FROM BLUE TO GREEN In addition to being more cost-effective than blue wrap, rigid containers reduce medical waste.

Will that staple of sterilization known as blue wrap soon be virtually extinct, elbowed aside by more cost-effective and more green-conscious rigid containers? That's definitely the trend, says Gail Horvath, MSN, RN, CNOR, CRCST, a patient safety analyst and consultant for ECRI Institute, a non-profit healthcare research organization in Plymouth Meeting, Pa. The one big stumbling block is that some manufacturers have yet to validate that their instruments can achieve sterilization in rigid containers. And they have limited motivation to do so once they've garnered FDA approval by proving that their instruments can be sterilized in blue wrap. Validation is a long, tedious process that involves a lot of work on their part and little financial reward.

Blue wrap remains the only option for sterilizing some commonly used surgical items, including heavy orthopedic instruments, with some manufacturers finding it difficult to verify that they've been able to achieve sterilization in every nook and cranny of a given instrument. But more and more manufacturers are finding ways to prove their instruments can be sterilized in containers. The reasons are many, says Ms. Horvath.

1. Eliminate "torn-wrapper" syndrome. Anyone who's spent significant time in the OR knows that holes in wraps happen regularly. Often there's a patient on the table already under anesthesia, and then you discover there's a hole in the blue wrap. What do you do? Wait up to 3 hours to turn it over again, or do you flash — use an immediate-use steam sterilization cycle to re-sterilize the tray? It's a no-win situation you'd rather not face. Eliminating "torn-wrapper syndrome" reduces delays in surgery and can help eliminate the need to flash.

2. Rigid containers cost less. The price tag for a medium to large container may look daunting — typically $300 to $500 — but time is on the container's side. The container is more cost-effective, but you're paying it all up front, instead of over time. True, it may cost only a couple of dollars to wrap a tray, but those numbers add up quickly, especially when you consider that a container may last 10 years or more. Say you spend $3 every time you wrap a given tray, and you wrap that tray once a day. That's $15 a week. Project that over 10 years, and you'll have spent upwards of $7,000 (plus the cost of disposal).

BUILT TO LAST Evidence increasingly suggests that rigid containers do a better job of protecting delicate instruments.

3. Rigid containers are less time-consuming. No matter how efficient your processing technicians are, wrapping and taping instruments adds additional time to the process.

4. Rigid containers are easy to transport. Containers with handles tend to be easier to transport, and covered containers also provide an easy way to move instruments back from the OR. Anything that's contaminated or has bioburden should be covered during transport. Most ORs don't have dumbwaiters, so they're still moving contaminated instruments through public hallways at times. You shouldn't be exposing staff and other patients to potential bloodborne contaminants. Containers are a great barrier to microorganisms. Note, however, that some manufacturers say their containers aren't designed for transporting contaminated instruments.

5. Rigid containers are better for the environment. Though blue wrap can be recycled, it's not always a convenient or available option. The amount of waste generated by healthcare facilities is estimated to be as much as 4 billion pounds, much of which is generated in the OR and consists of packaging and disposable supplies.

6. Rigid containers aren't susceptible to compression. The weight of instruments wrapped in blue wrap and stacked on top of each other can create air pockets and holes. Compression can compromise sterility. That's not going to be a problem when you stack rigid containers.

Other considerations
Of course, containers take up more room than blue wrap, and storage space is bound to be a challenge for some. You also need to make sure your trays can safely contain delicate instruments without having them bounce around and bang into each other. That's why it's essential to follow manufacturers' instructions: the sterilizer manufacturer, the instrument manufacturer and the container manufacturer. Visual inspection is important, too. Make sure the lid fits securely and that there are no cracks or breakages.

How can you be sure rigid containers are still doing the job as they age? Ms. Horvath recommends having a routine schedule in which you test at least one size of each container each year. Use 5 biological indicators: one in each corner, plus one in the center, hanging from the lid. If it's a double-layer container, use 8 biologicals, plus one in the center. Test with both a small load and a full load. Small loads are a more difficult challenge, because the steam has more choices where to go.

There are several container manufacturers to choose among. It's a pretty competitive market. Do a cost analysis. Check to see whether the manufacturer has a good track record. What kinds of filters do their containers require? Some have reusable filters, which is another potential cost saving.

Above all, you need to know you're protecting your expensive surgical instruments as well as possible, and more and more evidence is showing that rigid containers provide more protection than wrap.