Melanie Perry with First Case stopped by the VERDA booth at AORN this year and conducted an interview with am O.R. nurse, passing by, and Len Sparks, VERDA’s Director of Operations. The results was insightful. The biggest take-away from this interaction may have been that while the O.R. nurse suspected water quality was playing into to spotting she was seeing on instruments – she wasn’t sure what more to do about it. Len shares personal experiences that highlight the both good and bad outcomes when poor water quality is the subject. Watch the nine minute video by clicking on the link below.
Transcript:
Melanie:
Hey everybody, it’s Melanie Perry with First Case and I am here with Nurse on the Street in the VERDA booth. And it’s going to be a little different for nurse on the street today because we’re talking about water quality. And while water quality is really important,
I’m no expert in water quality, but the experts here are. And so they’re going to help us get out some good information and answer some questions. And joining me also today is a nurse here that we grabbed in to ask some questions to. So tell me your name and where you’re from.
Mary:
I’m Mary and I’m from Raleigh, North Carolina. Great.
Melanie:
Thank you for joining me and letting me ask you questions. And then our expert over here today, Len Sparks from VERDA Water Quality Systems.
Alright, cool. So we’re gonna ask some questions and the very first one I wanna ask you is, tell me about water. What if, what do you know about water in the Operating Room?
Mary:
So we use water to clean the instruments. Um, but I don’t know anything about the testing or how we do it. There’s spots on the instruments, there’s spots inside the tray.
Melanie:
Um, so You know, so you’ve seen some things that, you know, probably related to water, but you don’t know the details?
Mary:
Correct.
Melanie:
Okay, so help me with the details, what’s making those spots?
Len:
Yeah, so it could be a lot of things. So, I guess my first question to you is like, so when that happened, what was the response? What did you guys end up doing to try and find out what was causing that?
Mary:
Well, we called for another tray to replace that one because we didn’t know if it was sterile since it had spots on it. And um, I don’t know what type of process they go through to test the water. So I’m certainly not an expert on any of that. I only like to take care of the instruments or deal with them in the Operating Room.
Melanie:
Right.
Len:
Yeah. Well I think that’s a really common situation where you just, you know, you see these problems and you’re not too sure what’s causing them. You have utility water you should use for basic washing and soaking and that doesn’t have really high requirements to it.
Tap water generally speaking is good enough for that. But then when you do a final rinse on it, it’s almost like washing your car. You need a nice clean final rinse to make sure there’s no residuals in it. And that can be the first part that can go wrong if that water isn’t clean enough, that can cause problems. And instruments were then getting sterilized, I’m guessing.
Mary:
Yes, Yes. Correct.
Len:
So you have these instruments that look wonderfully cleaned, there’s no spots, and they come out of the washer and they’re all dried out and then you wrap them up and they come out and they’re all stained and they’re all spotted.
So, it’s the steam; Now you’re looking at what’s the water source producing my steam. And a lot of times, the facility steam isn’t of sufficient quality. And then you ask, well what can we do to our steam? And in some cases hospitals realize they have to kind of step back and say we have to produce our own steam for sterile processing that is independent from what we do for the rest of the hospital because it’s so critical.
I just had a conversation yesterday with one of the nurses. They threw out a million dollars’ worth of instruments because it had caused them so much damage. They couldn’t reprocess them anymore. They couldn’t clean them anymore.
Melanie:
Okay, I’m going to jump in and interrupt because you’ve already got me like wondering about how these things work. So the water comes into the hospital through the municipal water system, but then what happens to make it better water or to make it better steam? Or what are you doing to the water to make it where we can use it safely?
Len:
Right. So, a lot of times people think about, well, I’m going to soften my water, which is really great because you’re taking out some of the elements that make hard water. People are kind of used to hard water, like the scale. But softening alone doesn’t remove the dissolved solids, it’s just sort of doing an ion exchange. So, you still have dissolved solids, just not like calcium buildup on there. When you want to final rinse, you want that to be as clean as water as possible. You don’t want any residuals to end up on there because that’s where like biofilm and bacteria can start growing on it.
Melanie:
Right. So, now you’re talking about doing something more than just a water softener. You need to do maybe like a reverse osmosis or ionization too?
Len:
Something has to go down and take out what’s dissolved. You know, think about sugar or salt in water. You can’t just put in a filter to remove it. You have to get down to a more sophisticated filtration system.
Melanie:
Okay. So I’m curious, Mary, you’ve seen some instruments with spots on them before. You’ve seen some instruments with some pitting or some rust or staining. What does your surgeon say when your instruments are messed up?
Mary:
Oh, what do they not say? They say things like, “Are you kidding me?”
I know they’re looking at the time and saying, “Okay, you’re delaying me”, and you know, that kind of thing. They’ll talk about delays and decreasing productivity.
Melanie:
How have instrument issues like staining, pitting, and spotting, how do they slow down your Operating Room?
Mary:
Having to go get another tray, for starters. Or if there’s not another instrument available, then they have to wait for that one to get reprocessed so it can be ready.
Melanie:
Right, and then suddenly we’re waiting and we’re waiting and we’re waiting. And then finally the Operating Room has a sterile tray again. So then let’s talk about how water can actually make our productivity what we want it to be.
Len:
Right. Yeah. So that’s not a great situation. We had a great opportunity to help one hospital where they were having these issues for nine months out of the year and it was impacting their surgical process. People were going for surgeries and they’re getting delayed and getting cancellations and rescheduling. Doctors were getting frustrated and upset and threatening to leave the hospital. It even got on the local news because there was a patient who was supposed to have open heart surgery whose surgery got canceled and the family got very upset – So now it’s in the news. VERDA Water Quality Systems came in and we set up. The key for them was not so much about the final rinse, but it was the steam and the the moment we fixed it they started creating a higher purity steam and the issue went away.
The crazy thing was, a number of years later they were doing a renovation and putting in new equipment and so they went back to the old way of processing their instruments for one single day and out of 240 trays, 237 failed.
Melanie:
Oh my goodness. That’s crazy! That’s crazy!
Len:
Right? It’s nuts. So, I mean, you know, it really can make a difference. It really can.
Melanie:
Absolutely.
Okay, so my last question for you, we are very familiar with AORN and guidelines and the guidelines that we are given for patient care and practice. Are you familiar with any guidelines that are related to water quality?
Mary:
I would say no. Those are not ones that we hear about very often.
Melanie:
Correct. So, tell us, what are those guidelines that we should be looking at when we talk about water quality?
Len:
There’s a standard now called ANSI/AAMI ST108. It came out in 2023. And it’s a standard for the quality of the utility water. That’s the water for basic soaking and washing of surgical instruments. It’s the quality of the critical water, which is your final rinsing and the quality of steam condensate for cleaning surgical instruments.
So, if you’re not checking your steam condensate, if you’re not checking your utility water, you’re not checking your critical water or you’re not checking all the points of use and you have a piece of equipment that has bacteria in it and you don’t realize it, then that processing right there is potentially a high risk.
ANSI/AAMI ST108 covers that and goes through best practices and guidelines. There are parameters too. There’s basically 18 parameters to take a look at. Everything from your pH and the connectivity to how many chlorides are in my water and all this fun stuff in there. And the thing is, you don’t have to be an expert in that, but you need to have someone on your team, someone, whether it’s inside the building or a third-party partner who has an expertise that can kind of help and guide you through that. Otherwise you’ll be hitting your head against the wall over and over again. Saying, “Here’s another instrument that has to be pre-processed. Here’s another one reprocessed 237 times.” Right?
Melanie:
It’s very frustrating for the doctors because then they have no confidence in the instruments they’re going to be using in surgeries. We want that confidence. We want that assurance that our instruments are clean, they’re sterile, and they’re safe to use.
We have seen in all of our Nurse On The Street interviews, we talk about this benefit of partnership with our vendor partners who can be these experts with these things that we’ve never heard about. So, I’m curious, what do you think about learning from our experts and our vendor partners, like VERDA Water Quality Systems, about something like water quality?
Mary:
I think it’s a great idea. That’s why we come here to the AORN Expo to learn and find out what we are missing.
Melanie:
Thank you both. You know, knowledge is power, a hundred percent. Thank you, Mary, for joining us and Len, thank you for sharing some of your expertise. I certainly don’t know a lot of this either but I know now that water is definitely not just water. So, thank you. Thank you so much.