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The word ”end” means not just the end, but also the goal. In Polish the ”end” is rarely used as the goal, and more can be associated with the closure of one stage and the start of a new and different one from the current reality. Thinking straight the end is a new beginning i.e. changes.

Changes are often associated with fear and temporary difficulties, which people are not always ready for. The need to leave the safe and tame zone always causes fear of what will happen.

If the proceedings are recorded in the medical procedure, the change of this action seems to be very difficult and unreasonable, because the current performance of procedures was effective and unchanged for many years. However, it often happens that the change involves a number of positive consequences, and thus modification of the previously stable reality in a very positive way.

The effects of changes associated with the introduction of ready-for-use-sets and the benefits resulting from that are discussed by:

Emilia Zawadzka

Master of Nursing with specialisation in epidemiological nursing – Dr. Władyslaw Biegański Regional Specialist Hospital in Grudziądz

Monika Cerkaska

MatoNews interviewer

Monika Cerkaska: Why did you decide to work with specialist sets? Is it only because of the relief for the Central Strerilisation Unit?

Emilia Zawadzka: From the moment the CSU started to support 11 operating rooms, we decided to use it only for the sterilisation of instruments. Relieving the work of CSU we resigned from creating sets of dressings material inside the hospital and decided to use sterile procedure and operative sets. I am thinking of ready-for-use sterile products, in a single package containing both the dressing material, Op-drapes and other components needed to perform a particular procedure. In this way the responsibility for the sterility of the material is transferred onto the manufacturer, and the CSU can focus on the preparation of sterile surgical instruments.

Due to such a decision, a large work load relief was also felt by nurses who were expected so far to prepare sets of dressing material. Not only the work comfort increased, but also ensured our and patients’ safety. The use one set specifically designed for a given surgical procedure eliminates the risk of error and thus minimises the risk of complications. In addition, the time devoted to prepare all the necessary materials for the surgery is much shorter, which is especially important in life-saving situations.

The use one set specifically designed for a given surgical procedure eliminates the risk of error and thus minimises the risk of complications.

M.C.: What kind of response from the doctors and nurses, the direct users of the sets, did you meet while changing into ready-for-use sets?

E.Z.: Any change or introduction of a new solution causes some concern among those who are directly affected. So it was in our case. Both among the doctors and nurses there were concerns that quickly disappeared when they started working with the sets. We all experienced better working conditions, and today we cannot imagine return to the previous state. It is much easier and safer to open one set than a few products in aseptic packages. While opening one package, we reduce the possibility of contamination of products and patients with pathogenic microorganisms. In high-risk procedures with high risk of complications the elimination of errors translates into patient’s safety, which is the most important thing for us.

M.C.: Which elements of the set are the most important for you?

E.Z.: First of all, the set should be complete, but not exaggerated. Unused elements constitute waste, for which, unfortunately, you would need to pay. Therefore, the most important are the basic elements, which if necessary can be supplemented with sterile material. In an emergency, when there is time pressure, it is important that the set contains everything necessary to carry out the procedure.

An important advantage of the product in the form of the set is the fact that the order of arrangement of individual elements can enforce the execution of particular activities, e.g. first the instrument table is covered, the OP-field is disinfected and secured in the right way. These are the activities which are always followed one another, and the order in which they appear has a big impact on the safety of the procedure.

M.C.: What about human habits? Do they not induce resistance to the use of medical devices in such a form?

E.Z.: The procedure should be carried out in a safe manner and habits should most of all provide the security. I do not see any conflict of interest.

Speaking of safety one must also think about legal security when a patient can claim against the hospital, like in the case of medical incidents. The awareness of patients is increasing, the affairs between the patient and the hospital quickly become media events, and each won process generates another claim. Therefore, it is important to have evidence that all the procedures in the treatment of the patient are carried out in a secure way. Medical records are proof in this case, which are facilitated by a TAG label i.e. stickers that can be stuck into the patient’s medical history and the documentation of the operating theatre.

M.C.: Which arguments do you think are stressed by the hospital manager?

E.Z.: I’m sure that epidemiological safety and costs. The cost reduction and of course the set price is very important, and for the director / manager the transparency of costs. The set price is equal to the real cost for the ward for the performed procedure. We are talking about a simple ratio: the number of sets is equal to the number of performed procedures. In this case we eliminate the so-called hidden costs and limit the possibility of manipulation of the costs of individual procedures.

M.C.: The economic aspect is a very strong argument. What about work ergonomics in the ward? Is it changing?

E.Z.: Of course. It great relief is felt by the personnel. Workload for nurses is very high, and in a situation where we use ready-made sets, all the energy is focused on the patient.

In addition, the use of sets streamlines logistics inside the hospital. Products are transported easier and safer.

M.C.: Thank you very much for your time.

Dr. Władyslaw Biegański Regional Specialist Hospital in Grudziądz has 40 wards, in which there are 1,050 beds and 53 specialised outpatient clinics. Modern operating theatre has 11 operating rooms supported by a Central Sterilisation Unit (CSU). Due to the large relief for the functioning of the CSU the hospital has completely changed the approach to purchase management of products for the greater use of ready-made sterile procedure and operative sets and the transition from reusable to disposable products.

Within the European Regional Development Fund the hospital acquired also funding for the purchase of new ambulances with equipment, for the construction of one of the most modern heliports in Poland and for a wide range of medical equipment that is used in the treatment of patients in the new clinic.

The use of large operative sets in the operating theatre of the Nicolaus Copernicus Provincial Specialist Hospital in Łódź are discussed by:

Sylwia Dąbrowska

Deputy Head of the Operating Theatre for Nursing – Nicolaus Copernicus Provincial Specialist Hospital in Łódź

Monika Cerkaska

MatoNews interviewer

Monika Cerkaska.: What urged you to start working with ready-made sets?

Sylwia Dąbrowska: The decision to introduce the standard use of disposable sets in the operating theatre happily coincided with the renovation of the operating theatre. Once, that is before the renovation, within the operating theatre we had a sterilisation unit, where in addition to current work for the needs of the theatre, there were also sets of non sterile materials prepared that in the next step were sterilised. After the renovation of the operating theatre, the sterilisation unit was closed and today the hospital has only a delivery and receipt point dealing with logistics, mainly of instruments and hospital clothing. Due to such a decision at one time we started to use disposable products such as surgical drapes, gowns and procedure or operative sets.

The renovation of the operating suite also reduced the size of storage space that we have. Therefore, we cannot afford to maintain a very large stock of non sterile products, which always occupied a lot of space. Nowadays, we use a very large number of implants, and they mainly take place in the operating room. Dressing materials are stored outside the operating room, and therefore it is easier and safer then to use a ready set. Such an organisational approach is very reasonable. Reducing the storage space, the space for the patient increases. And this is of course connected with money.

One move is enough to open the set, one set designed for a given procedure, and one label that allows the transfer of information to the documentation highly limit the time devoted to prepare for a surgery. This allows the medical staff to concentrate on their work around the patient.

M.C.: You mentioned the safety. It’s probably one of the most important reasons for the hospital, for which you have decided to work with the ready-for-use product?

S.D.: Of course, and it is for the hospital as a whole. This is a very strong argument for the manager – because the responsibility for sterility lies with the manufacturer – and for the entire epidemiological staff – for the use of sets reduces the number of hospital-acquired infections. It is also very important for us – as the medical staff. It is safer to open one packaging rather than opening individual packages of products needed to complete the procedure. The removable part of the label is a very safe element. To eliminate the error, which can be committed in the process of rewriting the data into the documentation, in this case only one sticker with a product code and expiration date is transferred. The product code fully identifies the contents of the package and there is no need for a more detailed label. At the big amount of material used and also having a limited amount of place in the documentation, the size label is adequate.

Another advantage of using the sets is to increase work comfort. One move is enough to open the set, one set designed for a given procedure, and one label that allows the transfer of information to the documentation highly limit the time devoted to prepare for a surgery. This allows the medical staff to concentrate on their work around the patient This is especially important in a situation where for example on call there are three operating rooms functioning, and there is just an enough number of nurses to do the work on the ward. Using the finished product allows for smooth work throughout the operating suite on duty. Of course, the comfort of using the sets is experienced not only in emergency situations, but also in our daily work. We minimise the duration of the procedure, which translates into individual savings, i.e.: lower consumption of energy and air conditioners, shorter anaesthesia, shorter work of a surgeon, anaesthetist and nurses. Minimising the time devoted to the preparation for a surgery, combined with efficient team work makes the performance of the procedure faster and cheaper.

M.C.: The cost is still to be discussed, but yet another question arises. Do I understand it correctly that the work with the sets increases the efficiency of the operating room?

S.D.: By all means yes. In addition to the mentioned sets also the high quality of disinfectants that allow for very rapid turnover of patients in the operating room contributes to better efficiency. Taking our hospital into consideration, I can say that until recently, daily we performed four procedures e.g. strumectomy. Today we can perform five operations and we have still some reserve time. This shows the efficiency and getting in sync of the team, as well as shorter time devoted to prepare for a surgery. This is most noticeable while analysing the productivity of the operating suite for a month or a year.

M.C.: Yet another question about the waste. Can we assume that the amount of waste gets reduced?

S.D.: It depends. Generally, the amount of medical waste coming from the operating theatre increases. This happens in all medical units using disposable products like disposable OP-drapes, medical devices, gowns, etc. However, the amount of waste, in the case of unit packages of the products used during the treatment certainly drops and is limited to a few, and not as it once was – a dozen or even dozens.

M.C.: So how do the costs of a procedure change after implementing disposable ready-for-use sets?

S.D.: I have no doubt that this solution is far more profitable for the hospital, because we have a finished and adjusted for our needs set, sterilised and delivered. Completing components inside the hospital in our reality would involve an additional job position, and that means an increase of the cost of the procedure. The best and the most advanced solution are sets dedicated for a particular medical procedure. This reduces not only the amount we opened dressing materials, but also in such sets you can find OP-drapes, a Mayo table cover, covers for equipment and cables, organisers for the equipment used during a surgery – a very useful and work ordering thing i.e. a whole load of sterile material. In this case, the cost of the given procedure is countable and very readable. The number of performed procedures is equal to the amount of used sets.

M.C.: Thank you very much for your time.

Nicolaus Copernicus Provincial Specialist Hospital in Łódź in its complex structure has: Specialist Hospital, Regional Oncology Centre, Dr. Janusz Korczak Paediatric Centre, Group of Clinics and Specialist Clinics as well as Diagnostic Department.

The biggest success for the hospital was the creation of the Bone Marrow Transplant Centre managed by a specialised team of experienced scientific and technical staff, and the creation of a Hospital Emergency Department integrated with a heliport forming a functional unit guaranteeing rapid rescue in life threatening situations. An important achievement was the modernisation of the Regional Oncology Centre.

Currently, the hospital provides comprehensive diagnosis and treatment at the highest level, thus providing conditions for faster patients’ recovery.

In the hospital there are also 12 associations and foundations supporting inter alia patients with cancer, leukaemia, haemophilia, rheumatic diseases, a heart transplant, and many others.

Nosocomial infections are a major problem in modern medicine, because many times they are mean a failure in the treatment and the emergence of complications. The most common problems associated with infections is the lack of aseptic behaviour in the where a medical procedure is performed, a delay in the diagnosis of infection or improper treatment. For the hospital, it is connected with the fact that all these aspects – prevention, diagnosis and treatment – must be done properly.

More and more hospitals decide to obtain an ISO certificate, which leads to the development of procedures for all phases of patient treatment, the observance of which will reduce the number of infections. Moreover, the awareness of the medical staff of this problem is increasing year by year.

The problem of nosocomial infections is also a challenge for manufacturers of medical devices used in the performance of specific procedures in health care units.

The answer to the security needs of the treatment are Matoset products that combine functionality and economy by intentional combining of dressing material. In other words, the individual Matoset is dedicated to a given medical procedure, and particular elements are arranged in a way forcing to perform activities in a particular sequence in accordance with asepsis principles. The structured arrangement and thoughtful composition translates to security, convenience and time saving.

Interview:

Monika Cerkaska – TZMO Product Manager

Katarzyna Moś – Master in Nursing with a specialisation in epidemiological nursing

M.C. In which situations the use of sterile Matoset sets worked best?

K. M. In our daily practice we use Matoset products mainly in treatment rooms, when we have to perform minor medical procedures, such as suture removal or dressing change. Using the sterile sets I am sure that I have all the necessary materials prepared and within a few moments I am able to perform a minor procedure. The ready-for-use sets are indispensable at the patient’s bedside when transporting the patient and performing a procedure in the treatment room is not possible.

M.C. And what about situations when you need to change the dressing at patient’s home?

K. M. Exactly. The health visitor will surely appreciate the comfort of using the sets. It is always certain that all necessary materials are prepared, and each patient has a sense of individual treatment and safety guarantee since the set is designed specifically for him.

M.C. So it much easier to work with the set?

K. M. Yes, it’s easier because they improve the course of a medical procedures, but also thanks to them the work is a lot safer. The arrangement of particular elements determines the actions to be performed. We cannot omit any items e.g. gloves, which are usually placed at the top, and only after their application it is possible to use other sterile components. This minimises the risk of infection, and this is important both for us and for the patient. The documentation process is facilitated by adhesive labels with information about the product, which can be placed in the patient’s records.

M.C. So can we conclude that the sets guarantee the asepsis regardless of the place of performing the procedure?

K. M. Yes, we can. The patient is not always in a place where it is possible to e.g. securely change a dressing. Matoset enables us to do so, and also reduce the time to prepare for the procedure and facilitate the organisation of the work.

M.C. At the end I have to ask – what about the costs?

K. M. The application of complete sets dedicated for a given procedure eliminates the need to open multiple unit packaging, which directly translates into the cost of the procedure. When you open a few packs it increases the possibility of infection of the sterile material. Besides, using the sets – all the content is deliberately used. The rational use of dressing material certainly reduces the cost of its purchase. In addition, medical staff does not have to devote time to complete the dressings for the procedure. In conclusion, I would like to add a few words about the catheter sets and sets for the disinfection of the surgical field, which will surely work well in emergency rooms, although, of course, not only. In situations where time counts, we are not always able to fully observe aseptic rules, the lack of which – as you know – can lead to complications and the cause of prolonged hospitalisation. A patient who is in a life-threatening situation requires undertaking multiple procedures at the same time. The risk of infection while saving lives is greater than during the planned procedures. Therefore, the use of Matoset in the form of ready-for-use sets, such as the catheter set helps to observe the asepsis. A set that contains all the necessary components including an adequate size catheter, allows for the reduction of unnecessary actions to a minimum. The same is true also in the case of the set for disinfecting surgical field, which is justified and fully used up when performing medical procedures in life-threatening conditions. During a resuscitation it is often necessary to apply an endovascular electrode or perform a subclavian vein puncture. Having the complete disinfection set we can take care of the proper preparation of the patient for such procedures in a short time. It is important to save a patient without putting him at any additional risk that after a successful resuscitation may lead to an unwanted contamination. We save the patient and instead “give” him an infection and extended hospital stay. The state of emergency passes, and the patient will require treatment for complications resulting from non-compliance with the basic aseptic principles, the observance of which is certainly facilitated by the Matoset.

M.C. Thank you very much for your time.

Bożena Krymska

Specialist for epidemiological and cardiac nursing – Silesian Centre for Heart Diseases in Zabrze

The quality of medical services means meeting or surpassing the expectations of the patient, the compliance with standards and the degree of realising the benchmarks. According to H. Lenartowicz high-quality health care is one that corresponds to certain criteria, indicating compliance with current professional knowledge and that which, under given circumstances, enables the patients to achieve desired health results. The quality of offered medical services is very important because it concerns the priceless value of life and health of the people making use it.

Although the quality is in fact the satisfaction with well performed medical services, for each party – the performer and the recipient of the service – it means something else.

1. For the patient, the quality of medical services depends on the efficient recovery or health improvement after leaving the hospital.
2. For employee of the health care facility, the quality is understood as the compatibility of this service with current professional knowledge and achieving health improvement without adverse events.
3. For the management of the facility, the quality is to provide services at a sufficiently high level with a correspondingly lower cost.

Any medical procedure performed in a patient comprises several steps:

• preparation of a set,
• performing medical actions,
• disposal of the set, waste management,
• documenting the procedure,
• preparing equipment and reusable instruments for reuse.

Each of these steps requires effort, resources and time. Performing the procedure under various conditions, especially in rapid situations and in emergency rooms, is at high risk of error, which can undoubtedly affect the quality of the procedure, and therefore the quality of the overall medical service.

All of the above steps can be improved by ready-for-use sets adjusted for different procedures and medical treatments. The preparation of a “traditional” set includes the completion of an appropriate amount of equipment, instruments, medicines, and dressing material needed to perform the procedure. However, a ready-for-use set saves the preparation time, especially if the particular procedure is performed urgently. The nurse does not have to wonder how many items to prepare and what exactly is needed. The set provides materials needed to carry out the procedure in terms of their quality and quantity.

The content of the final set forces to perform the procedure in one correct way without omitting certain activities. An example would be the optimum number of six gauze tampons included in the set for bladder catheterisation, which demands to devote enough time to disinfect the area surrounding the urethral meatus, if all the tampons are used. The outer package in form of a rigid blister, often with a few chambers, may serve as a container for liquids or waste material, eliminating the need for additional vessels.

The ready-for-use allow to perform a procedure, opening only one sterile package, which greatly reduces the amount of waste, e.g. many external packaging of: sterile swabs, instruments, gloves, syringes, etc. The sets are completed optimally for a given procedure, which means that any such intervention is carried out using the same amount of equipment and dressing material. In practice, when we complete a set ourselves, there is often a tendency to open more packaging of e.g. dressing material than needed (swabs, cotton balls), just in case, in order not to run out.

The procedure performed using a ready-for-use set quickly becomes standardised, enables to easily monitor the consumption of materials, and thus counting the cost.

It is very easy to clean after the procedure. Everything that has been used is one medical waste. In view of the fact that everything in the set is disposable, the entire material is directed to the waste, without the need to segregate.

It is very simple and accurate to document the performed procedure due to the included self-adhesive labels.

The use of disposable instruments included in the set brings savings, resulting from the elimination of further re-sterilisation. The sterilisation process means additional costs: water, electricity, disinfecting agents, sterilisation packaging, , sterilisation tests, and human effort.

One of the major advantages of the sets is the elimination of adverse events, such as the prevention of infections. Returning to the quality of medical services, the implementation of a program to prevent hospital infections, and systemic efforts to prevent errors in medical procedures is very important to ensure high quality. Reducing the number of infections is an objective indicator of the quality of medical services, and any infection that occurred, and which could have been avoided, is a failure of the institution providing health services. The ready-for-use sets “tailored” to a specific procedure are a perfect tool to prevent such failures. The sets guarantee the sterility of equipment and materials used to perform the procedure. Therefore, the manufacturer takes the responsibility for their sterility, and thus for the quality of the medical device.

Undoubtedly, the application of the sets in practice improves work, gives satisfaction to medical staff, reduces costs, and leads to patient satisfaction. Moreover, better quality of medical care leads to the increased competitiveness of the medical facility in the market.

Literature

1. Ciuruś M., Hygiene procedures in health care facilities, Institute for Health Protection, Warsaw 2009.
2. Dykowska G., Opolski J., The quality of health care services, self-education package, Warsaw 2001.
3. Heczko PB Wójkowska-Mach J. (red.), Hospital infections. Handbook for infection control teams, PZWL, Warsaw 2009.
4. Holub, J., Competitive quality strategy on the medical service market, [in:] Nogalski B., Rybicki J. (red.), Modern management of a health care facility, Dom Organizatora, Toruń 2002.
5. Lenartowicz H., Quality management in nursing, CEM, Warsaw 1998.
6. Maciag A. Kruszewski, K., Topczewska-Tylińska K., Michalak J., The Role of processes, standards and procedures in shaping the quality of health services, Alfa-medica Press, Bielsko-Biala, 2007.
7. Piątek, A. Improving the quality of nursing care [in] Ksykiewicz-Dorota A. (red.), Fundamentals of organising nursing care, published by Czelej, Lublin 2004.