CREDIT: Thomas Chintala, Jr.

A Call to Action around Loaner Quality

A recent photograph of surgical instruments haphazardly stacked on a trash can outside a hospital took our corner of the internet by storm and provided a sobering snapshot of a much larger issue within sterile processing and the medical device world. While the specifics of this photo are concerning enough, the broader implications of it reveal systemic gaps surrounding vendor tray management that require real collaboration and action across the healthcare ecosystem. These gaps don’t merely represent an operational failure of medical device companies or reps, and addressing these gaps will require more than just process improvements; it calls for a shift in culture and values across all stakeholders involved.

The variable landscape of care and handling

There is currently a tremendous amount of variability in how vendor representatives, companies, and couriers handle surgical trays. Some are stellar examples of meticulous care; others end up going viral for stacking trays on top of trash cans or hauling them to a hospital in the open bed of a pickup truck.

This inconsistency stems from two key factors, in my opinion. First, expectations for appropriate care and handling of these critical devices are not clearly defined or standardized within medical device companies or outside in broader industry documents. Second, little to no accountability mechanisms exist for lapses in protocol or errors in judgment by vendors and couriers.

This lack of guidance and oversight has created an environment akin to the Wild West, where adherence to safety and quality protocols is hit-or-miss rather than the norm. Such a scenario is not only detrimental to the patients, but it also poses legal and reputational risks to healthcare providers. Thus, the stakes are too high to ignore the absence of a cohesive and enforceable set of standards for vendor tray management.

Chain of custody and quality gaps

The photograph also hints at deeper supply chain management flaws. In an ideal system, vendor trays would have rigorous oversight and documentation of every step of their cycles in and out of healthcare facilities. However, pervasive issues with inventory tracking, logistics transparency, and recordkeeping among vendors lead to unacceptable gaps in quality assurance.

For many companies, the chain of custody and condition of their trays at any given moment is a black hole. These kinds of broken processes aren’t merely inconvenient; they are potential catalysts for surgical quality events, some of which can have catastrophic consequences for our patients. Solving for this traceability and documentation challenge is not an option if we are to really move forward with clinical confidence in instrumentation like this coming into our facilities from the outside.

Patient expectations and the moral imperative

While we obviously have the ability to effectively clean and disinfect contaminated trays in sterile processing, this does not absolve the responsibility of all parties to collaboratively work to prevent external contamination from occurring in the first place. Patients hold an underlying expectation—rightly so—that surgical instruments will be treated with the utmost care from manufacturing all the way through until they are opened sterile in the operating room. Meeting this expectation is not just a best practice, but a moral imperative for an industry entrusted with people’s lives.

It is not unreasonable for patients to expect, and our teams to ensure, that external contamination such as roaches, leaves, concrete debris, and similar nonhealthcare-related debris stays out of their instruments. Living up to these expectations is integral to building and sustaining the public’s trust in our healthcare system. In today’s information-rich age, one incident like this can have a domino effect on consumer confidence and ultimately impact care-seeking behavior.

The way forward, together

Fixing these challenges is going to be no easy feat. Systemic shortcomings like this will require cross-industry coordination and commitment at every level, role, and stage of the device workflow.

First, clear standards of practice for vendor tray handling must be established and endorsed by healthcare facilities, sterile processing leaders, vendors, regulators, and other stakeholders. Second, inventory management and chain of custody both outside and inside of our healthcare facilities should be developed to provide real transparency, oversight, and accountability at every link in the device supply chain.

Obviously, all of this has to happen in collaboration with stakeholders on all sides of the equation. Practical examples of the kinds of questions we should be asking ourselves are:

  • What can architects and hospital planners do to build better, more vendor-conscious spaces in our facilities to better facilitate the flow of devices in and out of our hospital?
  • How can we align incentives for quality care and handling across individual reps, couriers, warehouse staff, and more? (i.e., What is in it for each of them?)
  • Is there more we can do in sterile processing to reduce the numbers of instrument trays coming and going from our departments?
  • Are there graduated phases of this process that can be slowly rolled out over time to increase adoption?

At the end of the day, photos like this have the ability to prompt us to industry action in ways that mere words sometimes cannot. But action alone is not the solution either. We need action, fueled by collaboration, guided by a clear mission, and informed with real clinical feedback from those in the field most impacted by the current broken system.

If you would like to see this challenge tackled, begin speaking to your own vendor representatives about their perspectives. Start bringing up this topic at local networking events and educational conferences. Keep coming back to it time and time again until we reach the critical mass needed as an industry to get it fixed.

The only way forward is together. What say you?