Containerizing Orthopaedic instrument sets save labor,
money and time
Barbara J. Campbell, R.N., M.S., CNOR
Clinical Team Leader, Supply Chain Management
Reprinted from January 1, 2005
Summary
The number of orthopaedic procedures being performed
across the country is being increased dramatically. This
paper examines one of our system hospitals that is trying to
determine ways to keep down costs, improve work
ergonomics and reduce impact to the environment by
changing from wrapped sets to rigid sterilization containers.
We are encouraging the orthopaedic vendor community to
provide the instrumentation in rigid sterile container
systems. By changing to Aesculap SterilContainers™ at St.
Rose, we would save over $13,000 a year on disposable costs.
Additionally, sterile containers help us achieve our mission
to reduce our impact on the environment.
The Situation
As a member of the supply chain management team for
Catholic Health West, we are trying to reduce cost at one of
our facilities, St. Rose. An area of escalating costs is in
orthopaedic surgery, one of the fastest growing areas of
surgery today. St. Rose Dominican Hospital, Sienna Campus
in Henderson, NV performs over 650 orthopaedic cases
annually. Within a 12-month period, St. Rose will have
performed 222 total hip arthroplasties and 346 total knee
replacements as well as over 80 hip and knee revisions. With
each surgery needing many sets of specialty instruments, St.
Rose saw their reprocessing cost and demand for quick
reprocessing times continually increase.
“The costs of the wrap material and labor cost continue to rise.
We have increased the number of total joint procedures and are
looking for ways to reduce cost and the time it takes to turn
around the instrument sets. St. Rose’s environmental mission is to
reduce waste and it’s source by redesigning processes” Peggy
Cullum, BSN, CNOR, Surgical Services Director.
The Problem
Orthopaedic surgery generally requires about 6 sets for a
total hip or a total knee and up to 10 sets for a revision
procedure. St. Rose used sterilization wrap for processing
and storage of these sets. These large and heavy wrapped
sets were placed haphazardly on top of each other.
CS personnel had a difficult time figuring out
what was in each set and often had to move
3 or more sets around to find the right one
for the next procedure. Stacking heavy
wrapped sets on top of each other also
presented a potential hazard of falling.
St. Rose performed orthopaedic surgeries 2
days a week, scheduling up to 10 surgeries per
day. To the CS, this often meant turning around the
sets 5 times during the day. The time constraints put an even
heavier burden on the CS department to turn each set
around as quickly as possible.
Containerizing Orthopaedic instrument sets save labor, money and time, Barbara J. Campbell, R.N., M.S., CNOR
The biggest challenge of all with the orthopaedic sets was
the cost associated with processing. Like many other
hospitals, St. Rose was challenged to keep their costs down
while the number of procedures being performed rose. The
cost associated with wrapping one set of instruments is
listed below:
Item
48" Wrapper
O.R. Towel
White Towel
Integrator
Steam Tape
Total Material Cost Per Set
Total Labor Cost Per Set
Amount
Cost Each
1
1
1
1
1
$1.89
$0.07
$0.20
$0.11
$0.04
$2.31
$0.20 / minute
7 minutes
Total Cost Per Set
The disposable cost associated with using rigid sterile
container system is estimated at:
Item
Filters
Locks
Internal Integrator
Indicator Cards
Total Material Cost
Labor Cost
Total Cost
Amount
Cost Each
2
2
1
1
$0.02
$0.04
$0.11
$0.06
$0.29
$0.20 / minute
2 minutes
$0.69
$3.71
That meant for each total hip or knee surgery, the cost
associated with wrapping 6 sets was $22.26. For a knee or
hip revision, the total cost for wrapping 10 sets increased to
$37.10. Over a year, St. Rose discovered that it was spending
$15,908 on wrapping orthopedic sets alone, sets that the
hospital did not even own!
Annual Cost of Wrap Materials
$9,000
$8,000
$7,000
$6,000
$5,000
$4,000
$3,000
$2,000
$1,000
$-
$7,702
$4,942
$1,484
$1,781
Total Hip
Arthoplasties
Hip Revisions
Total Knee
Replacements
Knee Revisions
This dollar amount did not include other costs such as the
occasional reprocessing that was necessary due to either
wrap puncture or wet sets. Additionally, disposal costs were
starting to increase with the increase in the number of sets
wrapped.
The Solution
Rigid sterile container systems were pioneered more than`
100 years ago. Currently there are many different types of
rigid sterilization containers in the market, most of which are
made of aluminum and plastic. Aluminum systems like the
ones from Aesculap are reusable and use very few disposable
items, cutting down on the cost. Rigid containers, by
reducing disposable items, also cut down on the amount of
waste impact on the environment.
For each set placed in a rigid sterile container system instead
of wrapped, the CS department can save 5 minutes of time
and $3.02 in costs! In addition, Aesculap’s SterilContainer™
System allows multiple sets to be placed inside a single
container enabling the consolidation of the number of
containers needed for each orthopedic procedure. Instead of
6 sets to wrap individually for a total knee or hip, only 4
SterilContainers™ are needed to accommodate all the
instrumentation. Instead of 10 sets to wrap individually for a
revision, 6 SterilContainers™ could accommodate all the
instrumentation.
This results in a savings of $19.42 for each total hip or knee
procedure and a savings of $32.84 for each revision
procedure for disposable materials alone. Over the course
of a year, St. Rose would
save $13,920 in disposable
costs! There would also be a
potential savings of an
estimated 325 hours a year of
central services labor!
Containerizing Orthopaedic instrument sets save labor, money and time, Barbara J. Campbell, R.N., M.S., CNOR
Annual Disposable Cost of Wrap verses Container
Disposables at St. Rose
Wrap
Container
$9,000
$7,702
$8,000
$7,000
$6,000
$5,000
$4,942
• Ease of Identification
Aesculap SterilContainers™
can be labeled in several
ways for easy set
identification. Lids of
containers can be colorcoded. Aesculap
SterilContainers™ also
contain slots where customized
colored labels can be placed.
$4,000
$3,000
$1,781
$2,000
$1,000
$1,484
$983
$630
$204
$Total Hip
Arthoplasties
Hip Revisions
$170
Total Knee
Replacements
Knee Revisions
For St. Rose, the purchase of Aesculap SterilContainer™
System represents an investment that will pay off very
quickly. The initial cost of purchasing containers for all their
loaner sets would be $16,400. The pay back period when
considering total cost would be only 14 months. As a result
of our analysis, we are encouraging the orthopedic vendor
community to provide the instrumentation in Aesculap’s
SterilContainer™ System.
• Safe Handling
SterilContainers™ are safe and easy-to-handle, therefore
reducing the potential for staff injuries and improving
processing time.
Aesculap’s SterilContainer™ System also provides a
lightweight and durable method of storing the orthopaedic
sets. Aesculap containers typically weight 20% less than
other containers. Beyond the huge cost savings associated
with using sterile containers, there are many other reasons
why switching to Aesculap’s SterilContainers™ would be a
benefit for the CS.
Benefits to the Staff
• Less Waste
The disposable items associated with containers are
significantly less than the wrap in both weight and
volume. This saves the hospital cost in disposal and
reduces the impact on the environment.
• Ease of Stacking
Wrapped sets are often
laid haphazardly on top
of one another. Aesculap
SterilContainers™ are
designed to stack on top
of each other securely
for both sterilization and
storage.
About the facility
St. Rose of Sienna is a 215 bed facility that is part of Catholic Health West. Catholic Healthcare West consists of 39 acute
care facilities located on the west coast in California, Nevada and Arizona. Their mission is to deliver compassionate,
high-quality, affordable health services. In total, the 39 facilities have 7,805 acute care beds and work with over 7,000
physicians.
In addition to providing health care, CHW seeks to address the underlying causes of illness, including environmental
dangers. CHW is proud to be the first health care system in the nation to endorse the CERES principles, a model code of
environmental conduct (www.ceres.org). Our Materials Policy pursues several environmental goals. First, we seek to
reduce waste at its source by redesigning processes and purchasing practices to reduce the amount of virgin materials
purchased. Second, once a procurement need is identified, we try to purchase goods with recycled content that can
specifically be recycled, and have a low life cycle impact on the environment. Once our purchases reach the end of their
initial use, we focus on recycling, reuse within the hospital, transfer to another user (such as the community or needy
organizations), and finally proper waste disposal. A cross-functional decision-making group, the “Value Analysis
Committee,” exists at the system and local facility level to help analyze and make these purchasing decisions.
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