orthopaedic screw ‘banks’

[Anonymous]

Can I learn from others about how you have managed these please? Has anyone got data on screw breakages?

[ We have a large number of screw banks in use. These get replenished with new screws to replace those used. And so most of these screws go through an undocumented series of sterilisation cycles.

Clear concerns include:

a) The new screws have instructions for use that preclude resterilisation

b) The AS4187 says we should track all reprocessed material like this and not reprocess ad infinitum

c) That structural integrity of the screw is compromised (might be associated with breakages in patient ) There may be other deleterious changes to the material as well.

The alternative to banks is dispensing individual screws as required by each case. Other countries have mandated such. More expensive – we are getting resistance to change!

Thanks
John
Dr John Ferguson MBBS DTM&H FRACP FRCPA
Director, Infection Prevention Service | Hunter New England Local Health District
John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
T: 61 2 49214444 | F: 61 2 49214440 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf
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[Louise Christine Grant]

Dear John,
I would also be interested to hear what other hospitals are doing with their screw banks.
I have similar concerns about what damage continual resterilisations does to the screws and plates and the lack of traceability that results.
Another concern of mine is how clean are these screw containers? They are usually not unassembled when they are put through the washer disinfectors.

With screw breakages, there is also the skill of the person driving the screw.

From my many years of experience as a perioperative nurse, on most occasions the surgeon and or trainee know what size screw they want with sufficient timing for the circulating nurse to open a sterile screw and not delay the surgical procedure at all.

Regards

Louise Grant PhD Cand, MCl Sc(Periop)
Project Consultant Reprocessing Compliance
Top End Health Service | Northern Territory Government
Room 221, Building 4, Royal Darwin Hospital,
Rocklands Drive, Tiwi NT 0810 | PO Box 41326 Casuarina NT 0811
t 08 8944 8005 | m 0404 491 183 | e Louise.Grant@nt.gov.au | http://www.health.nt.gov.au

TEHS Vision: Building Better Care | Better Health | Better Communities Together
TEHS Values: Trust and Teamwork | Excellence and Equity | Honesty and Accountability | Service and Innovation

Can I learn from others about how you have managed these please? Has anyone got data on screw breakages?

[ We have a large number of screw banks in use. These get replenished with new screws to replace those used. And so most of these screws go through an undocumented series of sterilisation cycles.

Clear concerns include:

a) The new screws have instructions for use that preclude resterilisation

b) The AS4187 says we should track all reprocessed material like this and not reprocess ad infinitum

c) That structural integrity of the screw is compromised (might be associated with breakages in patient ) There may be other deleterious changes to the material as well.

The alternative to banks is dispensing individual screws as required by each case. Other countries have mandated such. More expensive – we are getting resistance to change!

Thanks
John
Dr John Ferguson MBBS DTM&H FRACP FRCPA
Director, Infection Prevention Service | Hunter New England Local Health District
John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
T: 61 2 49214444 | F: 61 2 49214440 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf
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[Anonymous]

John,

This is a challenge for us all. We (fortunately) had agreement by Surgery, to transition from screw banks to sterile single use implants. This was agreed to back when the gap analysis was undertaken at the end of 2016. This still created a number of new challenges, predominately around space for storage of the implants. To help spread the costs out, we did this over two to three years. We have managed to transition about 90% of the systems from when we started.

This has not completely removed the problem as we have discovered that there are still a number of screw banks and other implant systems that do not have sterile single use available. I can send you a list of these systems outside of this group as per the group policy.

We have received varying feedback from some of these company reps. Some companies are denying all knowledge of the need to have sterile single use available, which I find hard to believe. Others identify limitations, as the implants are manufactured overseas and they have no control with how they are supplied. I believe this is an opportunity for us all to collectively apply pressure to change this situation.

The good news, is that these sets are limited to our “infrequent use” trauma sets. I have been advised that some of these sets are also on the “outdated” side. While the surgeons prefer to use the newer systems, they like to have the “just in case” fallback position available.

I have asked the staff in the operating theatres to explore this further. We are currently looking at ways that we can record the manufacturer’s batch/lot number in the tray list, as this is part of the intent of the Standard (as below). We do have limitations with the electronic tracking system we have in place. As you have identified, this does not mitigate the risk potentially compromising the structural integrity of the implant. Another suggestion is to reprocess all of these items into individual packages with the required information.

I would be interested to know what others sites are doing as well. I have absolutely no data on implant breakages from screw banks. Anecdotally, the staff recently advised me that when the sets are opened for stocktakes by the vendor, they have noted “colour changes” to some of the implants! I have asked for more information!

[cid:image001.jpg@01D5CADC.D0B3FC50]

I hope this helps.

Kind regards

Mandy Davidson
RN; GCert Inf Pre & Cont; MPHTM; Cert III Sterilisation; Cert IV TAE; Immunisation cred; CICP-A
Clinical Nurse Consultant – 4187 Implementation project
Infection Prevention & Control

[cid:image001.png@01D3A192.E1513890]
T
07 4433 1873 | 0402 987 432
E
Mandy.Davidson@health.qld.gov.au
W
http://www.health.qld.gov.au/townsville

Townsville Hospital and Health Service
100 Angus Smith Drive, Douglas, QLD 4814
[Facebook-Icon] [Twitter-Icon] [Linkedin-Icon]
Townsville Hospital and Health Service acknowledges the Traditional Owners of the land, and pays respect to Elders past, present and future.

Can I learn from others about how you have managed these please? Has anyone got data on screw breakages?

[ We have a large number of screw banks in use. These get replenished with new screws to replace those used. And so most of these screws go through an undocumented series of sterilisation cycles.

Clear concerns include:

1. The new screws have instructions for use that preclude resterilisation
2. The AS4187 says we should track all reprocessed material like this and not reprocess ad infinitum
3. That structural integrity of the screw is compromised (might be associated with breakages in patient ) There may be other deleterious changes to the material as well.

The alternative to banks is dispensing individual screws as required by each case. Other countries have mandated such. More expensive – we are getting resistance to change!

Thanks
John
Dr John Ferguson MBBS DTM&H FRACP FRCPA
Director, Infection Prevention Service | Hunter New England Local Health District
John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
T: 61 2 49214444 | F: 61 2 49214440 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf
Mon
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[Anonymous]

Hi John,

I read your post with great interest and glad someone is raising this issue!

In my facility, I tried very hard to mandate individually packaged screws and I gave the companies 18 months to comply.
I continued to harass the company reps on a weekly basis and constantly requested to know where they were up to with my bid to do away with screw banks.

There was major resistance to change initially, probably more so from the surgeons than the nursing staff, but with time everyone learns to adjust.
I am pleased with the progress we have been able to make in a short period of time. Although we are not entirely where we would like to be, we have certainly come along way given the high amount of screw banks we previously had. 3 years on, we still have further progress to make and I won’t stop until we get to where we need to be.

One issue I probably didn’t address (or think about initially) was the need to have extra storage space when converting from screw banks to individually packaged screws however I have found the major companies are able to provide great storage solutions for these products (mobile towers on wheels).

I fully understand the concerns you have raised in regards to the reprocessing of screws, traceability issues and matters pertaining to the integrity of the screws and the increased risk of breakages among other risks. These are the exact reasons why I started on my venture to making a change.

I am aware that other countries have mandated the use of individually packaged screws and struggle to comprehend that Australia has not yet been able to achieve this. As an industry, we need to take a strong stance on this issue, stand up to these companies and demand a better service. I think a national approach on this issue would definitely assist in getting change to happen as we are way behind the rest of the world.

I would be interested to know how others in the industry feel about making a change.

Kind regards,

Darren Martin | CSD Manager | Acute Health
PO Box 126 Bendigo Victoria 3552
03 5454 7184
0409 900 682
darren.martin@bendigohealth.org.au
http://www.bendigohealth.org.au
http://www.bendigohealthfoundation.org.au
[Vision statement]

Bendigo Health would like to acknowledge the Traditional Custodians of the land and pay our respects to Elders past, present and emerging.
[cid:image002.jpg@01D5CAE6.693AD5D0]

Can I learn from others about how you have managed these please? Has anyone got data on screw breakages?

[ We have a large number of screw banks in use. These get replenished with new screws to replace those used. And so most of these screws go through an undocumented series of sterilisation cycles.

Clear concerns include:

a) The new screws have instructions for use that preclude resterilisation

b) The AS4187 says we should track all reprocessed material like this and not reprocess ad infinitum

c) That structural integrity of the screw is compromised (might be associated with breakages in patient ) There may be other deleterious changes to the material as well.

The alternative to banks is dispensing individual screws as required by each case. Other countries have mandated such. More expensive – we are getting resistance to change!

Thanks
John
Dr John Ferguson MBBS DTM&H FRACP FRCPA
Director, Infection Prevention Service | Hunter New England Local Health District
John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
T: 61 2 49214444 | F: 61 2 49214440 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf
Mon

Tues

Wed

Thurs

Fri

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x

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[cid:image005.png@01D41F3E.1B59CB50]

[cid:image002.png@01D5CAC7.3FE0AFD0]

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[kerrin Maher]

Hi,
I am also following this with great interest. This issue has been raised and muted as being a risk however it appears to have lost momentum. This forum has reminded me to raise it again.

Kind regards
Kerrin

Kerrin Maher RN BN
Nurse Unit Manager | Central Sterilising Department
QEll Jubilee Hospital | Metro South Health
Kessels Road QLD 4108
t. 07 31826151
e. kerrin.maher@health.qld.gov.au

Hi John,

I read your post with great interest and glad someone is raising this issue!

In my facility, I tried very hard to mandate individually packaged screws and I gave the companies 18 months to comply.
I continued to harass the company reps on a weekly basis and constantly requested to know where they were up to with my bid to do away with screw banks.

There was major resistance to change initially, probably more so from the surgeons than the nursing staff, but with time everyone learns to adjust.
I am pleased with the progress we have been able to make in a short period of time. Although we are not entirely where we would like to be, we have certainly come along way given the high amount of screw banks we previously had. 3 years on, we still have further progress to make and I won’t stop until we get to where we need to be.

One issue I probably didn’t address (or think about initially) was the need to have extra storage space when converting from screw banks to individually packaged screws however I have found the major companies are able to provide great storage solutions for these products (mobile towers on wheels).

I fully understand the concerns you have raised in regards to the reprocessing of screws, traceability issues and matters pertaining to the integrity of the screws and the increased risk of breakages among other risks. These are the exact reasons why I started on my venture to making a change.

I am aware that other countries have mandated the use of individually packaged screws and struggle to comprehend that Australia has not yet been able to achieve this. As an industry, we need to take a strong stance on this issue, stand up to these companies and demand a better service. I think a national approach on this issue would definitely assist in getting change to happen as we are way behind the rest of the world.

I would be interested to know how others in the industry feel about making a change.

Kind regards,

Darren Martin | CSD Manager | Acute Health
PO Box 126 Bendigo Victoria 3552
03 5454 7184
0409 900 682
darren.martin@bendigohealth.org.au
http://www.bendigohealth.org.au
http://www.bendigohealthfoundation.org.au
[Vision statement]
Bendigo Health would like to acknowledge the Traditional Custodians of the land and pay our respects to Elders past, present and emerging.
[cid:image002.jpg@01D5CAE6.693AD5D0]

Can I learn from others about how you have managed these please? Has anyone got data on screw breakages?

[ We have a large number of screw banks in use. These get replenished with new screws to replace those used. And so most of these screws go through an undocumented series of sterilisation cycles.

Clear concerns include:

1. The new screws have instructions for use that preclude resterilisation
2. The AS4187 says we should track all reprocessed material like this and not reprocess ad infinitum
3. That structural integrity of the screw is compromised (might be associated with breakages in patient ) There may be other deleterious changes to the material as well.

The alternative to banks is dispensing individual screws as required by each case. Other countries have mandated such. More expensive – we are getting resistance to change!

Thanks
John
Dr John Ferguson MBBS DTM&H FRACP FRCPA
Director, Infection Prevention Service | Hunter New England Local Health District
John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
T: 61 2 49214444 | F: 61 2 49214440 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf
Mon
Tues
Wed
Thurs
Fri
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[cid:image005.png@01D41F3E.1B59CB50]
x
[cid:image005.png@01D41F3E.1B59CB50]
[cid:image005.png@01D41F3E.1B59CB50]
[cid:image002.png@01D5CAC7.3FE0AFD0]

This message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it and notify the sender.

Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
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[Lesley Alway]

Dear John, issue of importance and being reviewed in many domains I know Terry Mcauley has conducted considerable research and presented papers on this unacceptable practice. Perhaps ask Terry to provide feedback
Regards
Lesley Alway
SHR

Lesley Alway
Strategic Health Resources
0408324727

> On 14 Jan 2020, at 10:42 am, John Ferguson (Hunter New England LHD) wrote:
>
> Can I learn from others about how you have managed these please? Has anyone got data on screw breakages?
>
>
> [ We have a large number of screw banks in use. These get replenished with new screws to replace those used. And so most of these screws go through an undocumented series of sterilisation cycles.
>
> Clear concerns include:
> a) The new screws have instructions for use that preclude resterilisation
> b) The AS4187 says we should track all reprocessed material like this and not reprocess ad infinitum
> c) That structural integrity of the screw is compromised (might be associated with breakages in patient ) There may be other deleterious changes to the material as well.
>
> The alternative to banks is dispensing individual screws as required by each case. Other countries have mandated such. More expensive we are getting resistance to change!
>
> Thanks
> John
> Dr John Ferguson MBBS DTM&H FRACP FRCPA
> Director, Infection Prevention Service | Hunter New England Local Health District
> John Hunter Hospital, Locked Bag 1, Newcastle Mail Centre, NSW 2310, Australia
> T: 61 2 49214444 | F: 61 2 49214440 | M: +61(0)428 885573 (Speed Dial 67607) | Tw @mdjkf
> Mon
> Tues
> Wed
> Thurs
> Fri
>
>
> x
>
>
>
>
>
>
>
> This message is intended for the addressee named and may contain confidential information. If you are not the intended recipient, please delete it and notify the sender.
>
> Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.
>
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MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.

The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

Archive of all messages are available at http://aicalist.org.au/archives – registration and login required.

Replies to this message will be directed back to the list. To create a new message send an email to acipclist@acipc.org.au

To send a message to the list administrator send an email to admin@acipc.org.au

You can unsubscribe manually from this list by sending ‘signoff acipclist’ (without the quotes) to listserv@aicalist.org.au

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