When used correctly, rigid sterilization containers provide a higher level of protection against instrument contamination than blue wrap and tape. Sounds like a basic concept, but I've seen plenty of dinged-up and dirty containers in use at reputable facilities across the country. So when it comes to readying rigid sterilization containers for use, these 6 practices must be, well, rigidly enforced.
1. Test and retest
The work begins even before you select a brand of containers for use in your facility. A key question: Is the brand you're considering compatible with your sterilization equipment? Some containers are meant only for steam sterilization, for example. When you've narrowed the field, ask vendors to send samples of their models. The manufacturers will have validated these samples, but you'll want to verify that each device is acceptable for use through your own product testing.
You want to create a challenging scenario to see which containers are conducive to the most effective sterilization. Here's how. Place both biological indicators and class 5 chemical indicators in each container you want to test. Ask the manufacturer to identify which parts of their containers are most resistant to sterilization and place the indicators in those locations (typically, that will be the corners). Mark each indicator based on where it's placed in the container ("UL" for upper left and "LR" for lower right, for example). Next, load each container into the sterilizer in the most challenging location, such as above the sterilizer's drain. Be sure to mark each container sample as a test case to ensure it never ends up in an OR. After you've selected a brand and made a purchase, you'll want to continue this testing yearly to ensure containers remain validated for use.
2. Clean correctly
Some staff members falsely assume containers that are taken to the OR and removed before the patient arrives can be used again without being cleaned. You must wash rigid containers before every use, with no exceptions. Equally important is that you wash containers according to their specific manufacturer's instructions for use. I've seen staff wipe down containers with bleach wipes, even when the instructions didn't indicate they could be used. It's also important to consult a manufacturer's disassembly instructions. For example, you must remove the filter plates in containers before cleaning.
Instructions for use also indicate if you should wash containers manually or mechanically, or use both methods. After manual washing, thoroughly rinse detergent out of the container, because residue can negatively impact the container. Also be sure to use the detergent noted in a container's instructions for use. For example, many containers cannot be exposed to alkaline cleaning products. Also be sure to use lint-free or low-linting cloth during manual cleaning.
If you opt for mechanical washing, make sure to properly load containers into the automated washer. Think of these machines like your dishwasher at home; if you overload it, without enough space between items, the cleaning solution can't access all the surfaces. How close is too close when placing containers? It depends largely on how your washer arms are positioned and how its racks are laid out. Also, consult the washer's instructions for use, because some units require that you place sterilization containers on a special rack.
3. Assemble as directed
After cleaning, carefully reassemble instrument sets and place them in the rigid containers for sterilization. Again, consult a container's instructions for use to see which items are validated for the containers you use. For example, some containers are not appropriate for lumened instruments and others cannot handle absorbent materials, such as towels. Loaner instruments can be put only into containers validated for this use. Peel packs for single instruments should never be put inside a container. In addition, no items should be placed outside of a container's manufacturer-approved instrument rack or basket.
If you're using posts to hold ringed instruments in place, make sure they've been validated for the sterilization container. Also, turn the container upside down to make sure these holders were installed properly and are held securely in place.
The Association for the Advancement of Medical Instrumentation (AAMI) and AORN both dictate that assembled containers for steam sterilization should weigh no more than 25 pounds. This guidance is more about protecting sterile processing staff members who have to lift containers than it is about preventing contamination of the equipment.
Pay attention to the density of the instruments and items you place in a container. Picture 25 pounds of surgical instrumentation spread across a cafeteria tray. Now picture that same amount of instrumentation jammed into a shoebox. Because there's less surface area in the shoebox, the instrument mass will be denser and, therefore, more difficult to sterilize. Because AAMI simply states that density should be "evenly distributed," you must rely on your own experience for determining how you should arrange items in containers. When using sterilization containers for low-temperature sterilization modalities, it's important to check instructions for both the sterilizer and the container for load or poundage restrictions.
4. Inspect closely
Look over containers before each sterilization cycle to ensure there are no nicks, cracks or warping. While dents are sometimes overlooked, they compromise the sterility of instruments as much as a tear in blue wrap would. No, it doesn't matter if you can still close the lid. It's also important to check that a container's gaskets are still pliable, and this holds true whether the gaskets are meant to be replaced regularly or whether they're under lifetime warranty. Even a slightly nicked or stained gasket may affect a container's seal. Also, check that your filter-holding mechanism is still in good working order. Does it provide a nice snug fit for the filter and are all the rivets and fasteners still tight? Are the handles still solidly attached? It's important to spot a container's integrity issues before subjecting it to any sterilization modality.
5. Handle with care
Place containers flat in sterilizers and never stack them directly on top of one another a hand should fit between each container. And never place them above any wrapped items in the same load, as condensation can drip from the equipment. Consult the autoclave manufacturer's instructions for use for information regarding maximum poundage per load.
Before unloading rigid containers from sterilizers, make sure the containers have reached room temperature. Some facilities are now relying on infrared testers to determine the exact surface temperature of heated containers. If containers are at all wet at the time of removal, which can be the result of poor steam quality or a sterilizer malfunction, you should reject the cycle.
6. Store and transport
Store rigid containers in a sterile environment 8 to 20 inches from the floor and at least 18 inches below any sprinkler head. Place containers on storage shelves; the bottom shelf should be solid. You can stack them, but don't place more than a couple on top of each other. During transport, place containers on a closed cart to protect their integrity, and the staff member doing the transporting should move cautiously so that the cart's contents aren't knocked around. Upon arrival in the OR, a member of the surgical team should inspect a container's integrity before its contents are used. OSM