Cheron Rojo, Sterile Processing Department Educator at Children's Hospital Central California, first nominated Healthmark’s TOSI™ for the Excellence in Surgical Products Awards. Here, he talks about the impact this product can have on a facility.

November 17, 2010

Surgical Products: How did you learn about the TOSI and how did you decide it was a product you’d like to try out?

Rojo:I was first introduced to the TOSI test back around 2004 at a vendor exhibit booth. It was not much to look at, but something caught my eye; it was a device to test your washers. At the time there was nothing of its kind, and the concept of “If it is not clean, it is not sterile” made sense.

I put some of the samples in my bag and I took it with me. When I used the product for the first time, it did not turn. It wasn’t turning like the pictures said it would, and I thought the product didn’t work. I called tech support for the product and found that the product did not turn because the washers at the time had no detergent/enzyme coming through the lines, all the spray arms were plugged, the temperature was too high for the detergent/enzyme and the dilution rate was incorrect. How long had it not been working? Without this product, we would have continued to think our washer was operating at its full potential.

Surgical Products: How does using the TOSI benefit your facility, as well as others?

Rojo:Over the years, I have used and currently use the TOSI test as one of my tests when I was auditing facilities in my area. Every time, the results are accurate; telling me what is the issue. On one of my audits, the spray arms were put on incorrectly and were aimed at the walls of the chamber and there was no solution coming through due to huge air pockets in the lines.

The pictures shown were taken from an audit at one facility where the tests did not pass. The items with the test were blocking the arms from rotating, so the instrumentation in the chamber were not getting the impingement of the arms, and note that the peel pack on the top has a suture needle with it, which was also caught. The other items in the pictures plugging the arms were: suture booties, color code tape and seals from the original installation of the washer.  

In 2009, the first recommendation by AAMI was issued saying that you had to test your washers weekly, preferably daily. At our facility, we test our washers with the TOSI daily. Since we’ve started using TOSI, we have more support by our maintenance department. They can’t know every piece of equipment that detailed and a lot of times, they are kind of thrown in there to figure out what is wrong with the equipment, but they don’t know all the ins and outs of the machine – they know basic stuff. Now, when the test fails, our staff shows them the fail and it helps them figure out what it could be. Are the blades plugged? Is there air in the line when there’s no solution coming through?

Surgical Products: What does this product do for patient and staff safety, and infection prevention?

Rojo:If it’s not clean, it’s not sterile. A piece of tissue doesn’t become sterile tissue. If it goes into the body, even though it’s been sterilized, it’s still a foreign body and the body is going to react to that. If the blades are plugged and it’s not cleaned correctly and the staff happen to overlook that kind of stuff, that is a big deal.

And, it’s not just about patient care, but it’s about co-workers. If the instruments are not being cleaned, so there is no detergent, they come out with a blood smell – well, I’m touching that!

Surgical Products: What do you think was the biggest draw for your peers to vote for this product?

Rojo:I think since the AAMI recommendation, people are now very aware and educated to know that washers have to be tested. You have to see if they’re working correctly. People are starting to understand that it is very important to test your washers – as important as testing your sterilizers – and that’s why they voted the way they did.