CIS Self-Study Lesson Plan
Lesson No. CIS 232 (Instrument Continuing Education - ICE)
Sponsored by:
Computerized Instrument
Tracking Systems
Learning Objectives
1. Describe benefits and challenges of (CSSD). Tracking systems can be as simple as pen and paper or as sophisticated
computerized instrument tracking as computer systems that inform the operating room (OR) charge nurse about in-
systems
2. Explain how computerized instru-
ment tracking systems can, if pre-
ferred, be phased into a Central Sterile
Supply Department
3. Discuss the reports that can be gener-
ated by a computerized instrument
tracking system
Instrument Continuing Education (ICE) lessons
provide members with ongoing education in
the complex and ever-changing area of surgical
instrument care and handling. These lessons are
designed for CIS technicians, but can be of value
to any CRCST technician who works with surgical
instrumentation.
Earn Continuing Education Credits:
Online: You can use these lessons as an in-service
with your staff, or visit www.iahcsmm.org for online
grading at a nominal fee.
By mail: For written grading of individual lessons,
send completed 15-question quiz and $15
to: PEC Business Office, Purdue University, Stew-
art Center Room 110, 128 Memorial Mall, West
Lafayette, IN 47907-2034.
Scoring: Each 15 question online quiz with a
passing score of 70% or higher is worth two points
(2 contact hours) toward your CIS re-certification
(6 points) or CRCST re-certification (12 points).
IAHCSMM provides online grading service for
any of the Lesson Plan varieties. Purdue University
provides grading services solely for CRCST and
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More information: Direct any questions about
online grading to IAHCSMM at 312.440.0078.
Questions about written grading are answered by
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by Lynda Balcerek, CRCST
Formerly OR Support Assistant
Community Memorial Hospital
Menomonee Falls, WI
I
nstrument tracking systems are a part of every Central Sterile Supply Department
strument availability for the surgeries as the procedures are being scheduled. This
lesson will explain the benefits and challenges of Computerized Instrument Tracking
Systems (CITS), explore the types of CITS currently available, and review the types of
reports they can generate.
CITS Benefits CSSD managers using computerized
Users of a CITS know where all instru- instrument tracking can simplify the
ments and sets are all the time. Therefore, training that is required. For example,
when a surgical procedure is added, the new employees can easily learn how to
location of a specialized instrument need- use the program and identify the instru-
ed for the case can be easily and quickly ments being tracked by it. Also, current
determined. If the required instruments employees can learn to identify new
are in use for another case or cannot be instruments more quickly.
processed before the case is scheduled A CITS provides legible labels for
to begin, the added case may need to be wrapped instruments. Instruments can be
delayed or the instrument will need to misplaced if their labels cannot be read,
be cleaned and immediate-use sterilized and a computer-generated label will be
(flashed) if the added case is emergent. easier to read.
Specific sets can be identified as having Instrument tracking reports can be
been used on a specific patient. Then, if a generated with just a few clicks of the
recall needs to be implemented, this will computer mouse. Results of biological
eliminate the need for many patients to indicator testing, lists of incomplete sets
undergo unnecessary testing. This, in from the previous day, and sets requiring
turn, saves the hospital in lab test costs maintenance are examples of the reports
and the time required for notifications. that can be easily produced. Each is
Inventory optimization is enhanced important for the day-to-day operation of
when a CITS is in place. Certified Instru- an efficient CSSD.
ment Specialist (CIS) technicians can Managers can use the CITS to monitor
manage instrument maintenance and the productivity of instrument processing
repairs because the system tracks usage. employees. Does the production line slow
The system can also maintain applicable around one person? Are staff members
information about warranties and the taking excessive breaks? The answers to
useful life of each specific instrument. these and related questions are helpful to
 CIS Self-Study Lesson Plan

monitor the quantity of processing out-

put and to provide for accurate employee
evaluations.
One significant benefit to the use of a
CITS can be a reduced need for imme-
diate-use (flash) sterilization. When a
comprehensive CITS is in place, CSSD
employees are notified by computer when
a surgery case is added. This improved
communication helps the CIS techni-
cians plan their work to best ensure that
instruments will be sterile and available
in the surgical suite before the procedure
begins. Knowing which instruments most
frequently require immediate-use ster-
ilization may be helpful in justifying the
purchase of additional instruments.

CITS Challenges
One challenge to using CITS is the mas-
sive disruption to the work load as the
system is implemented. For example, the
laser etching systems used with fully auto-
mated tracking systems that scan at every
station require a two dimensional matrix
“dot” code that is permanently applied to
the instrument. Therefore, every set and
individual instrument will need to be
opened so the matrix dot can be applied.
A system using bar codes will also require
that every processed set be opened. Some
companies’ software programs are only
able to scan bar codes on sets rather than
the dot codes on individual instruments. This CIS technician scans a bar code to bring up a computerized count sheet.
It’s important to know which system will
work best for the hospital before a track- tained. The CITS can be backed-up with Implementing Computerized
ing system purchase is made. the facility’s emergency electricity system. Instrument Tracking Systems
Organizing instrument storage areas Alternatively, another type of manual In the first phase of implementing a fully
before implementation of the CITS will back-up system will be needed to manage computerized instrument tracking system,
make the start-up process flow more instruments if power outages occur. a computer will be installed at each set
smoothly. A complete inventory will The cost of the CITS must also be con- assembly station. The company installing
be a good place to start. Grouping the sidered. Companies offering CITS often the computer program will require a copy
instrument by surgery types (for example, sell them in modules that build upon of a count sheet that lists every instru-
orthopedic, neurological and laparoscop- one another, and this makes it easier to ment required for a set, and it can include
ic) will make this process go faster. budget for the cost of the total system. An photos and assembly instructions for
All computer systems are vulnerable example of this process is discussed in the each instrument inside the set. Specialty
to power outages. The tracking system next section. instruments will comprise their own sets
currently in use will need to be main- and are then treated like all other sets.
 CIS Self-Study Lesson Plan

When the system is operational, the

CIS technician scans the bar code or the
matrix dot. Many software programs
also allow the CIS technician to type in
the name of the instrument tray into the
computer. The scanning process under-
taken by the technician brings the count
sheet, photos and set assembly instruc-
tions on the computer screen along with
the instrument’s name and catalog num-
ber and quantity of instruments needed.
The technician can then assemble the set
while closely following instructions, print
the count sheet, and send both to the
sterilization station.
If an instrument or implant is missing
(for example, an implantable screw from a
trauma orthopedic set), this can be noted
on the computer, and it will be included
As instruments sets in the sterilizer load are scanned, the CITS is updated.
on the next day’s report. When shared
with surgery department personnel, the
sales representative can be contacted to indicate the exact location of the set, even
request that the set be filled. if it is in the wrong place.
Before installing the next level of a A complete CITS is even more compre-
CITS, a full inventory of all sets and hensive than the above-described system
instruments will be required because the and includes the placement of scanners in
tracking system to be used can only be the surgery department so specific trays
accurate if the inventory is accurate. can be scanned for particular procedures.
The next phase in implementing a For example, the system will indicate that
CITS is to place scanners throughout the Dr. Smith used general tray #6 on patient
entire CSSD. When the instruments reach Jane Doe. If there was a problem with the
decontamination, they are scanned, and sterilizer that created a load recall, the
the screen will display any special wash- OR charge nurse will be informed that
ing instructions. For example, sagittal general tray number six was used by Dr.
saws must be manually washed. After Smith on Jane Doe. Only Ms. Doe will
the washing process, the instruments need to be notified. The system works
are scanned at the assembly station. The in reverse, as well: if it is discovered that
same program discussed above is used for patient Jane Doe has a disease, such as
set assembly. CIS technician using a computerized count sheet to Creutzfeldt-Jakob Disease (CJD), then
When the sets are put onto the rack assemble a set. only those patients on whom general tray
to go into the sterilizer, they are again #6 was used in their surgery will need to
scanned, and any specific sterilization vides a quick and legible documentation be notified.
instructions will be shown on the screen. of each sterilizer’s load. When selecting a CITS, it is important
This information can then resolve any When the load is released, the scanning to ensure that the tracking system can
confusion about, for example, which continues. The shelf space where the set interface with the OR scheduling sys-
scopes must be placed into the ethylene is stored will have a bar code or a matrix tem. This is vital to guarantee the most
oxide (EtO) load and which can go into dot, and it will be scanned when the set effective communication between the
the steam sterilizer. This scan also pro- is placed in storage. The CITS will then two departments. Knowing when cases
 CIS Self-Study Lesson Plan
are added or canceled and when surgery
times are changed is essential to plan and
organize work in the CSSD. As well, link-
ing the scheduling system to the physi-
cian’s preference card and the CITS allows
OR personnel to know the location of
applicable instruments when a schedule
change occurs.
A CSSD facilitator will be valuable
when the CITS is implemented. This
person serves as a within-facility liaison
between the computer software company
and the CSSD. He or she will interact
with the company to organize the
implementation process, assist with
training and answer questions, such as
how to input information about new
instruments after the initial implementa-
tion is completed.
CITS Reports
Even the most basic CITS can generate
many different reports, and it may take
some time to determine those which
will be most useful for the CSSD and the
hospital.
Daily reports about pending biological
indicators are important. Every morning,
this report can tell the CIS technician
working the sterilization station which
biologicals must be read. If a biological is
positive, one click of the computer mouse
will pull up what was in that load so the
recall can begin.
An incomplete sets report facilitates
the replacement of missing instruments
and implants, and it is also a valuable
tool. Instruments are misplaced for many
reasons, and it is always important to have
complete sets available.
A set maintenance report tracks the
number of uses for each set. It indicates
the number of remaining uses before a
set must be sent for general maintenance.
Normally, when there are less than five
remaining uses, the set should be sent for
maintenance.
In Conclusion
CITS offers many benefits, including the
comprehensive accounting of all instru-
ments and the generation of numerous
helpful reports. Many CSSDs implement
a CITS in phases to better manage costs
and time requirements, and to resolve
any implementation challenges in an
organized manner.
Acknowledgments
The author wishes to thank Tim Neubert, Carol
England and Jamie Molina of Aesculap Inc.
Additional Reading
Julie E. Williamson. Tracking Real Progress:
Scalable, Integrative Solutions Push Instrument
Tracking To New Heights. Healthcare Purchasing
News. February, 2009.
Lynda Balcerek. Instrument Marking Systems.
CIS Lesson 229.Communique. Jan – Feb, 2012.
Lisa Waters-Davis. Protect your Patients and
Facility With Instrument Tracking. SurgiStrate-
gies. Feb 18, 2009.
IAHCSMM acknowledges the assistance of the
following two CSSD professionals who reviewed
this lesson plan:
Lisa Huber, BA, CRCST, ACE, FCS; Sterile
Processing Manager, Anderson Hospital,
Maryville, IL
Paula VaNdiver, CRCST, CIS, CS Technician;
Orthopedic Specialist, Anderson Hospital,
Maryville, IL
Instrument Continuing Education (ICE) lessons
provide members with ongoing education in
the complex and ever-changing area of surgical
instrument care and handling. These lessons
are designed for CIS technicians, but can be of
value to any CRCST technician who works with
surgical instrumentation.
You can use these lessons as an in-service
with your staff, or visit www.iahcsmm.org for
online grading at a nominal fee.
Each lesson plan graded online with a passing
score of 70% or higher is worth two points
(2 contact hours). You can use these points toward
either your re-certification of CRCST (12 points)
or CIS (6 points).
Mailed submissions to IAHCSMM will not be
graded and will not be granted a point value (pa-
per/pencil grading of the ICE Lesson Plans is not
available through IAHCSMM or Purdue University;
IAHCSMM accepts only online submissions).
CIS Self-Study
Lesson Plans
Technical Editor
Carla McDermott, RN, ACE,
CRCST
Clinical Nurse III
South Florida Baptist Hospital
Plant City, FL
Series Writer/Editor
Jack D. Ninemeier, Ph.D.
Michigan State University
East Lansing, MI
IAHCSMM is looking for volunteers to
write or contribute information for our
CIS Self-Study Lessons. Doing so is
a great way to contribute to your own
professional development, to your
Association, and to your Central Sterile
Supply Department peers.
Our Team will provide guidelines
and help you with the lesson to assure
it will be an enjoyable process. For more
information, please contact Elizabeth
Berrios (elizabeth@iahcsmm.org).
 Sponsored by:
CIS Self-Study Lesson Plan Quiz -
Computerized Instrument Tracking Systems
Lesson No. CIS 232 (Instrument Continuing Education - ICE) • Lesson expires July 2015

1. Which is a benefit of a CITS? 7. A full inventory of all instruments and sets 12. During the first phase of CITS imple-
a. Identify location of sets is necessary for an accurate CITS. mentation, computers will be installed in
b. Inventory optimization a. True be installed in each set assembly station.
c. Legible labels for wrapped instruments b. False a. True
d. All of the above b. False
8. When sets are placed on rack to go into
2. A CITS _____ simplify the training process. the sterilizer, they are scanned, and 13. CITS can report the results of biological
a. Can any specific sterilization instructions will indicator testing
b. Cannot be shown. a. true
a. True b. false
3. CSSD managers can use a CITS to track b. False
the productivity of their employees. 14. CITS help to justify the purchase of
a. True 9. The CITS will not be able to locate a set if additional instruments
b. False it has been placed in the wrong sterile a. True
storage area. b. False
4. Which is a challenge to the use of a CITS? a. True
a. Reduced need for immediate use b. False 15. Which type of system requires that each
sterilization set and instrument be opened when a
b. The availability of numerous tracking 10. Purchasing a CITS that will interface with CITS is implemented?
reports the OR scheduling system a. Laser etching
c. Work load disruption during a. Improves communication between the b. Bar code
implementation departments c. A and B above
d. None of the above are challenges b. Gives CIS technicians guidance in d. None of the above
managing work loads
5. Manual back-up systems are not c. Surprises the CSSD with instrument
necessary when a CITS is in use. requests
a. True d. Both A and B
b. False
11. CITS can produce which of the following
6. What information is contained in a reports?
computerized count sheet? a. Loads that are recalled
a. Instruments needed for the set b. Set maintenance
b. Photos of instruments c. Completed sets
c. Special set assembly instructions d. Number of mouse clicks
d. All of the above

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