Obsolescence Planning and the Value of ETCO

Part 1 of 2

The practice of equipment obsolescence planning is gaining traction with key hospital managers — especially those overseeing emergency rooms, operating rooms or sterile processing departments.

The reason is quite simple — the smartest department managers have a purpose and plan to win more than their fair share in each year’s annual equipment budget battle. We’re talking about a formal plan, with written arguments at the core of the document.

The best plans also include an especially important section related to enhanced total cost of operation, or ETCO. The point of ETCO is to increase the efficiency of the installed equipment by reducing unnecessary down time and stopping unnecessary service request calls to manufacturers.
This section of a skilled manager’s equipment obsolescence plan will provide a competitive advantage over other equipment requests at budget time.

Five solutions to help hospitals utilize the power of ‘Big Data’ analytics

The medical world is making a large shift toward “big data” to make faster, more informed and accurate decisions. Big Data is defined as chunks of information too large or complex for traditional databases to handle. Every day, doctors, nurses, technicians and hospital administrators are flooded with information. Data about patients, trends, outcomes, equipment, technology and more.
In such an information-saturated environment, it would be easy to become overwhelmed. A report on big data from Healthbox, a Healthcare Information and Management Systems Society (HIMSS) solution and advisory firm, acknowledges as much.
“The sheer volume, velocity and variety of data being collected poses challenges for harnessing and ensuring its validity to benefit both the macro, population-level health and the micro, evidence-based precision medicine,” says the report.
Translated: It’s hard for any one person in the health system to keep up with, much less analyze, the enormous volume of data being generated day in and day out from so many sources – medical devices, wearables, electronic health records, medical imaging, genomic sequencing and pharmaceutical research, just to name a few.
Fortunately, there are powerful tools available for hospitals that not only collect critical information, but also can cut through the mountains of data and make it usable for clinical and business decision making. Keckler Medical provides leading “big data” technology solutions to assist acute care hospitals overcome these challenges throughout Northern California and Nevada.

Like most industries, health care is moving toward big data solutions. These systems help clinical teams and administrators make more informed, more accurate and faster decisions to achieve safer patient outcomes while improving room utilization and workflow efficiencies to save the hospital money. And at the administrative level, it is a huge advantage to have this real-time data at their fingertips.

An article in the January 2018 journal of NEJM Catalyst suggests there are two trends at play pushing the healthcare industry to embrace big data.
“The first is the move from a pay-for-service model, which financially rewards caregivers for performing procedures, to a value-based care model, which rewards them based on the health of their patient populations,” the story says, adding that “healthcare data analytics will enable the measurement and tracking of population health, thereby enabling this switch.”
The second trend, according to the story, “involves using big data analysis to deliver information that is evidence-based and will, over time, increase efficiencies and help sharpen our understanding of the best practices associated with any disease, injury or illness.”
Keckler offers its customers multiple big data and video integration systems that allow hospitals and other healthcare facilities to more accurately manage and utilize their data and video records. Here are five examples:
  1. Skytron LENS (Location Enabled Notification System) Real-Time Location System (RTLS):  Manage assets with ease and track potential infections.  An asset-tracking system and a workflow enhancement system that many staff members within a hospital can utilize.  Infection control is vital in a facility.  This system allows you to access interaction history between patients, staff and equipment to contain infectious outbreaks.  You can pinpoint exactly where a piece of equipment is located in the facility as well as examine the workflow of staff and patients.  It can improve efficiencies by tracking a stretcher as soon as it enters the operating room. The surgeon would get a notification to be in the room in the next 10 minutes. It can also pinpoint the precise location of a piece of piece of equipment that is due for preventive maintenance to save the biomedical engineer perhaps an hour trying to track down the item in the hospital. Designed to boost productivity, improve workflow and lower equipment costs.  
  2. SkyVision Intuitive Hub – Content Media Management System: This system can capture, archive and stream all video from operating rooms or other procedure environments. Doctors can record, store, share and collaborate with other physicians on videos and images with this innovative solution.  A doctor can be in the middle of a procedure and send a link via the Cloud to another physician 50 miles away and say, “Here’s what I’m looking at. What would you do?” Or a training hospital can have a room full of students watching the procedure, either live or later as part of their lessons. You can enhance surgical quality and patient outcomes through review and analysis.  
  3.  SkyVision Ascend Video Integration System:  This intuitive system allows staff to easily route images from any compatible device, allowing you to see what you want, where you want it.  Simple to Use; Access Stored Media from Anywhere; Communicate Audibly and Visually through SkyVision; Simple Installation; Reduced Footprint; Vendor Neutral
  4. Umano Medical Wi-Fi Bed Connectivity: Umano is a leading manufacturer of hospital beds. The newly added wi-fi connected technology allows multiple pieces of patient data to be collected from the bed itself to “talk” with computers and handheld devices, allowing for continuous and easier patient monitoring. It’s all about bed connectivity to enhance workflow and provide superior patient outcomes.

Our team prides itself on solving complex problems

J.M. Keckler Medical Company’s founders started the company 50 years ago and quickly gained traction by providing a higher level of attentiveness and service than their customers were accustomed to. Mike and Susie Keckler called on healthcare professionals in the morning and then personally delivered that day’s orders in the afternoon.

Since that modest start, the company has grown steadily and today is recognized throughout California and Nevada as a leader in the medical equipment industry. Among many other things, Keckler Medical is respected and admired for our unique ability to successfully solve time-sensitive complex problems.


Humility, Honesty and Hard Work

Mike Keckler’s approach to problem-solving sets the standard for every company employee who interacts with customers. When he meets with decision-makers to discuss an issue they’re facing, he always frames the conversation this way: “I don’t fully understand your problem right now. But I will. And I will contact you tomorrow with a proposed solution.” And then, he listens — intently.

The Keckler Medical team has learned it develops the most effective solutions when it starts by being humble and honest in determining an organization’s needs and our ability to meet those requirements.

From that basis of deep understanding, team members work hard to deliver the required products and services on time and within budget – regardless of the challenges faced along the way. Keckler’s “listen-assess-act” approach has another proven benefit — it reduces stress and creates confidence in all stakeholders. The sense that Keckler truly “has the back” of people and organizations whose reputation is on the line is why so many healthcare providers turn to us again and again.

Investing in Prompt, Effective Solutions

Every company promises “prompt solutions,” but Keckler Medical invests in them. We understand that when you need service on your equipment, you don’t have the luxury of waiting for a technician to make multiple trips between our warehouse and your facility. That’s why we enable our team members to complete more service calls on the first visit.

It’s also why we stock our vans with the most commonly needed tools, parts and supplies. There is a high cost to maintaining that kind of inventory, but it’s an investment that pays tremendous dividends for our customers.

Keckler also enables fast, comprehensive solutions by ensuring that our technicians are highly trained and fully certified. Plus, they spend many hours shadowing our experienced employees. And just as important as teaching technical skills, our training program instills in our employees the notion of grace under pressure. When a customer encounters problems that cause other companies to step away, we step up.

“I can recall several situations throughout our history when, through no fault of ours, serious issues occurred,” says Mike Keckler. “One, in particular, had a Keckler executive angry that we’d been put on the spot by another company’s mistake. My comment to him was something we’ve proven repeatedly: ‘When difficult circumstances arise, we’re at our best.’ We take pride in that fact, and our customers take comfort in it.”

With J.M. Keckler Medical, your challenge is our challenge; your urgent need is our urgent task. And that’s not marketing speak — it’s a fact. We call it “attentive service.” Our 50 years of successful business demonstrate that we prioritize long-term relationships over short-term profits. All it takes to confirm that assertion is working with Keckler Medical on one project.

Hiring great people, treating them well defines our philosophy

As much as many people like to analyze the factors that allow any company to become known as a great place to work, much of what makes the biggest difference is common sense – hire good people, train them well, offer compensation programs that allow them to make a reasonable living, and support and respect their lives outside of the workplace.

That’s what we’ve tried to do for the past 50 years at J.M. Keckler Medical Co. And while we don’t pretend to judge what other organizations do, we are proud that our philosophy has created a culture and an environment in which people feel empowered and trusted, which in turn inspires their loyalty to us and their dedication to the very important services we provide to our clients

We are in the healthcare business, after all. We exist to help people. We are a service company whose mission is to partner with our customers, employees, suppliers and lenders to solve complex problems related to capital equipment sales and service in the acute care industry.

So how do we do that? It starts with our people. There are countless ways we try to create a positive environment and workplace culture for our employees, from formal programs to informal (but just as powerful) human connections. Some of them include:

• Competitive pay and benefits. This isn’t the only or best way to show our gratitude to employees, but it is essential that we ensure they can provide for their families.

• Comprehensive technical training. From onsite technicians to sales reps to administrative staff, everyone in our company understands the products we represent. And with that knowledge comes confidence that helps our team perform well under pressure.

Autonomy. While teamwork is essential to providing exceptional customer service, we encourage our employees to be critical thinkers who don’t hesitate to make important decisions. We’ve trained them and we trust them.

• Life skills. Whether in a classroom setting or a casual conversation, we share helpful, practical knowledge in a friendly, non-judgmental way when, where and with whom it will be most beneficial.

• The J.M. Keckler Medical compensation “matrix.” Each employee has different needs from their employment package. That’s why we’re studying a program where team members can customize their compensation by selecting options that best address their needs — including things like pay, benefits, paid leave, insurance and more.  

Doing it for the Right Reasons

We’ve never applied to any of the numerous “great place to work” competitions. We’ve steered clear of them not because we don’t think we match up well, but because that’s not why we do what we do.

We care about our employees and our customers — it’s as simple as that.

Creating a positive work environment enables us to attract and retain the most talented and dedicated people in the business. Our team of healthcare champions have allowed us to establish and maintain relationships with some remarkable healthcare organizations throughout Northern California and Western Nevada. If there’s anything self-serving about our efforts in this area, it’s that they ensure we get to work and interact every day with happy and invested people!

Grateful Employees go the Extra Mile

Most people would agree that business owners have an obligation to their employees to create workplaces that are positive, and enjoyable. It’s the least we can do for the people who give so much of themselves to help the company succeed.
At J.M. Keckler Medical Co., we also believe we have an obligation to our customers to make our company a great place to work. Some may not immediately appreciate that connection, but it’s always been obvious to us.
We recognize and appreciate our employees’ hard work and dedication, and they make it clear that they’re grateful for our positive work environment. One of the ways they show this is by regularly going above and beyond for our customers.
Here is one example that reflects the Keckler Medical spirit:
“We got an urgent weekend call from a hospital administrator about problems with newly installed sterilizer equipment that absolutely had to be operational when their new facility opened on Monday morning,” recalled company owner and founder Mike Keckler. “Most companies would have committed to being there at the start of the next business day — at best. Our technicians took pride in Keckler’s reputation for stellar service and chose to arrive at 4 a.m.
“Just eight hours after we received the desperate administrator’s phone call, our technicians diagnosed the problem and completed the work in time to ensure the hospital and its understandably stressed administrator came out looking great and feeling grateful for the outstanding effort.”
Creating a Great Place to Work is Intentional
We are proud to say that we recruit, thoroughly train and fully support the best people in the medical equipment industry. Still, great employees can do an even better job of serving our customers in a culture where we put their best interests first.
Providing competitive pay and benefits is a given for any business that aspires to become a great place to work. But we believe it’s more than money that truly separates the best employers.
People who genuinely want to do good work and help the company achieve its business goals can be worn down by common workplace issues. A lack of opportunity for advancement, little or no recognition of jobs well done, poor internal communication and “corporate politics” can undermine and wreck morale.
And then there are issues that straddle the line between work and personal life. For example, a lack of money management skills and the associated financial struggles can cause employees to feel anxious or depressed. As a result, they may be unable to meet the work quality standards the company sets for them or that they set for themselves.
These challenges are why we consistently look for ways to improve our workplace — for our employees and, by extension, the customers they serve. Across all our departments — sales, service, logistics, customer care – our employees receive extensive and ongoing training from manufacturers on the equipment we sell and service. Keckler employees are lifelong learners who pride themselves on keeping up to date on all the changing technology. We believe the experience, industry knowledge and empathy that our employees bring to any situation involving medical equipment sets our company apart from the competition.
We also view our investments in our team members as absolutely vital to assuring that they will ultimately provide the very best service for our customers.
Ours is not the only way to do business, but we believe it’s a fundamental reason that J.M. Keckler Medical Co., Inc. has succeeded for nearly 50 years. We believe it takes high-quality people to deliver the high-quality healthcare millions of people in California and Nevada expect and deserve.

Planning a building project? Here is info you should know

Facilities directors, project managers and others associated with construction at hospitals and other medical facilities in California know there are a myriad of rules associated with those situations as well as a thicket of state and other agencies to enforce them.
Staying on top of building projects – whether it’s adding on to an existing facility or constructing something from the ground up – is a full-time responsibility. It’s critical that things are handled properly – to keep projects on time and on budget, and to ensure that patients can efficiently access and receive the high-quality healthcare that every facility seeks to deliver.
Sometimes, J.M. Keckler Medical Co. sales representatives are drawn into conversations about facilities needs and construction when they are discussing what is required for the installation or replacement of fixed equipment.
With that in mind, Project Manager, Stacey Seward, who has been with J. M. Keckler Medical for over 30 years, put together some common questions and a list of resources to seek answers to help his co-workers and their clients.
“I compiled the information so it could be provided to customers and our employees for clarification on when and what is required for construction,” Stacey explained. “The expectation is that we would provide a reference guide or road map for our customers and employees to use when evaluating the probability of construction for projects.”

Here are some frequently asked questions along with links to websites that provide clarity about what is required in various situations:

1. How do I determine if my planned project is under the jurisdiction of OSHPD / HCAI (the California Department of Health Care Access and Information)?  After determining the scope of the project, those in charge should consult with the OSHPD Compliance Officer prior to starting construction. The compliance officer will verify that the project is eligible for the FREER program, and determine which FREER options are available. There is a 48-page FREER manual available online that addresses building-related questions.

2. Should I use an architect or engineer when considering equipment upgrades at my medical facility? You should always consult a design professional such as an architect or engineer when considering a replacement of capital equipment. 

3. How should I respond to a manufacturer or supplier that tells me I don’t need OSHPD / HCAI involved or permits with upgrades to our operating room lights, boom or our SPD equipment? Ask the manufacturer / supplier to provide a scope of the project to install the new equipment, then refer to OSHPD/FDD New FREER Manual for clarification. https://hcai.ca.gov/wp-content/uploads/2020/10/FREER-Manual.pdf

4. Where can I find out information about OSHPD / HCAI? The following link provides information about OSHPD / HCAI, including their available resources: https://hcai.ca.gov/construction-finance/eservices-portal-information/#user-guides

5. Is it difficult to become a registered user for my projects at OSHPD / HCAI? They provide a user guide on how to use their HCAI Services Portal Client Access (eCA) User Guide https://hcai.ca.gov/wp-content/uploads/2020/10/Section-1-System-Overview-1.pdf

6. Where would I get a building permit application? This is the link to the online application form: https://hcai.ca.gov/wp-content/uploads/2020/10/HCAI-FD-302-Application-for-Building-Permit.pdf

 This is the link to the application for new projects: https://hcai.ca.gov/wp-content/uploads/2020/10/Section-5-Applications-for-New-Projects-1-1.pdf

7. How do I determine if my planned project is exempt from the permitting process? Here is a link to that information: https://hcai.ca.gov/wp-content/uploads/2020/10/PIN-36-Projects-of-50k-or-Less-Exempt-From-Plan-Review.pdf


The 6 Critical Steps to Managing Obsolescence

Stacey Seward has more than 30 years of experience in the medical equipment industry. He is highly regarded as a project manager at J.M. Keckler Medical Services, Inc. When it comes to keeping up with regular maintenance and planning for obsolescence, Steward has this advice for clients: “If you don’t schedule necessary maintenance or replacement, your equipment will schedule it for you.”
Healthcare organizations that effectively plan to manage obsolescence have two major advantages over competitors.
First, they experience fewer schedule disruptions due to equipment failures and avoid the associated consequences, from lost revenue to unhappy patients. Second, everyone who can be affected by those failures — from procurement departments to repair technicians to care teams — enjoys a more stress-free environment.
Today, in the last of our three-part series on obsolescence, we’ll discuss the six crucial steps every hospital, surgery center or clinic should take to properly manage obsolescence.

  • STEP 1: Create a system for recording information on your equipment. Whether you use a spreadsheet, database or some other tool, you must record important information about your equipment — things like the dates it was manufactured, implemented and most recently serviced; your preventative maintenance records; and manufacturer-announced obsolescence-related dates, etc.
  • STEP 2: Identify an acceptable level of obsolescence. It is virtually impossible to avoid having certain assets reach obsolescence before you take action. However, some devices may not be as critical to your operations as others. It’s crucial to decide where to focus your equipment management efforts.
  • STEP 3: Create a schedule for equipment risk analysis. The frequency of this review — monthly, quarterly, annually — will vary based on the type, condition and age of your equipment, and other factors. However, you must perform reviews when the scheduled dates arrive. It’s too easy to say, “I’ll revisit the spreadsheet when work slows down a bit,” and find months or years later that you never found or made the time to do so.
  • STEP 4: Keep spare parts and manuals for equipment in one central location. When you encounter a problem with a piece of equipment or get notifications about it, you should be able to determine your next steps quickly.
  • STEP 5: Involve everyone in obsolescence management. You might have one person or a committee lead your obsolescence management efforts, but everyone in your organization should play a role. Sharing anything from observations on how a piece of equipment is performing to news about OEMs announcing new products can be helpful.
  • STEP 6: Partner with a trusted product and service provider. It’s essential to work with a company like J.M. Keckler Medical that has five decades of industry experience, a skilled and agile workforce, strong relationships with leading OEMs and a track record of attentive service. We’re an invaluable obsolescence management resource to our customers. This includes serving as consultants to help facilities assess their equipment and develop obsolescence management strategies.

No obsolescence management strategy can guarantee a smooth transition from old equipment to new in every instance. Sometimes, equipment fails early and unexpectedly. But there is tremendous peace of mind and reduced risk of down time in having a plan for keeping teams equipped, and maintaining a relationship with Keckler for rapid response and resolution when problems arise.

Planning for the complexity of obsolescence

Obsolescence is not something that most people think about often. If the concept registers in their consciousness, it’s typically an awareness that, eventually, they’ll have to replace their smartphone or personal computer.
For healthcare professionals — particularly those responsible for keeping capital equipment like sterile processing systems and operating room tables working at a hospital, ambulatory surgery center or clinic — obsolescence poses a much more ominous threat.
If you fail to anticipate it and don’t take action, you can end up watching helplessly as operating rooms go idle and schedulers scramble to move procedures around. You may also have to face the anger and frustration of everyone from care teams to patients and their families.
In some instances, you may be able to find ways to keep obsolete equipment functioning for a limited time. However, those measures tend to be extremely costly. Consequently, healthcare organizations must understand obsolescence and implement processes for addressing it.
Today, in the second in a three-part series of blogs, we’ll discuss how to identify obsolescence in medical facilities.

Four types of obsolescence

Obsolescence occurs when machinery or equipment is “no longer in use or no longer useful.” There are multiple reasons why a facility may choose to stop using a piece of equipment. The four most common are:
  1. Technical obsolescence. This occurs when a piece of equipment can no longer be serviced or repaired due to changes in technology.
  2. Functional obsolescence. An asset is functionally obsolete when parts are no longer available and the manufacturer no longer supports it.
  3. Compatibility obsolescence. In some instances, a piece of equipment still functions correctly, but it can no longer be integrated with other, more advanced devices or systems.
  4. Regulatory obsolescence. Changes to regulations on equipment safety, energy efficiency, etc., can result in equipment being deemed obsolete.
Decision-makers must be proactive about keeping facilities properly equipped and preventing service interruptions.

Three stages of obsolescence

Fortunately for healthcare equipment procurement professionals, obsolescence doesn’t happen overnight. The end of a device’s useful life occurs in stages that vary by equipment type and maker, but typically include:
  1. Notification of pending obsolescence. The original equipment manufacturer (OEM) gives advance notice to equipment owners that they will no longer manufacture a device as of a specified date.
  2. Notification that parts will no longer be available. Even after an OEM no longer produces a device, you can still typically get replacement parts for it for several years. Manufacturers announce the date after which they’ll no longer provide parts.
  3. Notification of equipment “sunsetting.” In most cases, OEMs will specify a “drop dead” date, after which they will no longer provide support or assistance of any kind with old equipment.
OEMs provide these notifications to help healthcare organizations stay ahead of the obsolescence curve. However, you shouldn’t rely on those communications alone. It’s easy in busy environments to overlook these notices or read them but forget to take action.

You can protect your organization from the operational and financial consequences of obsolescence by developing a plan for managing it.

Next: In Part 3 of our series, we’ll talk about the six steps every hospital, surgery center or clinic should take to avoid being bitten by the obsolescence bug.

Obsolescence: Time can be an ally or adversary

Obsolescence can be a scary word for acute care hospitals, ambulatory surgery centers, clinics and other medical facilities. Obsolescence occurs when something doesn’t work or is no longer useful, and parts, services and resources are no longer provided by the original equipment manufacturer.
Today, in the first of a series of blogs, we’ll discuss what obsolescence is and the impact it could have on medical facilities.
The idea that a critical component in an operating room (OR), sterilizing processing department (SPD), lab or other key area can suddenly not function – and then be difficult to fix or replace – can be a nightmare for medical administrators. An empty OR, for instance, is an underperforming asset that can dramatically impact the bottom line of any facility.
Unfortunately, that scenario can be all too real in many medical settings.

Multiple costs to obsolescence

In any facility, equipment being obsolete or approaching an out-of-service date can cause a bigger disruption in patient care and overall performance. SPDs, for instance, are often considered the “heartbeat” of a hospital. Being able to efficiently sterilize surgical instruments will keep ORs humming while generating much-needed income. An OR that needs to be rebuilt can cost hundreds of thousands of dollars and many months or even years to complete, especially if key parts are delayed.
Whatever the reason, unscheduled down time related to obsolescence can be costly in multiple ways, further underscoring the need to plan ahead.
“Most facilities have back up surgical tables in the event one is down,” Keckler explained. “In contrast, if a hospital’s SPD is down, it is costly financially as well as in relationships with surgeons and patients. It can affect the reputation of a facility as well as patient satisfaction. Equipment must be operationally efficient in order to deliver quality patient care. The consequences of obsolescence are just endless.”

Next: In Part 2 of our series, we’ll discuss how to identify obsolescence in medical facilities.

Creating a great place to work

Many companies say they want to be recognized and respected as a great place to work. Far fewer live up to that lofty standard, for many different reasons. It’s easy to say, but hard to do.
What do some of those great employers have in common? If you think, “A good pay and benefits package,” you’re only scratching the surface. Great employers also actively listen to their employees and ask for feedback, then respond appropriately. They invest in them. They leverage their workforce’s years of been-there-done-that experience into processes that best serve customers – and drive profits.

At J.M. Keckler, Inc., we seek to empower our 24 mostly sales-and service-based employees and make them proud of where they have chosen to work. Since 1973, we have created a culture and environment in which our employees can thrive through ongoing training, new opportunities and challenges, and fair compensation and benefits – all while working for the premier supplier of cutting-edge medical equipment sales, service and technology solutions in the acute care Industry in Northern California and Nevada.

We are proud that the average employee has been with Keckler for more than 10 years. We believe their experience and industry knowledge sets our company apart from the competition.
During the pandemic, our employees were considered “essential workers” and have logged thousands of hours repairing and maintaining the vital life-saving equipment found in nearly every hospital in Northern California. When the virus touched us, we covered for team members until they were better. Most importantly, while other businesses struggled to maintain staffing, not a single Keckler employee was laid off.
“The No. 1 strength of our JMK team is the way we respond to time-sensitive, complicated and adverse business situations,” said CEO Mike Keckler. “COVID -19 has presented our greatest challenge ever. The way our team has responded, to a person, is the greatest example we can cite of dedication and commitment in our half-century of business.”

Do you recognize yourself in us?

While recruiting, hiring, and retaining people who embrace and carry out our customer-centric philosophy is the foundation of Keckler’s success, we also aspire to do business with like-minded organizations who share our principals and devotion to sound, ethical business practices and treating employees right. We believe our support of such companies helps create a virtuous circle of honesty, integrity and respect. And this is our commitment to and foundation for wanting to create and maintain a great place to work.
Success is not guaranteed. Even a business with a nearly 50-year track record like Keckler must continually adapt and find the resolve to essentially embark on a renewal mission. That’s one reason that over the past few months, our management team and employees have begun a fresh dialog about what it means to be a great place to work given the company’s operating history and current reality.

This blog – and those that follow – is intended to share our narrative as we take a proactive and perhaps predictive approach to maintaining a positive, supportive work environment. Future blogs will touch on the impact that it’s having on our employees, customers, suppliers and even lenders.

Don’t miss this moment of change

It is our belief that we are at a unique time in history; perhaps, by many measures, an inflection point for transformative change not seen in decades. There are many important factors at play:
  • The impact of technology
  • The evolving concepts of work, compensation and education
  • The balance between careers and family or leisure time
  • The prevalence of legal drugs and alcohol use
  • Even the way society views serious mental and physical health issues
All these factors as they are today and as they will shift into the future will have a dramatic impact on every operating business. And the shifts explained by our human nature are likely to proceed at a pace never seen in our global sphere of business.
COVID is not the source of these changes; rather, the pandemic has undeniably cast a bright light on workplace shifts already unfolding and perhaps bursting at the seams. Though we are just one small company in Central California, we believe our experience and the examples we set in collaborating with our employees to create a great place to work can inform – and possibly even inspire — other businesses to make even better choices in their own workplace cultures.
Not convinced? Here’s one more tangible reason why any business owner should want to create a “great place to work” environment. According to multiple national surveys by human resource experts, the average open position takes about seven weeks to fill and has a financial impact of $5,000 to $25,000 because of recruiting and lost productivity. Higher-level positions costs soar even higher within an organization. Constant turnover at all levels of the company, exhaustive recruitment and continuous training is bad for the soul of any business.

Wet Packs Prevention Protocol

Keckler Medical occasionally hears feedback from end users regarding condensate issues (wet packs) following sterilization. A wet load required that the sterilized materials be rejected and re-sterilized. This, in turn, can cause surgery delays and lost revenue in Healthcare settings.

Wet packs are the most difficult and complex technical issue to resolve in steam sterilization because of the numerous potential causes of excess condensation.

When working to identify the source of the problem, the following troubleshooting protocol is used by JMK based on over 40 years of experience.
Check the most common suspect first – steam quality.

JMK’s experience, along with that of numerous other sterilization experts, has shown that poor steam quality accounts for >95% of all wet packs issues!

Steam Quality

The first thing that end users must evaluate is the quality of the steam supplied to the sterilizer. Poor quality steam is defined as less than 97% (greater than 3% water content by weight) and can lead to excessive condensate formation within the sterilizer.
Things to check and evaluate:
  • Determine if excessive demand is being placed on the in-house boiler. Excess demand can cause carryover of water into the steam supply system
  • Examine the steam supply system for potential areas of condensate formation such as dead legs or improperly trapped or insulated piping
  • If the sterilizer is not physically close to the boiler, condensate will form and will need to be removed from the piping before the steam reaches the sterilizer. This is accomplished by properly located steam traps and filters along the route of the steam piping
  • Insulating the steam piping will help rescue heat losses and in turn reduce condensate formation.
  • Check the jacket steam trap and check valve at the drain port to ensure they are functioning properly.
If it is positively determined that the steam supply is not the source of excess condensate, the next step is to evaluate what is being loaded into the sterilizer.

Load and Load Configuration

Another potential cause of wet packs is the load itself. Overly dense packing is frequently a cause of excessive condensation which cannot then be completely “flashed off’ by subsequent steam injections. Large quantities of hard-goods or complex packaging can prevent proper steam circulation. Proper load packing procedures are thoroughly described by AAMI and should be followed.
When steam enters the chamber and contacts the product, the steam will condense on the product when a portion of its heat energy (latent heat of condensation) is transferred to the load being sterilized.
The resulting condensate will fall to the chamber floor and be discharged through the drain system. Proper removal of the excess water is crucial to prevent insulating the load from the steam.

Steam Quality

A wet pack in a clinical setting is a very serious issue. The wet load, by law, cannot be used and must be re-processed. This, in turn, causes the hospital or surgical center to fall behind in its daily routine. These inefficiencies are costly and often highly emotional.

In most cases the root cause of the wet loads is due to poor steam quality.

Often the end users believe their problems are due to a malfunction with the steam sterilizer itself!

Poor steam quality is usually caused by the inadequate design of the steam system, including the following factors:

  • Long piping runs from the in-house boiler to the sterilizer(s) with one or more “dead legs” (one temporary piping run was over 300 feet)
  • Lack of a bucket steam trap placed in the proper physical relationship to the sterilizer
  • Lack of a steam separator placed in the proper physical relationship to the sterilizer
  • Steam pressure not up to specification

This can be easily avoided if the proper attention to steam quality is provided early in the project (well before installation and start-up).

Again, discussions and agreements prior to installation will be the key to a well functioning sterilization process.

Other Technical Recommendations

Elevation wise, the separator should be mounted near but not above the sterilizer inlet with the trap line locating the bucket trap close to the floor. The bottom of the bucket trap should not be set below the drain line elevation.

Bowie Dick Testing – Part 2 of 2


The first step in troubleshooting is to verify that the vacuum system is performing properly.

  1. Have cycle parameters been changed to reduce the number of pre-vac or depth of prevacs?
  2. Vacuum pump seal water temperature must be below 70 degrees F.
  3. Water pressure to the ejector must be greater than 50 psig.
  4. Check for foreign material in the ejector.
There are two possible causes of a failed Bowie Dick test:
  1. Air not completely removed by pre-vac pulses
  2. Air leaking into chamber while under vacuum

The second step is a quick inspection of the most common causes of chamber leaks.

  1. Verify by independent test gauge that steam or air pressure to the seal gasket is set at 30-32 psig. Replace the gasket if worn or damaged. Use Dow Corning 111 silicone grease to lube the gasket.
  2. Inspect check valves common to the chamber for wear, damage, or foreign material that could be preventing a proper seal.
  3. Remove the air in filter and plug solenoid valve to verify that the valve is not leaking.
  4. Inspect for a loose pressure transducer.
  5. Remove and plug the chamber gauge and tubing.
  6. Verify that the RTD ferrule is not leaking.
  7. (While performing a vacuum test only!) Remove and plug the chamber safety valve to verify that the valve is not leaking. Replace the safety valve immediately and do not leave sterilizer unattended under any circumstances.
NOTE: Steam leaks to the chamber will not cause a Bowie Dick failure…only air leaks will!!!

The third step involves a chamber leak test.

Pipe fitting leaks (common during installation start-ups) often are due to the affects of transportation and handling. Vacuum leaks and pressure leaks are not the same! Looking for steam or condensate leaks while the chamber is pressurized is not a valid test for vacuum leaks.

If you need sterilizer service be sure to call Keckler Medical’s team of experts.

Bowie Dick Testing – Part 1 of 2

A Bowie Dick (BD) test is used to check for proper chamber air removal in vacuum steam sterilizers (commonly referred to as pre-vac or high-vac sterilizers). If the BD test passes, it tells the laboratory that there has been sufficient air removal to achieve required steam penetration into a standard load.

It is important to remember that Bowie Dick tests are not recommended for use in any other type of sterilizer!

The Bowie Dick test is designed to detect air pockets trapped within the sterilizer chamber. One and only one Bowie Dick test pack is to be run in an otherwise empty sterilizer.

Most hospitals routinely run one Bowie Dick test in each vacuum sterilizer each day. While not absolutely required, it is a good idea that the test be run at the same time each day after the sterilizer is warm. It is important the the test not be run in a cold sterilizer. If a sterilizer has not been used within an hour prior to doing the Bowie Dick test, the chamber should be preheated to operating temperature by running at least one empty chamber cycle. A test run from a cold start may produce false failures. The warm-up cycle will also ensure that any air is cleared out of the lines.

If a Bowie Dick test should fail, another Bowie Dick test should be run as a verification step. If the second test also fails, the sterilizer should be put out of service until the problem is identified and corrected.

Numerous manufacturers throughout the world make and sell Bowie Dick tests directly to end users and through several distribution channels. Each manufacturer uses the same basic process of placing heat sensitive inks onto the commercial paper in various patterns.

A Bowie Dick test failure is noted by the lack of a total uniform change to the final color as specified by the Bowie Dick test manufacturer.

For more information on Bowie Dick Testing or service give us a call.

Door Gaskets – Maintenance and Service

The function of the door gasket is one of the most important features in any steam sterilizer. Its primary function is to serve as the primary seal to contain steam within the sterilizer chamber.

The Care and Evaluation of door gaskets:

  1. Visually inspect the door gasket frequently looking for signs of wear such as cracks or abrasion and replace when necessary.
  2. If outward steam is present around the chamber door, this is generally a visual indicator that the door gasket is failing and should be replaced immediately.
  3. Visually inspect the door gasket to make sure it is retracting completely into the gasket groove. If the door gasket is either partially or not retracting into the gasket groove, a problem with the vacuum system (either vacuum water ejector or electric pump) could be the cause.
  4. If a sterilizer will not pass a vacuum leak test, a bad door gasket may be the cause.
  5. If during the sterilizing cycle, the sterilizer gains temperature and the steam to chamber valve is closed, an internal leak in the door gasket may be allowing steam to fill the chamber and will eventually cause an “Over Temperature Alarm”, replace the door gasket immediately.
  6. Make certain that the steam pressure from the sterilizer steam pressure regulator is set properly and will not overpressure the sterilizer door gasket.

The door gasket is considered a wearable item on the sterilizer and normal life is 3 to 12 months depending on service. The extreme variability in normal life is affected by steam quality (assuming steam actuated), material which ends up in the door gasket groove from spillage, mechanical abrasion from a partially retracted door gasket, and the number of cycles run.

For more information on door gaskets or service give us a call.

Did You Know? Wet Pack Prevention – Part 3 of 3 – Sterilizer Operation and Maintenance

Wet packs caused by machine malfunction are generally the easiest to identify and correct.


  • Ensure that the correct cycle was selected
  • Verify that cycle parameters have not been changed
  • Verify correct load size and load configuration as outlined in “Did You Know”
  • Follow the ANSI/AAMI ST79 Standard


  • Verify that jacket temperature is controlling at the chamber set point
    • Is the floor of the chamber hot? If not, you could have a malfunctioning solenoid valve or jacket trap
  • Check the door gasket for wear. Replace if necessary.
  • Insure the steam to chamber valve is not leaking

During maintenance, verify that the vacuum system is operational at 25″ -28″ HG

If the Vacuum is not in this range, then check the following:

Ejector Vacuum System

  • Verify water pressure is 50 PSI or greater
  • Check for foreign material in the ejector
  • Inspect the chamber drain check valve
  • Inspect the chamber drain control valve

Vacuum Pump System

  • Verify proper flow of seal water
  • Verify correct rotation of pump
  • Inspect the chamber drain check valve
  • Inspect the chamber drain control valve
  • Verify the seal water temperature is less than 70°F
  • Verify proper water flow through the heat exchanger

Generally, these steps will reveal the source of the machine malfunction.

Having problems with wet packs? We are here to help.

Did You Know? Wet Pack Prevention – Part 2 of 3 – Pack Types and Pack Configurations

When discussing wet packs it is helpful to review the various pack configurations and their unique susceptibility to wetness. There are four primary pack types:

1. Paper/Poly or Steri-Peel

2. Paper/Poly or Steri-Peel

3. Disposable Wrap

4. Rigid Containers

Rule #1

All materials to be sterilized must be dry when loaded in to chamber for processing. Moisture loaded into the chamber will not be sufficiently removed during the cycle.

Rule #2

Containers, large instrument sets, and basin ware should be loaded on the lower shelf. Steri-Peel, towel packs, and light weight packs should be loaded on the upper shelf. Containers and instrument sets should never be stacked.

Condensate is formed as steam gives up its heat to the packs. The amount of condensate is proportional to the weight of the load. While the load heats up to the set point, temperature steam converts to water, rains to the chamber floor, and is mostly removed by the chamber steam trap. Residual water is flashed back to vapor by the heated jacket and removed by vacuum during the drying phase. If heavy instrument sets are placed on the top shelf, the lower shelf will experience a rain storm. 15 lb. instrument trays will condensate about a cup of water while heating from 70° F to 270° F.

Rule #3

 Water likes to pool. Pooled water is the enemy of drying. Evaporation only takes place on the surface. A pool takes longer to evaporate.

Pools Inside of Packs
Are formed in closed end vessels not positioned to drain.

  • Basins
  • Eye Cups
  • Tubing
  • Cup Shaped Instruments
  • Small Trays

Rigid containers should be prepared with a muslin wrap in the bottom to wick moisture over a large surface area to enhance drying.

Pools Outside of Packs
These pools are formed by poor loading technique. Folds and creases of disposable wrap will hold and pool water. Care should be given to positioning these packs to minimize pooling.

Steri-peel should always be positioned on edge and separated in a rack (similar to a letter rack) to allow condensation to drip off the bottom edge.

Water droplets on the outside of Steri-peel or disposable wrap is not desirable, but will not contaminate the pack. They should simply be blotted off with a cotton towel. Water repellency is the benefit of disposable wrap.

Muslin packs are typically easier to dry since muslin can absorb a lot of water and disperse it over a large surface. There can be a 20% moisture content in cotton before it feels wet.

If we could watch the sterilization process, we would see a dense fog caused by the continual phase change from liquid to vapor and vapor to liquid. Steam sterilization takes place in a saturated steam environment. Understanding pack construction and arrangement is the key to controlling wet packs.

Having problems with wet packs? We are here to help.

Did You Know? Wet Pack Prevention – Part 1 of 3

Wet packs are defined as moisture in or on a tray following an approved completed sterilization cycle. Wet packs must be avoided because moisture can serve as a growth media or provide a means for organisms to travel back into a sterile pack. If wet packs are discovered, the load must be reprocessed.

Wet packs are unfortunately a periodic, albeit highly emotional, frustrating, and costly issue for many users of steam sterilizers, regardless of brand.

When analyzing the root cause(s) of wet packs, it is best to remember that wet packs are not simply random events, but are often complex problems with several variables that have their origin in the laws of physics and thermodynamics.

Steam Quality

Some things that can cause poor steam quality include:

  • Malfunctioning steam traps
  • Poor steam pipe insulation
  • Time of the year
  • Time of the day
  • Additional loads
  • Steam supply lines
  • Boiler condition

Four Major Cause Areas

  1. Steam quality to the sterilizer
  2. Pack/Material preparation and loading density
  3. Operation and maintenance of the sterilizer
  4. Pack/Material handling after the sterilization process

Adding to this complexity is the fact that wet pack problems are often intermittent. Also, several different parties often play a role in discovering and solving the problem(s) – central sterilization technicians. Facility maintenance, ASAs, the sterilizer manufacturer, surgery, etc. As most of you have likely experienced with wet pack complaints, emotions can sometimes play a larger role than logic and must be considered when dealing with these issues.

Basic Initial Troubleshooting Questions and Data Collection

When first approached about a wet pack issue, you should observe directly or ask the following questions and record the data for further evaluation and troubleshooting:

  1. Date and time wet packs were first noted?
  2. Are the sterilizer cycle parameters set correctly?
  3. Who operated the equipment during the cycle where wet packs were found?
  4. Do one or more employees experience wet packs more than other employees?
  5. How long has the employee been operating the sterilizer? Is he/she inexperienced? New?
  6. Do wet packs generally occur at a certain time each day?
  7. Do they happen only on certain shifts?
  8. Do they occur more frequently in a particular season of the year?
  9. What is the humidity in the area where the packs were assembled and wrapped?
  10. What maintenance has recently been conducted on the sterilizer?
  11. What maintenance has been conducted recently on the boiler and associated systems?
  12. Do wet packs occur only with certain size/type of instrument trays or containers?
  13. How densely packed are the sterilizer loads? Is there adequate space for steam circulation or could dead zones form in chamber?
  14. Are only approved trays and loading carts (if applicable) being used?

Keckler expert offers tips to safely move surgical tables

Surgical tables are significant investments for hospitals and surgery centers, often running tens of thousands of dollars each. So it makes sense that medical staff who regularly have to move these expensive and complex pieces of equipment know how to do so safely and easily.
One of the most popular and respected brands of surgical tables is Skytron, which makes more than a dozen tables that serve a range of purposes and have many important features to ensure patient safety and assist operating room staff. The exclusive distributor of Skytron products in Central and Northern California and Northern Nevada is Keckler Medical.

The Keckler team not only proudly sells Skytron surgical tables, it is also the factory authorized service center for them, providing expert advice about their care and maintenance.

A question that often comes up regarding surgical tables is how to safely move them out of an operating room – whether for maintenance or because a different table is needed for a specific procedure. 

A senior technician at Keckler, offered these tips:

    • It is recommended that two people work together to move tables.
    • Unplug the power cord before moving a table. Running over the cord can damage it and risk safety problems.
    • Always make sure the brakes are unlocked before trying to move a table.
    • Never use the emergency brake release to move a table unless there is an actual emergency. If the emergency brake is used, it must be reset before it is operational again.
    • Always push a table; don’t pull.
    • Push tables so that the casters are in the front. Pushing in the wrong direction can damage the brake pads.
    • Never pull a table by its power cord. Doing so can damage the cord, cause sparks or possibly an electrical shock.
    • Never pull on the head section or the leg section of a table. They can come off and operators can lose control of the table.
    • If a table starts to roll away out of control, let it go. Tables weigh between 600 and 700 pounds, depending on the model. They can injure operators who try to stop them.
    • Once the table is properly positioned, lock the brakes.
The Keckler team has certified technicians who have passed Skytron’s rigorous, weeklong training course at its Grand Rapids, Mich., plant. Skytron recommends that each surgical table is serviced every six months. The Keckler technicians travel to hospitals and surgical centers to perform routine parts and maintenance work — a process than typically takes about two hours per table — as well as to make emergency repairs.

Modern hospital beds address risk of falls, pressure ulcers

Each year, between 700,000 and 1 million patients fall in a hospital in the United States, according to the Agency for Healthcare Research.

About a third of those falls result in an injury to the patient. Sadly, about 11,000 of those falls lead to deaths. The agency estimates that non-fatal falls in adults 65 years and older cost about $50 billion each year, while fatal falls average a cost of $754 million each year.

Pressure ulcers are another all-too-frequent occurrence in hospitals. In some U.S. facilities, as many as a third of patients develop some degree of pressure ulcer while being treated or while recuperating from a surgical procedure.
To avoid becoming part of these statistics, hospitals have developed extensive protocols to reduce the risk of falls as well as patients developing pressure ulcers. One of the most effective methods of minimizing risk is to provide patients with beds and mattresses that incorporate the most current technology that can warn health care workers of potential issues.

Companies making high-quality hospital beds are Umano, Span-America and Oxy-Mat. All are leaders in the industry, well respected and available through Keckler Medical.

Umano’s beds are used in many health care settings — from high-acuity critical care through long-term care and even inpatient psychiatric or correctional health. They are designed to maximize fall prevention and infection control, while being easy to use for caregivers and the lowest total cost of ownership for the hospital’s budget.

One of their most important features is the low height of 10 inches off the floor, reducing the risk of a fall while the patient is in the bed as well as making it easier for patients to get in and out of bed. Ingress and egress are two of the riskiest times for falls.
Sensors alert nurses to when a patient gets out of bed, rolls near the edge or moves the upper torso (level of sensitivity controlled by caregiver). Lightweight construction and dual casters make the beds easy to move, but they also are sturdy – they can handle maximum patient weights up to 1,060 pounds, and have length and width adjustments for bariatric or taller patient needs.
The beds also include an integrated computer system, which incorporates the latest technology such as full-color smart screens, turn reminders, unique safety warnings and a system that logs patient weights and exit alarms. There are USB ports and auxiliary outlets to provide ease of use (for the caregiver and patient), reduce fall risk, remove trip hazards and allow for software upgrades over time.

Span-America and Oxy-Mat both offer mattresses that reduce the risk of pressure ulcers and skin shearing.

Span-America’s mattresses incorporate low air loss and pressure redistribution technology where body length air chambers slowly inflate and deflate to reduce pressure points and turn the patient every 12 to 15 minutes. Its Geo-Mattress® UltraMax™ reactive surface with 3-Dimensional Zoning™ offers protection to the seat section against “bottoming out” even during repeated head and foot of bed elevating. The UltraMax™ bi-directional stretch cover prevents heels, hips and shoulder blades from “digging into” the surface. Instead, patients are gently guided back to the original position following head of bed elevation.

The Oxy-Mat mattress has air pockets in foam that disperse pressure points “on the bony prominences” of the body. The unique design reduces the vertical and horizontal shear forces that lead to pressure ulcers in the sacrum, scapula, trochanter, ischium, head and heels. The mattress helps the patient’s own body to naturally optimize deep-tissue blood oxygen values in anatomical areas at the greatest risk of pressure injury development.

Whether the hospital’s initiatives are to reduce the risk of patient falls, reduce the risk of pressure ulcers, reduce the risk of hospital acquired infections or maximize (recently) reduced capital budgets, Keckler Medical can assist with products from Umano Medical, Span-America and Oxy-Mat.