Last quarter, part 1 of this 2-part series spoke to the decontamination phase of reprocessing. Budgeting appropriately for your identified needs and those that are not expected is key to the success of your instrument reprocessing. The focus of this article will be to discuss the budget considerations for sterilization, looking again at labor, utilities, supplies, equipment maintenance, and capital budget planning.
- Labor – One of the most important considerations when it comes to sterilization is having the same consistent and standard ways of performing the tasks necessary to achieve sterilization. If your organization can afford full-time staff member(s) in this area, the organization will benefit from having that dedicated sterile processing tech (or techs). If your Center is ophthalmology only with 2 ORs then one tech should be sufficient. One will have to assess the volume, types of procedures performed, and hours of operation to determine the appropriate staffing levels.A major theme is that in smaller facilities, RNs are cross-trained to perform the duties of processing techs. This approach has positive as well as negative connotations. A positive result is that you will not hire an additional staff member. If using an RN, she/he must be competent, this means that training will be critical. Understanding what is being done and why it is being done is essential as nurses typically do not have a background in processing. Online courses can be one offering but nothing beats an experienced person providing on-the-job education and training. Certification is mandatory in some states but even with this mandate, it is not enough. The staff member whether it be a processing tech, or an RN must be competent. In real-world experience, many certified individuals are not competent, and the result proves this statement. Having dedicated staff can lower your cost of sterilization.The objective is that by providing staff who are competent and provide a consistent approach to sterilization, the organization will have productivity and assurance levels that may not be achieved by rotating an individual into this area. Additionally, minimizing your risk and liability from sterilization issues and failures is worth the cost of hiring a trained, competent employee.
- Utilities – Do you know what it costs to run a sterilization cycle in your facility? If you search the literature you may find examples of what others have determined but proceed with great hesitation. No two facilities are alike. Contract with an independent vendor who does not have a product or service to sell you and who can help quantify and calculate your cost per cycle. Manufacturer representatives use averages and costs are not adjusted to your location. Your utilities do not cost the same as someone in the next city/town.In today’s marketplace, the price of electricity and water has skyrocketed. Seek alternative solutions, for example, many do not understand that during a drying cycle in a full-size steam autoclave, not only are you using electricity to provide the heat to dry your trays and other items in the chamber, but you are also using hundreds of gallons of water for each cycle in this drying phase of the sterilization cycle. Discover the technological advancement in the packaging market that does not require any dry time. It is the responsibility of the user to read and understand the IFU, if not call the manufacturer as opposed to going on a blog site.Water is a critical element in steam sterilization. Most will ask you if you have treated your water. For a long period of time, this referred to whether you had treated your water for hardness. While this is still important, the percentage of dissolved solids is a bigger issue when it comes to your water. Many organizations have had their water tested many years ago and some may never have had their water tested. Few follow AAMI’s TIR 34 (water for reprocessing of medical devices) which recommends quarterly water sampling. When you see that your instruments have become “colorized” or even “multicolored,” this is indicative that you have a water chemistry issue. It is far less expensive to hire a water vendor who can take a water sample, provide the levels of the elements in your water, and suggest what you need to do to bring it into balance than to routinely buy new instruments. Budget with a cushion when it comes to utilities as this is one area of expenses where you will not see a decrease in the foreseeable future.
- Supplies and Consumables – What supplies and soft goods do you use in your sterilization needs? Routine expenses can include wraps, monitoring supplies (biological and chemical), filters, locks, cushions, absorbent liners, autoclave tapes, documentation records, tapes for sterilizers, markers, etc. Take a walk around your processing area and list all the items that you have in this area. Make sure you have the true and actual cost per item by using the latest invoice that you have received for each item. Develop a consistent approach in your methodology to determine the cost to process an item, to name a few:
- Labor: quantify the time to assemble and place in sterilizer (wrap/package, load onto cart or place in the sterilizer, unload, time in handling the biological monitor into the incubator and recording the results). Calculate the most expensive cost per minute of labor, the least cost per minute of labor, and then the average cost per minute of labor.
- Packaging Materials: cost of filters, locks, tray name ID badge, peel pouch, chemical indicators, tape, wrap, marking materials, liners, etc.
- Testing Materials: cost of a Bowie Dick test, chemical indicator(s) used on each item and the biological indicator (is it in a test pack?), and documentation records. Review your sterilization policies and procedures and identify any new technological advancements or substitutions that can be made to better your financial expenses in this area.
- Equipment Maintenance – How many sterilizers do you have in your department? If your answer is only one, you may be testing fate because with one you have no backup. How long can you function without a sterilizer? Do you have enough instrument trays to perform surgery for 2-3 days without your sterilizer? Do you have a maintenance agreement for your sterilizer(s)? with a guaranteed response time? What if the part is not in stock and you must wait an additional day or days for it to ship and arrive? How much risk are you willing to assume? How “happy” will your attendings be or your patients when a sterilization issue shuts down your organization?Besides having a plan for the above with a maintenance contract, what other preventative strategies are being practiced when it comes to your equipment? If your equipment is not cared for per the Instructions for Use (IFU) you can very easily be incurring additional expenses. Always plan for preventative maintenance, quality routine monitoring, and unexpected repairs.
- Capital Budget Planning – Not much different from the decontamination article, in the development of a realistic and timely budget, one must have a good understanding of the sterilization and ancillary equipment that you have already purchased, the useful life of that equipment (what are you basing that on?) and what may be your future needs. A sterilizer is one of the most expensive items that you own. Taking care of it is a must but that may still not keep it from having a major issue. Replace equipment as close to the manufacturer’s guidelines to prevent possible increased costs in other areas. Planning your future replacement will help you manage this capital expense.A budget will contain operational expenditures as well as capital expenditures. There is a further division into fixed costs (costs that do not change in relation to the volume of processing output in the processing area) as well as variable costs (costs that change in relation to the volume of processing output in the processing area). The development of your budget should be an ongoing task. Collect data and identify needs before the actual planning process begins. If this is your first attempt at developing a budget, call a friend. Find someone who has been successful in budget development and learn from the experienced.
Barbara Ann Harmer, MHA, BSN, RN
ASORN Past President
Published in ASORN EyeKnow eNewsletter – March 2023
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