BoneChat #58 - Startup SteriCUBE has solved the bottleneck in Sterile Processing to support the OR.

So welcome to Bone Chat discussion number 58 with Alex Wenber at SteriCube. Alex and I worked together at Wright Medical during what I call the golden years in the 2000s, um, and then since then Alex has led marketing in 3 startups that have produced exits. Sonoma Orthopedics, Omni Life Science, and Crossroads Extremities. So I asked Alex to join us on BoneChat to learn more about this innovation in sterilization that gets rid of those nasty blue wraps that we all hate. So welcome, Alex. The mic is yours.

Okay, thank you. Good to be here. Let me hopefully not destroy credibility by Getting this slide up. Okay, can everybody see it?

Yes.

Perfect. All right. Okay, so we have about 15 slides. I'm going to go through them pretty quickly. Obviously, if anybody has any questions along the way, please stop me, but I'd like to do the question— unplug and do the question and answer session after. At the conclusions of the slides. I'm going to give a kind of an introduction to the problem we solve, and we're gonna talk about some existing technologies and then just obviously give an overview of what SteriCube does. So SteriCube is basically a big container. It's a big cabinet with shelves like an oven that's used to process instruments with sterilization and then run them to surgery. And we could spend a couple hours here talking about why SteriCube is a phenomenal sterilization device because we truly feel it is the best way to sterilize out there. But what's interesting, at least from a marketing perspective, is that our customer's not really concerned with that. They, they believe it sterilizes. They use and they purchase SteriCube because of efficiency. And it drives efficiency in two different departments. It's great for the sterilization department, it's great for the operating room. Especially when dealing with how, how quickly you can move between surgeries. So forgive me for this slide. It's— let me know if it's insulting anybody's intelligence, but I had literally been in orthopedic medical device for 25 years and I didn't fully understand how sterilization worked. And I think a lot of us are like that. You know, the sterilization department's in the bowels of the hospital. Nobody ever goes down there and your instruments miraculously appear for surgery. So I just wanted to take us through it. Instruments are all housed in an outer case, and especially those used for hip and knee replacement. They have custom trays from the manufacturers and they're used in surgery and they're brought through decontamination, which is just a thorough cleaning, and they're put back in these trays and then they have to be wrapped or put in a rigid container for sterilization, because after sterilization there needs to be a barrier between the instruments and the outside air. So you have blue wrap and you have a rigid container. And step 3 is what these look like sitting in a sterilization, you know, an autoclave in the sterile chamber. They're sterilized, the cycle takes about an hour and a half, then they're taken out and they're stacked to cool for 2 to 3 hours, and then they're picked and brought to surgery. This is one of our best videos to show what it's like unwrapping blue wrap trays for surgery. So the person on the left is the circulating nurse and she opens up the blue wrap and then the scrub tech takes the tray out and she holds that tray. And these trays can weigh up to 25 pounds and she holds it while the circulating nurse takes this big piece of blue wrap and holds it up to the light. She's supposed to do that for, I think, a couple minutes, but nobody ever does. They do it for 15 seconds. And for that reason, about 18% of the time there are holes as big as the diameter of a pencil that are not found. Wow. So this takes a lot of time, but they're not necessarily finding the perforations that happen. Sorry, let's next, uh, let me, uh, all right, so that's in the operating room. Now we're going to talk about the sterilization department, and blue wrap is phenomenal. If it doesn't get holes in it, it is great. It'll hold a sterile barrier for a long time, well over a year. But just like unwrapping, it takes time. Wrapping it takes a lot of time, and especially because they do a lot of things to prevent Tears. So this is somebody in SPD who's been doing this for, I believe, 20-some-odd years. You'll see she takes her blue wrap, she put a napkin down on top of the blue wrap to protect the blue wrap from the bottom of the tray, and she makes sure there's everything inside. She puts a lid on, and then she puts these corner protectors on just to make sure, because these things always rip at the corners, and that's extra cost and time. And now you can see she's wrapping this tray. Now we've sped this up to 10 times speed. This takes about 3 minutes. Per tray. So if you got 12 trays for a surgery, which is pretty common, you're dealing with a lot of time. So after she does all this and puts it on the rack, it's sterilized, and then it's picked for surgery, and it's called a case cart. And they'll take all these blue wrap trays and stack them on top of each other and bring them to surgery. And this is where these things get ripped because they pull them off the case cart and it causes these perforations. Make sense before I go on? Yes.

Okay, we've all been there.

Okay, all right, so what a lot of hospitals are doing because they're tired of the blue wrap is they're going to something called a rigid container, which I showed you earlier. And we're going to see her grab a stack of rigid containers. Once again, the circulating nurse opens the rigid container, and all of them have filters that they'll hold up to the light Meanwhile, the scrub tech holds the tray. Now this is an interesting one. All of these rigid containers have a flat anodized aluminum bottom. So what you'll see is at the end of pull, after she pulls the tray out, the circulating nurse will run her hand along the bottom and sides of the tray. And why she's doing that is to see if it's wet, because the issue with rigid containers is something called wet loads or wet packs. And if there's water, that's synonymous with bacteria. So they immediately get rid of the tray and get rid of the instruments if there's a wet pack. So although rigid containers are much faster than blue wrap, 78% of facilities report wet loads or wet packs. It's everywhere. It's ubiquitous throughout the industry. And the filters on the top of these containers are great for getting in steam,. But as part of the sterilization process, the steam has to get out, and that's where you can have issues. So these flat bottoms of these trays collect moisture sometimes, and that's why they have to check it with their hands. So while this is all going on in the operating room, while somebody's holding the blue wrap up to the light and somebody else is holding the tray, the surgeon is sitting in the lounge. And the surgeon in the lounge, the surgeon is the revenue generator for the hospital. That person should be doing surgery, not be sitting in a lounge. And one of the best quotes we found is a surgeon in Phoenix who says, "I spend 10 hours at the hospital to do 6 hours of surgery." And this is the primary reason why people are bringing SteriCube into their hospitals to speed this OR turnover. So this is a standard features image of SteriCube. I'm not gonna go through it all, but I wanna show you 2 different things. These filters, we call them cross ventilation filters. There are 2 on top and 2 on the sides. We call them cross ventilation because it works just like cross ventilation in your car or house. When you want airflow, you open windows on opposite sides of the house. And so SteriCube gets great steam penetration when it's in the autoclave. It's very, very dense and it gets every nook and cranny. The other thing I wanted to call your attention to is the funnel floor. And this is an important patent that SteriCube has. Because we're the only device out there that has a flat floor— I'm sorry, that has a funnel-shaped floor instead of a flat floor. And this allows any condensate to always leak out instead of collecting at the bottom. So here is our animation of how SteriCube works. This is a SteriCube sitting in the sterilizer. We're going to show a side view of it, and you'll see the steam start to enter, and it'll start penetrating the SteriCube through these cross ventilation filters, and it's going to get nice and dense within that SteriCube. Now, this is, you know, this is one cycle of the autoclave. A second cycle is the vacuum part where it sucks all the steam out, and it gets sucked out through the bottom of the autoclave, and that's where we have our funnel floor. Anyway, and so you can see the steam following the funnel floor along with the con— any condensate that collects. We have a ceramic filter at the bottom to make sure nothing can come back in and it all gets sucked out. And that's why SteriCubes, we, we do not hear about the idea of a wet pack with a SteriCube. That's not something that we have happen. All right, so with regard to cooling time, you know, I mentioned before that you have to cool these rigid containers and, and blue wrap trays after sterilization. They cool them for 2 to 3 hours. And the reason they do that is to let all the moisture evaporate. Well, SteriCube, you know, because we have this funnel floor, we don't have a moisture issue. And also there's a lot of surface area with a SteriCube. It's a big box, so it takes about 45 minutes to cool versus 2 to 3 hours with standard instruments. So I wanna show you these comparison videos between what's it's like to use SteriCube versus traditional technology. So first, you've already seen the video on the left of somebody unloading blue wrap trays and rigid containers. And on the right you're gonna see SteriCube. So on the right you see the circulating nurse, they check the filters, the SteriCube, they open the door, they push it towards the scrub tech and then they leave. They go somewhere else in the building to go get the patient or do other things to help the room turn over faster. Meanwhile, the scrub tech can just unload everything in there and it'll take her about a minute to do that. In the meantime, if you were using rigid containers or blue wrap, you'd still be going through all of this and it'd be a lot less safe than what you see with the SteriCube. Now we have comparison videos, the SPD sterilization department versus SteriCube. Once again, you've seen the person on the left wrap a tray, but this is gonna, you're gonna see her wrap and get, prepare all the trays for surgery versus using SteriCube on the right. And you should be pretty happy that we sped this up because you'd be sitting here for half an hour watching this. Anyway, about 6 and a half minutes, you're done with SteriCube, and you save almost 30 minutes here by using SteriCube versus traditional technologies.

Have you done the math on how many, like, man labor hours is saved for a busy hospital?

The math, we actually have something we use when we go to facilities. It varies so much between volume and number of employees and actually number of sterilizers, but it really, I think what you're getting at, it adds up very quickly. Yeah. Okay, last but not least, a lot of facilities are trying offsite sterilization. I don't know if you're familiar with it, but they don't want to deal with the expense of having a sterilization department or the man hours associated with it. So there are these warehouses that'll do all the sterilization for you. We are validated for that. So you can actually use a SteriCube. You can sterilize at the offsite facility, put it on a truck, bring it to your hospital and wheel it right in.

What, what is there— what's the name of that, uh, service? Is it like 10 different companies or like 2 or 3?

Uh, there are several, there are several companies doing it.

Is it an ASC thing mostly because they hate trays, or—

you know, I'm not an expert in it, um, but we have seen it in hospitals and ASCs.

Okay.

And that, that's all I had for a presentation, so I was hoping we can unplug and— yeah.