Surgical Packs Research Articles

Solutions for Reducing Perioperative Supply Waste.

Health care costs continue to increase in the United States, and unused perioperative supplies can contribute to both these costs and increased waste. Reducing perioperative waste can decrease hospital costs and promote sustainability. Perioperative leaders can consider a variety of solutions to decrease unused perioperative supplies, including streamlining and standardizing surgical packs, implementing surgeon scorecards and a surgical receipt system, and updating surgeon preference cards. The available literature does not provide data on waste reduction for all listed solutions; however, these initiatives have had positive financial effects for hospitals through either direct cost reduction or cost avoidance. Although the cost of implementation may vary among hospitals, streamlining surgical packs (including custom packs) appears to be an effective solution with a lower cost than other strategies, and avoids the wasting of opened supplies that are not needed.

Anesthesia and Operating Room Waste Management

Introduction Operating rooms (ORs) are associated with high waste generation that contribute significantly to the overall hospital waste production, costs, and environmental impact. Hence, this study sought to explore the impact of the revision of single-use surgical packs in waste reduction and hospital cost savings. Methods A systematic review with meta-analysis was conducted to assess waste reduction strategies in operating rooms. A search was conducted on databases to evaluate the impacts of interventions on anesthesia waste reduction and cost savings. The search was limited to studies conducted between 2014 and 2024. Results The findings of the systematic review indicate that the revision of single-use surgical packs was associated with significant reductions in OR and anesthesia waste production and hospital costs. Conclusion The findings show that waste reduction initiatives could be effective in enhancing the sustainability of surgical procedures. The study underscores the role of simple but sustainable practices in addressing persistent environmental and financial challenges in the healthcare sector.

Interventions to Reduce Surgical Waste Burden: A Systematic Review.

Operating suites are significant drivers of waste, pollution, and costs. Surgeons can help fight the climate crisis by implementing innovative strategies aimed at mitigating the environmental impact of surgical procedures and decreasing operational costs, and moving toward a more sustainable healthcare system. This study aims to review the literature describing interventions that reduce surgical waste. PubMed, Cochrane, and Embase were searched. Studies reporting interventions to reduce operative waste, including emissions, energy, trash, and other, were included. Case reports, opinion-based reports, reviews, and meta-analyses were excluded. Study quality was rated using MINORS and Jadad scales. Data were extracted from each study to calculate waste on a per case basis. Narrative review of studies was performed rather than meta-analysis. The search yielded 675 unique hits, of which 13 (level of evidence: I-III) met inclusion criteria. Included studies were categorized by intervention type in relation to the operating and procedure room. Three studies evaluated provider education initiatives, three evaluated setup of instruments, two evaluated single-use items, four evaluated technique changes, and one evaluated surgical venue. Seven studies reported significant reductions in disposable surgical waste throughput, and seven reported significant reductions in cost. The results of this systemic review demonstrated the effectiveness of surgical waste reduction initiatives in reducing waste volume, cost, and carbon emissions. Within plastic surgery, minimal surgical packs resulted in reduced gross waste and cost while promoting patient satisfaction in hand surgery, supporting the continued development and implementation of such initiatives in a surgical context.

Eco-sustainability in ophthalmology.

The purpose of this review is to evaluate the current state of eco-sustainability in ophthalmology, highlighting key practices, recent advancements, and areas requiring improvement. This review aims to provide ophthalmologists with a comprehensive overview of sustainable practices that can reduce environmental impact. Recent studies have identified several areas within ophthalmology where sustainable practices can be implemented including multidose eyedrops, adjusting surgical packs, making package inserts available electronically, and reusing surgical instruments. Moreover, there is an increasing emphasis on waste reduction both in the surgical and clinical setting, by decreasing the use of unnecessary materials and implementing more efficient use of recycling programs. Telemedicine has also emerged as a sustainable option, reducing the carbon footprint associated with patient travel. Despite these advancements, significant challenges remain, particularly in balancing the cost and accessibility of sustainable options with traditional practices. Eco-sustainability in ophthalmology is gaining momentum as the medical community aims to reduce its environmental impact. While progress has been made, further efforts are required to overcome financial and logistical barriers to widespread implementation. Continued research, education, and policy development are essential to advancing eco-sustainable practices, ensuring that environmental considerations become an integral part of ophthalmic care.

Implementing the Use of Surgical Packs to Minimize Waste and Improve Productivity.

Implementing the Use of Surgical Packs to Minimize Waste and Improve Productivity.

Opening Sterile Surgical Packs

Welcome to our Basic Skills for the OR Series! Complete series includes: Scalpels Surgical Sutures Surgical Staplers Opening Sterile Surgical Packs Opening Sterile Surgical Instrument Containers Laparoscopic Instruments

Reducing Disposable Surgical Items: Decreasing Environmental Impact and Costs at a Children's Hospital, a Pilot Study

IntroductionUnited States landfill waste generated in the operating room (OR) is estimated to be three billion tons per year. The goal of this study was to analyze the environmental and fiscal impact of right-sizing surgical supplies at a medium-sized children's hospital using lean methodology to reduce physical waste generated in the operating room. MethodsA multidisciplinary task force was created to reduce waste in the OR of an academic children's hospital. A single-center case study, proof-of-concept, and scalability analysis of operative waste reduction was performed. Surgical packs were identified as a target. Pack utilization was monitored during an initial pilot analysis for 12 d then followed by a focused 3-week period, capturing all unused items by participating surgical services. Items discarded in more than 85% of cases were excluded in subsequent preformed packs. ResultsPilot review identified 46 items in 113 procedures for removal from surgical packs. Subsequent 3-week analysis focusing on two surgical services, and 359 procedures identified a potential $1,111.88 savings with elimination of minimally used items. Over 1 y, removal of all minimally used items from seven surgical services diverted two tons of plastic landfill waste, saved $27,503 in surgical pack acquisition-costs, and prevented the theoretical loss of $13,824 in wasted supplies. Additional purchasing analysis has resulted in another $70,000 of savings through supply chain streamlining. Application of this process nationally could prevent >6000 tons of waste in the United States per year. ConclusionsApplication of a simple iterative process to reduce waste in the OR can result in substantial waste diversion and cost savings. Broad adoption of such a process to reduce OR waste could greatly reduce the environmental impact of surgical care.

Comprehensive Custom-Pak® in Cataract and Vitreoretinal Surgery in Canadian Hospitals: Time and Budget Impact Analysis.

Surgical procedure packs are commonly used in ophthalmological surgeries, but quantitative evidence demonstrating the time efficiency and economic impact of their use is limited. Evaluating the time and cost of surgical pack use is particularly important for publicly funded healthcare systems with tight budgets and/or an emphasis on value-based care. This study sought to estimate the economic impact of comprehensive surgical pack use in cataract and vitreoretinal (retina) surgeries across operating room (OR), materials management, and accounting departments in Canada. A budget impact model developed for the United States (US) from a self-reported cross-sectional study was adapted for Canada. The US study obtained data via an online survey and timing exercises of surgical procedures. The model was adapted using relevant Canadian-specific labor and cost inputs. Use of generic commodity packs (no proprietary equipment-specific supplies) was compared to full utilization of Custom-Pak®, a comprehensive pack (disposables plus equipment-specific supplies) in cataract and retina surgeries at the facility and aggregate group (provincewide) levels. Switching from generic to comprehensive pack use in all 2500 cataract procedures at a community hospital saves 287 labor hours per year, primarily in the materials management department. Surgery preparation (OR) hours saved allow for an additional 196 potential procedures annually. Most of the Canadian Dollar (CAD) $39,815 annual cost savings are realized for the OR. Aggregating across 50,000 cataract surgeries at the provincial level yields savings of 5608 hours and 3916 additional procedures, translating to hidden cost reductions of CAD$790,632 annually. Implementing full Custom-Pak use at the facility level in 1000 retina cases saves $10,650 annually; provincewide, 127 potential additional procedures can be gained. Comprehensive Custom-Pak use improves efficiency in cataract and retina surgeries saving substantial time and cost in Canadian hospitals, potentially allowing more patients to have these procedures, and reducing wait times.

SG-APSIC1130: Zero wet pack Pimporn Sirikraiwattanawong, Thailand

Objectives: We noted moisture in Thompson retractor sets after steam sterilization in our hospital. Moisture can cause severe problems leading to potentially contaminated instruments that carry infection risk to patients and cause procedure delays, wasted time and effort, greater workload, and higher costs. We sought to reduce the number of retractor sets with moisture to zero. Methods: The central sterile supply (CSS) team discussed the cause of the problem. We hypothesized that temperature difference between the sterilizer chamber and inside the container might create condensation and thus moisture in the final surgical set. We collected and analyzed data and proposed an experiment to improve the sterilization process. We performed a trial of sterilization process improvements pertaining to proper loading technique and the packaging process. We also evaluated the appropriate drying time for rigid containers. We then rearranged the process and adjusted the cooling time from 30 to 60 minutes after steaming. Results: Moisture in Thompson retractor packs occurred because of thicker, rigid containers. We removed the previous type of lining material to separately steam the rigid surgical instrument, and we extended the cooling time to 60 minutes. We updated standard operation procedures and continued to monitor and re-evaluate the process. Conclusions: We identified the primary cause of moisture in Thompson retractor sets after steam sterilization. We illustrated that avoiding sterilizer overload, avoiding contact with fabric wrapping materials, and proper cooling time kept the pack moisture free. Occurrences of moisture in surgical packs after sterilization should be reported and handled efficiently by CSS personnel to preserve quality and avoid waste.

Application of healthcare failure mode and effect analysis in controlling surgical instrument packaging defects

Surgical instrument packaging defects may affect the safety of medical care and patients and waste the hospital workforce, material resources, and financial resources. This study explored the application of healthcare failure mode and effect analysis in controlling surgical instrument packaging defects. We retrospectively evaluated the packaging process of 183,642 surgical instruments packaged in our hospital during January–June 2020 using the healthcare failure mode and effect analysis. Besides, we used a decision tree model to determine the steps requiring improvement and formulate the improvement measures. We applied the improvement measures to 190,231 surgical instrument packs packaged in our hospital during July–December 2020. Based on the healthcare failure mode and effect analysis, we compared the packaging defect rates before and after adopting the improvement measures. Of the 183,642 packs selected before adopting the improvement measures, 98 defects occurred, with a defect rate of 0.053%. However, of the 190,231 packs selected after adopting the improvement measures, 22 defects occurred, with a defect rate of 0.012%. The defect rate of surgical instrument packaging handled by the central sterile supply department staff was significantly reduced (χ2 = 50.822, P = 0.001) after adopting the improvement measures. Using the medical failure mode and effect analysis method to control the defects in surgical instrument packaging can effectively reduce the packaging defect rate, ensuring patient safety.

Economic Impact Analysis of Custom Pak® on Cataract and Vitreoretinal Surgery in the United States.

Implicit costs of surgical preparation and materials management for cataract/anterior segment and retinal/posterior segment procedures are often unquantified. Use of ophthalmological surgical procedure packs is common in these surgeries; however, there is little in the literature demonstrating their time and cost impacts. Understanding the costs and potential benefits of surgical pack procedure use is important for administrators in purchasing decision-making. The objective of this study is to estimate the economic impact of Alcon Custom Pak® on cataract and vitreoretinal (retina) surgery in hospitals and ambulatory surgical centers (ASCs) across operating room (OR), materials management, and accounting departments. We conducted a study in 2019 among US hospitals and ASCs using an online survey and a surgery timing exercise. Surgical technicians and supply chain managers were surveyed regarding current cataract and retina surgery practices including OR, materials management, and accounting tasks. Surgical technicians timed cataract and retina surgeries, recording activity timestamps and surgical supply use from Alcon Custom Pak and other sources. Using the survey and timing exercise inputs and literature and government sources, we developed a budget impact model (BIM) to quantify hidden costs of time and labor spent across the entire surgery supply life cycle. Representing a geographical mix of 99 facilities, surgical technicians (56 cataract/46 retina) and supply chain managers (23 cataract/24 retina) provided data for their institutions. Technicians timed 290 cataract and 250 retina surgeries. In the BIM, increasing baseline Custom Pak utilization to 100% of surgeries while also sourcing all relevant supplies from Custom Pak results in annual cost savings ranging from $92,273 to $217,675 across procedure type and setting, allowing for between 75 (retina ASC) and 266 (cataract hospital) potential additional procedures per facility/year. This study demonstrates that increasing Custom Pak usage can potentially save time, reduce hidden costs, and increase throughput.

The impact of waste reduction in general surgery operating rooms

IntroductionOperating rooms are responsible for a significant burden of waste and negative environmental impact. This study aimed to reduce OR waste and improve both environmental impact and hospital cost savings. MethodsThe unused items in two standard single-use surgical packs were tracked for general surgery cases. A new pack was created excluding the most frequently unused items. The feasibility of the new pack was then tested, and a projected cost savings analysis was performed. ResultsA total of 35 general surgery operations were tracked using two standard packs ($89.51 or $93.68 per case, each 23.2 lbs). The new pack ($46.88 per case, 20.8 lbs) was then successfully used in nine cases. The projected cost-savings of substituting the new pack was $45,719 annually with a 2437 pounds annual waste reduction. ConclusionsSimple and feasible adjustments to standard single-use surgical packs can have a significant impact on waste reduction and cost-savings.

Environmental Sustainability in Orthopaedic Surgery.

Climate change has been increasingly recognized in the healthcare sector over recent years, with global implications in infrastructure, economics, and public health. As a result, a growing field of study examines the role of healthcare in contributing to environmental sustainability. These analyses commonly focus on the environmental impact of the operating room, due to extensive energy and resource utilization in surgery. While much of this literature has arisen from other surgical specialties, several environmental sustainability studies have begun appearing in the field of orthopaedic surgery, consisting mostly of waste audits and, less frequently, more comprehensive environmental life cycle assessments. The present study aims to review this limited evidence. The results suggest that methods to reduce the environmental impact of the operating room include proper selection of anesthetic techniques that have a smaller carbon footprint, minimization of single use instruments, use of minimalist custom-design surgical packs, proper separation of waste, and continuation or implementation of recycling protocols. Future directions of research include higher-level studies, such as comprehensive life cycle assessments, to identify more opportunities to decrease the environmental impact of orthopaedic surgery.

PNS17 Value of a Comprehensive Ophthalmology Custom Pack in a Canadian Setting

To estimate the economic impact of custom surgical packs, sets of disposables and sterile supplies optimally arranged and customized for each surgeon, on cataract and vitreoretinal (vit-ret) surgeries across accounting, materials management, and operating room (OR) departments at hospital and aggregate group levels in Canada. A self-reported time and motion study was conducted in the USA in 2019 among surgical technicians and supply chain managers. Current surgery preparation and materials management practices data were collected via an online survey by surgical technicians (27 cataract/26 vit-ret) and supply chain managers (19 cataract/15 vit-ret). Technicians timed 140 cataract and 140 vit-ret surgeries, recording surgical supply use from a comprehensive pack (Alcon’s Custom Pak®) and other sources. Using these inputs and Canadian facility and labor parameters, a budget impact model (BIM) was developed to estimate time and labor costs across three departments. Assuming 100% use of “generic commodity packs” (no equipment-specific supplies), we explored the impact of transitioning to 100% use of a “comprehensive pack” (Custom Pak®) in one vit-ret and two cataract scenarios. Switching from generic commodity pack use to 100% comprehensive pack use in 1,000 community hospital vit-ret cases saves 27 materials management labor hours and 11 surgery preparation hours annually, translating to 13 additional procedures or CAD$23,853 – primarily OR costs. Implementing this change in 2,500 community hospital cataract cases saves 186 materials management hours and 78 preparation hours annually, or 196 equivalent procedures totaling CAD$53,819. Transitioning from generic commodity pack use to exclusive comprehensive pack use in 50,000 cataract cases at the aggregate group level saves 3,588 materials management hours and 1,550 OR labor hours yearly, gaining 3,916 procedures and saving CAD$1,070,609. Comprehensive surgical pack use improves cataract and vit-ret surgery efficiency, saving substantial operating room and materials management time and cost in Canadian hospitals.

PMD37 Hospital Efficiency Driven By Custom Surgical Packs in Cataract and Vitreoretinal Surgery.

Previous research highlights that the optimal configuration of surgical packs is associated with the potential for substantial cost savings. In the case of cataract and vitreoretinal (vit-ret) surgery equipment related disposables (i.e. fluid-management systems/total-plus-pack and irrigation solution), are frequently not included in custom surgical pack (c-pak) configuration. The objective of this research was therefore to estimate the impact of including equipment-related disposables (as part of c-pak configuration), on hospital efficiency. This research is underpinned by primary data collection in a cross-sectional analysis of cataract and vit-ret surgeries conducted in the US: whereby a survey was conducted among US technicians (27 for Cataract, 26 for vit-ret) and supply chain managers (19 for Cataract, 15 for VR). Technicians timed 140 cataract surgeries and 140 vit-ret surgeries, recording surgical supply use. Using these inputs, a decision-analytic model was developed which estimates the time associated with surgery preparation materials management, and accounting for both types of surgeries. The model simulation was run from the perspective of a hospital performing 1,000 cataract and 250 vitreoretinal surgeries, annually. Custom packs were configured fully with or without equipment-related disposables, ie. 100% use of each option was assumed. Over a one-year time horizon, the configuration of custom surgical packs with equipment-related disposables was associated with a time saving of 17 hours in the case of cataract surgery, approximately equivalent to the time taken to perform 31 cataract surgeries. For vit-ret, estimates are as follows: a time saving of 4 hours, approximately equivalent to 3 vit-ret procedures. Further time savings were demonstrated in the case of Material Management (37 hours) and Accounting (2 hours). When configuring custom surgical packs for cataract and vitreoretinal procedures, the inclusion of equipment-related disposables could improve hospital efficiency, through faster surgery preparation and streamlined materials management, facilitating the reduction of hidden costs.

USNS COMFORT (T-AH 20) Surgical Services Response to the COVID-19 Pandemic in New York City.

USNS COMFORT (T-AH 20) Surgical Services Response to the COVID-19 Pandemic in New York City.

Common Sources of Pre-, Peri- and Post Surgical Site Infections (SSI) in Dogs during Clinical Students’ Surgical Practice

Surgical site infections (SSI) are important complication of Veterinary surgery. Pre, intra-, and post-surgical procedures are considered to be associated with SSI. An attempt to characterize veterinary SSI in small animal surgery practical was made. 15 dogs were grouped into 5 groups (with each group consisting of 3 dogs), in which skin-defect correction, caudectomy, cystotomy, orchidectomy, or ovariohysterectomy were performed by veterinary students under the guidance of qualified surgeons. Blood samples were obtained pre- and post-surgery. 120 swabs were taken from the following sites; students’ or surgeons’ hands (pre-/post-scrubbing), surgical tables, dog skin, random areas on surgical packs, kennels, and floors of surgical theatre. The microorganisms isolated were as follows; Staphylococcus aureus, Klebsiella spp, Micrococcus luteus, Enterobacter spp, and Bacillus subtilis, with Klebsiella being the highest. Leukocytosis, neutrophilia, monocytosis, increased bands, leukocytopenia, neutropenia, and lymphopenia were observed, with all being signs of infection. This study showed that the sources of SSI were numerous, including the followings; the dogs’ skin microflora, the students’ hands, surgical theater, surgical team, and the kennel. Proper scrubbing techniques should be adopted and maintained. The sterile field created should be kept and proper disinfection of the kennel should be ensured before returning the dogs after surgery.

Itens cirúrgicos individualizados e packs cirúrgicos personalizados na gestão do bloco opertaório

Enquadramento: no Bloco Operatório (BO) a eficiência é alcançada pela capacidade de os profissionais oferecerem cuidados de saúde de alta qualidade e simultaneamente encontrarem ideias inovadoras e criativas para diminuir os custos e aumentar a produtividade. Usar Packs Cirúrgicos Personalizados (PCP) em vez dos Itens Cirúrgicos Individuais (ICI) descartáveis poderá ser uma forma de alcançar essa eficiência. Objetivos: avaliar os custos e tempo dispensado na utilização dos ICI comparando-os com a utilização dos PCP, nas cirurgias de fratura trocantérica. Metodologia: estudo de natureza qualitativa, realizado num bloco operatório, entre novembro de 2017 e abril de 2018, com observação participante e análise documental de custos, tratamento de dados com recurso ao Statistical Package for the Social Sciences (SPSS), versão 25. Resultados: os custos associados aos ICI, por cirurgia, são em média 42,20€ enquanto que nos PCP o custo médio é de 33,33€. O tempo utilizado na colocação da mesa operatória com a utilização dos ICI é em média 6 minutos com 4 segundos e na utilização dos PCP decresce para 49 segundos. Conclusão: eficiência em BO e sustentabilidade financeira são garantidas com a utilização de PCP ao invés de ICI, contribuindo para a eliminação do desperdício com recurso a uma estratégia de otimização dos recursos disponíveis.

Rapid-lecture biological indicators’ monitoring of CEYE (SAPC) autoclaves of the School of Dentistry of the Technological University of Mexico (UNITEC)

Objective: To monitor autoclave effectiveness and conduct routine validation of sterilization cycles. Material and methods: An observational, cross-sectioned, qualitative and prospective study of three Sterilization and Packing Center autoclaves of the Technological University of Mexico of the School of Dentistry was conducted. The study included 96 surgical and non-surgical packs, and spanned the period from May 2012 to April 2015. Monthly assessments were conducted, according to Offi cial Mexican Norm stipulation number NOM-013-SSA2-1994, modifi cation 2006, using rapid lecture biological indicators (1292 3M Attest™). Sterilization efficiency was determined as biological annihilation elicited in these indicators. Effectiveness assessment was conducted after three hours with an automatic optic reader (3M Attest 290™). A positive witness was included in all readings. Results: Negative results were obtained in biological indicators readings used in autoclaves. A 100% effectiveness was achieved in sterilization processes of surgical and non surgical packs. All witnesses were positive. Conclusions: The effectiveness of Sterilization and Packing Center autoclaves of the Technological University of Mexico of the School of Dentistry was corroborated. The Norm established by the Mexican Health Ministry was complied with.

‘Tension Tile System’ (TTS): a simple innovative wound closure device

Wounds closed under severe tension often result in breakdown due to skin necrosis and suture cheese wiring causing both physical and financial morbidity. Although a few commercial wound closure systems have been described in the literature, but they are all expensive and not readily available. We have designed a simple and inexpensive system called ‘Tension Tile System’ (TTS) which utilizes plastic casing found in most sterile surgical suture packs. The device is easy to construct, sterile, inexpensive, easily available, and based on already proven principles of mechanical creep and stress relaxation. Large wounds in five patients were closed with the help of TTS system with no complications. We believe that this system will find wide application in all surgical fields where the wound encounters tension during closure.