Sterile success at Royal Inland
There are plenty of smiling faces in the basement of Royal Inland Hospital these days — something that wasn’t too common about two years ago.
That was when the hospital was mired in a controversy about unsterile equipment making its way into operating rooms, with surgeons refusing to proceed.
Letters were sent to 9,000 patients who had endoscopies, advising them they may have been exposed to less-than-sterile equipment.
Hospital administrator Marg Brown said those days were stressful for everyone because the staff was doing the best job it could with equipment that was likely state-of-the-art when the hospital was built, but had become inadequate for the demands of the 21st century.
Fast forward through the months — and through the $10.7 million spent on a new medical-device reprocessing (MDR) unit — and there is more equipment doing a better job in an area redesigned to accommodate the workflow.
And, Brown added, employees are not tripping over each other as they do their jobs.
MDR lead technician Gail Melnyk agrees.
From the new wireless-communications system they use to stay in touch with each other to the doubling of key sterilizing units to simply having better lighting to do their work, the new MDR, she said, “is fabulous.”
It’s a daunting job handling every tool a doctor may need for an operation, Melynk said.
Some surgeries can require up to 200 tools and each must be sterilized, checked, packaged and ready to be sent up for use.
It’s a time-consuming, but essential job, she said, noting there is a logic in how the process is set up.
There’s the “dirty” side, which is completely separate from the “clean” side.
Washers between the two areas are used to sterilize carts, trays and other equipment.
Even medical supplies that are sent in a sterile package — with some unique tools, hospitals share their resources — must be sterilized again.
With each step, documentation must be recorded.
The journey a simple brush takes from arriving in the MDR to being packaged for use in an operation could lead to several notations of the process required to ensure its sterility exists and has been verified visually and through the bar-code system used.
“Every piece of equipment and machine has documentation that is kept on it, too,” Brown said. “And the staff signs for everything used.”
The hospital is one of the first to use new autoclaves — sterilizers that work with pressurized steam — that are designed for smaller spaces, Brown said.
There is also one small autoclave designed for the truly specialized instruments that are not needed in bulk.
Using it avoids tying up a larger unit that could be busy sterilizing other tools.
“Our equipment in this hospital runs,” Melnyk said of the MDR.
“It runs and runs and runs.”
While the action happens in the basement, what happens upstairs in the former intensive-care and step-down units is also key.
That’s where equipment that will be needed is stored, waiting for the night staff to fill the various orders and get them ready for sterilization and to be used the next day, MDR supervisor Paulette Meier said.
It’s also where the calls go when something is needed, but not included in the kits sent to the ER and operating rooms for procedures.
“All we need to know is who the doctor is asking for it and we know what to get,” Meier said, noting most specialists have their own preferred methods of doing procedures.
They also need to know if the procedure is being done on an adult or child because size matters.
Brown said the new equipment and renovations not only provide a work environment she calls incredible, but it all helps restore public faith that was shaken when news of the sterilization issues became public.
“Technology is a lot of money,” she said, “but the investment was well worth it because it’s our guarantee for the public.”
Moving Royal Inland into the future
While she’s delighted with the new medical-device reprocessing unit, Marg Brown has another reason to be happy.
In the past 18 months, about 30 doctors have joined Royal Inland Hospital staff, including five family practitioners and plenty of specialists.
It hasn’t necessarily boosted the staff by that number, though; there have been some leave but, even in those situations, things have been good, the hospital administrator said.
She noted, for example, a neurosurgeon retired and was replaced by two in that specialty.
It wasn’t always so, with RIH putting a concerted effort into doctor recruitment for years.
“We haven’t seen any lack of interest when we’re looking for physicians,” Brown said. “We get a fair amount of interest.”
Brown said the process has also changed for the better in the way potential doctors are screened and interviewed.
One change at RIH that has helped, she said, is appointing a chief of staff, something the hospital has not had for years. Dr. David Sanden has taken on that job and has helped hospital administration identify areas where the need is greatest.
Sanden is also involved in recruitment and said one priority is to hire with an eye for sustainability as the hospital moves forward.
That future includes plenty more construction as the hospital prepares to build a new parkade and clinical space for outpatient programs, Brown said.
The structure will add 350 parking spaces to the hospital and two levels for outpatient services — “nothing where you need a recovery room,” Brown said —with a walkway connecting it to the second floor. There’s also potential for retail space on the first floor and the fifth floor will hold rooms used by the University of British Columbia medical-school program at RIH.
It’s all part of moving RIH into the future, she said — and she’s delighted with how the work is proceeding.
“We do lots of good in this hospital.”