Surgical instruments should arrive in the surgeon’s hands in the operating theatre at the right moment, correctly assembled, completely sterile and without delay. To achieve this, the delivery systems need to be improved as this project demonstrates
Surgical instruments are transferred into the operating theatre in containers referred to as ‘delivery systems’ or ‘trays’. They hold the instruments during the sterilisation process and protect them during transport and storage. The trays are handled by a range of hospital and medical personnel and need to meet different performance criteria. They play an important role – if these containers do not keep the instruments clean or secure, operations could be cancelled and surgery delayed with resulting financial costs to the hospital and health implications for the patient.
The primary aim of this project in partnership with orthopaedic systems company DePuy was to assess the current delivery systems for primary knee replacement instruments in order to pinpoint the main problems and identify opportunities for design inter-vention. Concepts were developed with the objectives of reducing turn-around time, improving durability and ease of use, and lowering cost.
A critical focus
A wide variety of research methods were employed, including observation, video ethnography and interviews. To thoroughly investigate the processes related to delivery systems, employees from the Central Sterile Services Department who handle trays on a daily basis were observed, and interviews with the facility managers were conducted. Relevant technical information was collated through desk research and contact with tray manufacturers.
Six areas of critical focus were defined from this study: the first looked at how the trays are handled throughout the cycle of use; the second looked at labelling, asking how information regarding content and sterility can be provided by the container; the third investigated the wrapping of the container to maintain sterility and help medical staff identify the type of tools inside; the fourth addressed the issue of moisture residue after the washing and sterilising process; the fifth assessed how well the containers need to work in the confined spaces of the surgical theatre: and the sixth looked at the layout of the instruments inside the container.
Two systems developed
From the many design concepts generated to address these issues, two were chosen for further development. The first consists of generic clips arranged within a lightweight aluminium base fixing all the instruments inside the tray. The shape of the clip allows for the secure capture of instruments of varying shapes and sizes. Images of instruments are provided to aid placement. The lightweight external cover includes handles that enable the trays to be carried easily when wrapped and allows for labelling or branding.
The second concept uses a metal sheet stamped into the shape of the instruments, placed directly into a simple wire basket with silicone handles for heat insulation. This allows for easier location of the instruments which can be washed in-situ. The concept is durable and quick to dry. A lid keeps the instruments in place. Both systems have been presented to medical staff for intensive assessment. As a result of positive feedback, elements will be taken forward into the next generation of containers, adding value to operating procedures, reducing risk of delays or errors and improving overall patient safety.
