Asklepios

Automatic Sterile Goods Supply at Asklepios Kliniken Group

Use of Robotics, Sensors and AI in the Reprocessing Unit for Medical Devices (RUMED)

Asklepios Kliniken Group

The Asklepios Kliniken Group is a clinic operator primarily active in Germany with 160 medical facilities in 14 federal states. Clinic processes at all locations are to be standardized and made more efficient by means of digitization measures.

Asklepios Klinikum Nord in Hamburg is playing a pioneering role in this. There, the AI, robotics and sensor-based supply of sterile medical devices is being tested by the Reprocessing Unit for Medical Devices (RUMED).

Sadmir Osmancevic, Head of Sterile Goods Supply at Asklepios, explains the digitalization measures of the clinics in an interview with RFID & Wireless IoT Global.

The medical devices in the RUMED are transported in metal, standardized trays. These are fed to the sterilization systems automatically by robots.

Rumed System

Monitoring and Transport of Medical Devices with Robotics, Sensors and AI

The supply of sterile goods must be ensured in all of the company's medical facilities. The sterilization of surgical goods takes place in the RUMED. The aim is to digitally control the sterilization process, precisely track the sterile goods as they are transported through the clinic, and increase the availability of the required medical devices.

In the contaminated area of the RUMED, clinic staff perform a pre-cleaning of the medical devices and place them on a standardized transport container, a metal tray. Clinic staff enter which tray is intended for which sterilization process on a tablet. The tray is picked up by a robot, which automatically transports it to the sterilization unit and places it there. The AI uses sensors to detect which medical devices are in the tray and RFID technology to determine which sterilization units are available.

After sterilization, the medical devices enter the clean area of the RUMED. This prevents medical devices that have already been sterilized from coming into contact with germs. By means of AI, each tray is checked for completeness. The AI is able to recognize entire loaded trays as well as individual surgical instruments and to differentiate between different medical devices.

A rollout of sensor technology and AI is being targeted beyond the RUMED for all operating rooms. This will make it possible to track the transport route of the clean sterile supplies to the operating room and the contaminated sterile supplies back to the RUMED by having the AI repeatedly check the trays for completeness.

Process Requirements

Automatic Assignment of Medical Devices to Sterilization Processes

There are various sterilization systems in the RUMED, including cleaning and disinfection devices, steam sterilizers, and low-temperature sterilizers with formaldehyde and hydrogen peroxide. Correct assignment of medical devices to the appropriate sterilization process is necessary to prevent damage to sterile items and to make them safe for use in operations.

After sterilization, the medical devices must not enter the contaminated area of the RUMED. For this reason, the RUMED is designed to allow loading of the sterilization equipment in the contaminated area and unloading in the clean area. The equipment thereby forms the passage for the medical devices between the two areas.

Tracking of Medical Devices

In the clean area of the RUMED, the preparation of the sterilized medical devices for transport to the operating room takes place. For this purpose, a set of required sterile goods is assembled in a metal transport container, the sieve. The error-free assignment of each medical product to the correct set is necessary to ensure that all the required products are available for an operation.

Already in trial operation is another innovative step: During the transport of the medical devices to the operating rooms and back to the RUMED, each sieve is checked for completeness at intermediate stations by means of AI and the medical devices in it are tracked. The AI must be able to recognize the different products.

Each tray with medical devices is assigned to a specific sterilization process

Manual pre-cleaning is required before loading the trays and feeding the medical devices to the sterilization equipment. Each tray with medical devices is assigned to a specific sterilization process.

Robotics, Sensors, AI & RFID

The robots detect via RFID which sterilization units are available to be filled with medical devices and loads them automatically.

Automated Process Control in the RUMED

The transport of the medical devices is controlled with WLAN and RFID. Both the transport robots and the sterilization equipment are RFID-capable, and the transport trays are equipped with RFID tags. Clinic staff use a tablet to enter which trays are intended for which sterilization process.

Robots pick up the loaded trays and use RFID to automatically identify which sterilization units are free for loading. The cleaning of up to eight trays is possible simultaneously in one cleaning and disinfection device. During transport in the RUMED, cameras and sensors ensure that there are no collisions between robots and objects or people in the vicinity.

Control of Medical Devices with Sensors and AI

Sensors and AI are used to check the completeness of the trays with medical devices and to track them from the RUMED to the operating room.

A camera system detects each medical device, and the AI can distinguish between more than 10,000 different medical devices as a result of a learning phase. It detects whether medical devices are missing or have been incorrectly assigned to the respective tray. The project is currently being tested under real clinical conditions.

Future plans include expanding the use of computer vision and AI to track the path of clean sterile supplies to the operating room and back to the RUMED as contaminated sterile supplies, saving manual process steps to inspect the medical devices. In doing so, the data captured by the cameras provides information on the location, timing and status of each tray and the medical devices inside. It is important to note that only the products themselves are captured by the camera system, not the employees involved in the RUMED, during transport and in the operating room.

In the future, AI and computer vision will be used to create more transparency and to ensure the traceability of medical devices in the clinic. Other clinics are to benefit from the process advantages and experiences of the pilot project in Hamburg.

Digitization Measures Achieve Benefits in the RUMED

Manual Workload in the RUMED Decreases

The use of robots in the RUMED significantly reduces the workload of hospital staff. Partial automation of the sterilization process and transport reduces walking distances. Additionally, the automated transport of medical devices in the RUMED achieves further time savings, as manual loading and unloading of the sterilization equipment is no longer necessary.

It is also possible to see exactly which medical devices are in the sterilization process or are intended for it. Precise assignment of medical devices to the correct process minimizes wear and extends the service life of the products. Subsequent processes after sterilization are also simplified or eliminated altogether.

Availability of Medical Devices Increases

Due to the simplified sterilization processes, the availability of medical devices that can be delivered to operating rooms by the RUMED is increasing. Here, the AI and sensor technology used ensures that the required medical devices are available for each delivery. When checked via computer vision, the AI detects all medical devices in the tray on the way from the RUMED to the operating room. The correct delivery of the required sterile goods is ensured for each operation.

Each tray has an RFID tag as well as a barcode for identification, but the medical devices themselves are not tagged. The AI solution enables the tracking of the individual products.

Interview

Standardization of Processes and Dgitization in the RUMED

Sadmir Osmancevic explains the digitization measures in the RUMED and the challenges that the new Medical Device Regulation poses for future digitization processes.
INTERVIEW WITH SADMIR OSMANCEVIC

Sadmir Osmancevic is head of sterile goods supply at the Asklepios Group.

1. What was the reason behind the decision to use RFID technology for the RUMED at Asklepios Klinik Nord in Hamburg?

In the RUMED, RFID offers the safest option for process control between the load carrier and the sterilization system. The robot itself is controlled via sensors and WLAN, and the load carrier is tagged with RFID. The trays can be uniquely assigned to each machine for sterilization. Furthermore, since the machines are also considered medical devices under the EU's new Medical Device Regulation, they must meet special requirements. RFID technology does not interfere with these products, so their use complies with the Medical Device Regulations that came into force in 2021.

2. How have employees responded to the new system?

The feedback after initial implementation was very positive, and the system makes the work of the clinic staff much easier. Long walking distances and the manual loading and unloading of sterilization equipment are eliminated by the use of the robots.

Follow-up processes are also simplified or eliminated. Controlling the system with the tablets used was also easy after a short learning phase. These changes were very much welcomed by the clinic staff.

3. What functions does the optical system for medical device tracking, which is currently in the clinical trial phase, provide?

The optical system is designed to track medical devices as they travel from the RUMED to the operating rooms and back. The advantage is that the AI of the visual control system independently learns to distinguish the medical devices from one another. This means that the process flow is simplified, even when new systems and products are used.

4. To what extent are there considerations to tag individual medical devices in the trays with RFID as well?

Medical instruments with integrated RFID tags are already being manufactured, but their use is not yet economical. Furthermore, medical devices and health guidelines have special requirements that make RFID use more difficult in this respect.

A scalpel, for example, consists of a disposable blade and a handle that can be used multiple times. The size of the tag and the adhesive used to attach the tag must be compatible with health guidelines. For this reason, the visual control system is being tested because there appears to be less complexity in using it.

5. How do you think the use of RFID in healthcare has changed, and how might this continue to change?

In recent years, RFID tags have shrunk to about half the size. This change offers new opportunities to use RFID for tagging medical devices. Another major change will be brought about by the new Medical Device Regulation coming into force in mid-2021, according to which all medical devices must be marked with a Unique Device Identification (UDI), which could also be stored on an RFID chip.

In this respect, however, implementation is more dependent on medical device manufacturers than on hospital operators. If the leading manufacturers were to integrate RFID into the medical devices, there would be a shift towards more RFID use, provided that this is economical for the clinic operators.