When instrument trays show up in the OR with torn, sliced or otherwise compromised blue wrap, it's a major source of frustration. Not just for the surgical teams who see their preparations and start times delayed, but also for the sterile processing technicians who have to rewrap and resterilize the instruments.
In our sterile processing department, we tried different kinds of wrapping and padding to cut down the number of compromised trays, but rigid sterilization containers really caught our attention. We were set to undergo a top-to-bottom renovation, so why not piggyback a switch from blue wrap to rigid containers onto it?
The use of reusable hard cases as an alternative to single-use polypropylene blue wrap for instrument sterilization and storage doesn't require a multi-million-dollar facility upgrade, though. While implementing the containers involves an upfront investment in new equipment, it carries a multi-faceted payoff over the long term.
Placing trays of instruments to be sterilized into sealable stainless steel or anodized aluminum containers provides an assurance of infection prevention, since there's no worry that the outer protection will tear as it's shelved, pulled or transported. You're also eliminating the staffing time and supply cost of blue wrap, not to mention the disposal cost and environmental impact of the waste it generates.
Keeping in mind
You'll want to keep a few factors in mind if you're planning to make the switch from blue wrap. First, there will be a size difference, since rigid sterilization containers tend to be bulkier than wrapped trays. Will your sterilizer be able to accommodate the same number of trays during a normal cycle? Also, will your storage room require expanded shelving to hold the metal cases?
Functional compatibility is another concern. Sterilization guidelines from AORN, AAMI and other groups emphasize the importance of making sure that an instrument and its packaging can be properly sterilized by a given method, and that the method is suitable for the instrument or packaging. Is your sterilizer validated for the container you're considering, and vice versa? How much time does it take to complete a cycle?
Remember, too, that rigid containers may not entirely eliminate the disposable costs of sterilization packaging, since some containers include single-use filtration components, chemical indicators and locks. Additionally, while some manufacturers offer a selection of different sized containers, you might still wrap smaller trays instruments in blue wrap, when a whole tray isn't necessary.
Put into practice
Perhaps the most effective way to implement rigid sterilization containers is to look at your most problematic areas. Do orthopedic, neurosurgical and spine surgeons frequently reject the instrument trays they're brought? Do heavy trays often end up in torn wrappers? Is sterilizing trays of loaner instruments from vendors the cause of case delays?
We started small, trialing 10 containers in 2 rooms for about a month of ortho and spine cases. When we started, we expected some pushback from the OR, and a need to convince them, but our doctors loved it. We bought 100 containers, which is when we saw the real results: fewer holes in wrappers, fewer delayed cases and significantly fewer immediate-use steam sterilizations.
Saving dollars has been a secondary benefit on top of that. We're spending less on blue wrap, and putting the containers to work for cataract surgery instruments means a faster turnaround and less demand to buy more inventory. Which is what corporate wants to see. With sterilization containers working so well at the largest hospital in their health system, they've recommended them to the surgical center. OSM
Pricing: Varies depending on container's size and features
FYI: As an alternative to blue wrap, Aesculap's container system offers easy utility, ergonomic design and durability in the service of reducing operational expenses and waste. The lightweight aluminum containers, available in mini, wide body and 24 sizes in between, open and close with a single-step latch. A one-piece, one-step process for filter retention plate removal and installation speeds the job. Tamper-evident locks let users know that the sterilized instruments inside stay that way. And colored lids make the contents easily identifiable, even in a cart full of containers.
SteriTite Universal Sealed Containers
Pricing: not disclosed
FYI: Manufactured from an aircraft-grade anodized aluminum alloy, Case Medical's durable sealed containers are corrosion resistant, validated for all methods of sterilization, including pre-vacuum and gravity displacement steam, hydrogen peroxide plasma, ethylene oxide (EtO) and ozone, and compatible with all sterilizable devices. The rigid containers eliminate the threat of torn and compromised blue wrap, and the integrated filtration system in their covers and the silicone gaskets in their lids maintain seals and sterility. They are available in a wide range of sizes and with solid or perforated bases.
Integrated Medical Systems International
MTS300 Multiple Tray Sterilization System
Pricing: Provided as part of sterile processing consulting services
FYI: Nicknamed "The Cube," this stainless steel sterilization cabinet and adjustable transfer cart can handle up to 12 orthopedic or neurosurgical instrument trays per load, then transport them for unloading and use in the OR, without the need for wrapping and unwrapping. Sterilized as a single unit, The Cube requires only 30 minutes of drying time and can keep its contents sterile for up to 30 days. It is available as a feature of sterile processing efficiency assessments by instrument repair and management firm IMS, a subsidiary of the Steris Corporation.
Innovative Sterilization Technologies
One Tray Sealed Sterilization Container
Pricing: not disclosed
FYI: The One Tray system from Innovative Sterilization Technologies harnesses the thermodynamic behavior of steam to terminally sterilize temperature-tolerant surgical instruments in a sealed container. The number, size and location of filter vents in the tray enable effective steam circulation throughout the container during a standard 4-minute, 270-degree pre-vacuum displacement cycle. They also mean no drying and cooling time is required following the cycle. The container's patented design features a sloped floor with a central retained-moisture collection area, which ensures sterility by eliminating prolonged contact between the filter elements and the resulting condensation.