when you think about an incubator, when we back in the days, we put a biologic on an incubator and is 72 hours before you can have a result. So what do you do? Do you hold a load for 72 hours now. And nowadays, in 23 minutes, we have a results. So that's a big improvement. We've had, we have washers now, that went from almost 15 minutes, you know, completion time to 23 minutes, and have the same outcome. And that's what I want to see. I want to see sterilizers, that will give us the same outcome, but faster, we could do them. And for that, we need to stop thinking how we thought before. But at the end of the day, we could have all of this in place. But if we don't have the right people in the right jobs, we're not going to have the outcome that we want. Like for my daughter, all the outcome that we want, like for my mom, right? So we could have all of this good medical devices created machines. But if we don't have the passion. So going back to my story, let's end this by going back to my story. You know, I am here today because that was something that was growing within me like a baby in a womb that wanted to be delivered, you know, and wanted to grow. And there was something inside of me and I didn't understand what that was at 18 years old. A kid that lived, you know, Brooklyn, with a single mom, with two siblings living out of the system. But we were content, whether it was just white rice and some and fried eggs, but we weren't content. But there was an instinct that pushed me to believe that there was something better out there. I wanted to Make a difference. I want to remember when Mom, my mom told me um, what why do you want to go and, and go to this place that you don't even know, and and why you want to work in a hospital when you're studying to be an architect and I told my mom, when I grow up, I always wanted to be like you in the health care. But I didn't have to be a nurse, I didn't have to be a doctor, my mom thought that I was going to be a doctor. And I'm not. We need people that are passionate about what they do. When that tray, it's in the very first room deaqon And you're handling it, you're thinking about my mom, you're thinking about my daughter, you're thinking about that patient, if I don't brush this, right? When you're doing that the VINCI arms, I don't feel like like soaking it for 30 minutes, I'm gonna do 15 minutes, nobody is looking. When we're going to run it in the washer, and everything in that load. It's a mix implantable and non implantable. And you just want to go on ahead and run it through a regular instrument cycle that has a lubricant in there. That's taken a shortcut, because you don't want to put it in the orthopedic, right, that doesn't have the lubricants cycle in there, because it takes too long. You on the other room, the assembly room, and you're doing the same thing. And you don't want to pick up the 150 instruments that are in there, you just got to go through it and looks good. You don't pick up those suctions, you don't open you don't inspect every single scissor. See we're taking shortcut. When we have instruments that go to the next room into the autoclave, and it tells you you have to expose it for 15 minutes or 30 Dry time and you put it together with a four minute cycle. That's taking a shortcut. So we could have all of this equipment in place. But if you don't have the drive, you said that word. And that's a good word, Pat, you don't have that drive. If you don't have that passion that makes you stop and say no. Necessary nesters mama's on their table or somebodies mom, oh, my mother, because you could be working in not knowing. You know, I had an employee that got a phone call, a phone call, and the phone call that she got. And she came in my office crying. And that was that her husband was now on that table fighting for his life, automobile accident on the way to work. And he did not survive. Right. So now all of a sudden that patient became a husband. So the future of SPD that starts with people filled with passion, people understanding what we do people following the iFuse and not taking any shortcuts. Because the final outcome, we want it to be positive. And that's what I see as far as the future. Yeah, do we want faster machines that we want better technology? Yeah, we want all that. But it's gonna be up to me to press the right button. Right, it's gonna be up to me to to follow those right and get certified get educated. I tell a lot of my employees when they come in, and I see the resume, I know they're not going to be with me for too long. They want to be a surgical tech. But they want to come to sterile processing. I'm really good. I want you to come here. Even if you only going to give me two years. I have people that have taken my course of nine years that are all over the United States. We still stay in contact supervisors, managers, lead technicians, because they tap into that knowledge and today, their success. It's because somebody believed in me like that manager that all of my colleagues told me, You're crazy, you know, but she believed in me. That's the future of sterile processing. And we got to keep that alive that way. Patrick Kothe 34:09 I hope you enjoyed this conversation with Nesta as much as I did, and like me, are a little bit more educated on what SPD does and how important they are a few of my takeaways. First training, you'll Nesta described what his staff go through how important training and certification is to the people that work in SPD but extends that out to the O our staff and physicians and also to US companies and reps who are also involved in this process. The second thing is respect. And it's a simple thing to give. But when it's not there, it says volumes about you as a person, and as a result, your company. So creating the relationship, as Nestor talked about is very important to make sure that those people are on your side, and are not adversaries. It's so simple as Nestor said, acknowledge what we do, acknowledge our efforts, use words of affirmation, so simple, yet so powerful. And the final thing is, it was locked up in his final message. And he talked about technology improvement is great. That's a way to we're bringing technology we're bringing technology to different people. And that's fantastic. And that's really a great thing to be able to do. But technology work without the drive and passion of the people who are implementing that technology is not going to get it done. Thank you for listening. Make sure you get episodes downloaded to your device automatically by following the mastering medical device podcast wherever you get your podcast. Also, please spread the word and tell a friend or 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
