By Tony Thurmond, CRCST, CIS, CHL, FCS
Sterile processing (SP) professionals must manage the seemingly countless instruments (sometimes, in the thousands) that flow through their departments. These individuals must not only know the proper names of these instruments and how they function, but also be skilled in cleaning, inspecting, testing and assembling them to ensure they are ready for their next use in patient care.
SP and operating room (OR) professionals have all experienced instruments with a nickname assigned to them (e.g., a “Joe’s Hoe”). In my experience as an SP manager and former surgical technologist, using nicknames for instruments is often more common than using the original name. Relying on these nicknames can be a disservice, however – not only for the inventor of the instrument but also for SP and OR professionals because there is significant value in understanding instruments’ proper names and functions. When OR team members use the proper instrument names when putting in requests for the SPD, this can significantly improve efficiencies by eliminating guesswork and ensuring staff members in both departments are on the same page regarding needed instrumentation.
What follows are examples of notable surgeon/inventors and the instruments they created:
• Dr. John Bookwalter III is responsible for several notable instruments, one of which is the Gelpi retractor (a device OR and SP professionals routinely use and manage). Bookwalter also had a focus on self-retaining retractors, which led him to develop the Bookwalter retractor after a late night in 1964 when he had to hold a retractor during an emergency surgery. While serving in the U.S. Army, he finalized his self-retaining retractor – a device that would give full exposure and prevent his residents from having to hold retractors for lengthy periods of time. At the time, he was working with Codman and Shurtleff on a pistol-grip needle holder, and he introduced the concept to the manufacturer and the company’s engineers. Although it was a cumbersome device, this creation decreased surgical time for the patient and increased the surgical exposure for the surgeon.
• Dr. Michael Debakey is widely known for many of his innovations in cardiovascular surgery, but his many contributions to medicine are still appreciated decades later. His many awards for his contributions include the Presidential Medal of Freedom, the National Medal of Science and the Congressional Gold Medal. Additionally, there are numerous institutions named after him. Debakey was the pioneer for the prestigious Baylor School of Medicine. He is known for developing surgical techniques and procedures, including the carotid endarterectomy. He was also among the first to perform an open-heart procedure and was the first to use grafts for vascular procedures designed with Dacron grafts he sewed on his wife’s sewing machine.
Many know Debakey for the forceps designed to assist with the exposure of vessels (without crushing or damaging the walls of the vessel itself). He also developed several clamps, again designed to avoid damaging delicate tissues and vessels. He will also be forever known for his development of the roller pump, which would later be developed into the heart-lung machine used in cardiology procedures. Debakey served in the U.S. Army and was instrumental in developing the mobile Army surgical hospital (M.A.S.H.) units, which would station medical and surgical staff closer to the front lines and increase the survival rate of wounded soldiers in the Korean War. His contributions to the surgical field will be taught and used for decades to come.
• Another notable inventor was Dr. Gavriil Ilizarov, an orthopedic surgeon based in Kurgan, Siberia. During his residency, he developed an external fixation system for the less-invasive treatment of bone fractures. By inserting pins into the proximal and distal portions of the fracture and affixing the pins to an external means of support, the fracture was stabilized and allowed time for healing. He soon discovered that with the gaps at the fracture site, bone healing would occur, creating a healing effect without an internal fixation approach. From this observation, Ilizarov discovered that an external device could help non-unionized fractures heal through surgical intervention. By carefully severing a bone (without severing the periosteum around it), one could separate two halves of a bone slightly and fix them in place; the bone would then fill in the gap. He further discovered that with this approach, the bone could grow in length as the bone matrix intermingled. Ilizarov was able to help patients with traumatic injuries that created improperly aligned bone fracture unions, or patients experiencing bone loss or bone deformities.
Conclusion
Learning about instrumentation used in patient care is valuable and I believe all SP and OR professionals can benefit from learning the history of the inventors and some background of the instruments’ development. I encourage every SP and OR professional to broaden their instrument knowledge, so they can align their requests and expectations and, ultimately, better serve their patients.
– Tony Thurmond, CRCST, CIS, CHL, FCS, serves as central service manager for Dayton Children’s Hospital. He is also a past-president, fellow and columnist for the Healthcare Sterile Processing Association (formerly the International Association of Healthcare Central Service Material Management).
