Once items are cleaned, dried, and
inspected, those requiring sterilization must be wrapped or placed
in rigid containers and should be arranged in instrument
trays/baskets. Best practice states that hinged instruments should
be opened; items with removable parts should be disassembled unless
the device manufacturer or researchers provide specific instructions
or test data to the contrary; complex instruments should be prepared
and sterilized according to device manufacturer’s instructions and
test data; devices with concave surfaces should be positioned to
facilitate drainage of water; heavy items should be positioned not
to damage delicate items; and the weight of the instrument set
should be based on the design and density of the instruments and the
distribution of metal mass. While there is no longer a specified
sterilization weight limit for surgical sets, heavy metal mass is a
cause of wet packs (i.e., moisture inside the case and tray after
completion of the sterilization cycle). Other parameters that may
influence drying are the density of the wraps and the design of the
set.
There are several choices in methods
to maintain sterility of surgical instruments, including rigid
containers, peel-open pouches (e.g., self-sealed or heat-sealed
plastic and paper pouches), roll stock or reels (i.e., paper-plastic
combinations of tubing designed to allow the user to cut and seal
the ends to form a pouch) and sterilization wraps (woven and
nonwoven). Healthcare facilities may use all of these packaging
options. The packaging material must allow penetration of the
sterilant, provide protection against contact contamination during
handling, provide an effective barrier to microbial penetration, and
maintain the sterility of the processed item after sterilization.
An ideal sterilization wrap would successfully address barrier
effectiveness, penetrability (i.e., allows sterilant to penetrate),
aeration (e.g., allows ETO to dissipate), ease of use, drapeability,
flexibility, puncture resistance, tear strength, toxicity, odor,
waste disposal, linting, cost, and transparency. Unacceptable
packaging for use with ETO (e.g., foil, polyvinylchloride, and
polyvinylidene chlorine [kitchen-type transparent wrap]) or hydrogen
peroxide gas plasma (e.g., linens and paper) should not be used to
wrap medical items.
In central
processing, double wrapping can be done sequentially or
non-sequentially (i.e., simultaneous wrapping). Wrapping should be
done in such a manner to avoid tenting and gapping. The sequential
wrap uses two sheets of the standard sterilization wrap, one wrapped
after the other. This procedure creates a package within a
package. The non-sequential process uses two sheets wrapped at the
same time so that the wrapping needs to be performed only once.
This latter method provides multiple layers of protection of
surgical instruments from contamination and saves time since
wrapping is done only once. Multiple layers are still common
practice due to the rigors of handling within the facility even
though the barrier efficacy of a single sheet of wrap has improved
over the years. Written and illustrated procedures for preparation
of items to be packaged should be readily available and used by
personnel when packaging procedures are performed.
See the complete recommendations on sterilizer and disinfection at
www.cdc.gov
“Guideline for Disinfection and Sterilization in Healthcare
Facilities, 2008”.
ATS, Inc. also stocks sterile packaging supplies including
sterilization pouches and indicator tapes – see
Supplies.
DID YOU KNOW?
§
Autoclave Testing Service, Inc. is one of the first companies
nationwide to offer a
Mail-In sterilizer
monitoring service using biological indicators. Serving the
healthcare industry throughout the United States and Canada since
1986, we have thousands of satisfied customers.
§
We have on-line test results
allowing you to access your results at your convenience! Your
Sterilizer Test Report (STR) is posted
on-line upon completion of
culturing, offering minimum turn-around time.
§
We have 24-hour test results for Steam sterilizers!
§
We have a comprehensive Glossary of Terms related to the sterile
processing area (scroll below to view the Glossary). This is
invaluable information, assisting you with this important area of
your facility.
ATS, Inc. now
stocks sterilization pouches, sterilizer cleaners, chemical
indicator products, sterilizers (new and used), ultrasonic cleaners,
water distillers, and more! (see
Supplies).
In-Office and Mail-To-Lab Testing!
Verify the sterilization process of all steam
sterilizers which include Statim, Midmark,
Tuttnauer, Lisa, Mocom and Pelton & Crane
sterilizers.
Bowie-Dick Test
Packs should be used daily to evaluate the
performance of air-removal (vacuum) system of
dynamic pre-vacuum type sterilizers. Available
as test cards or preassembled test packs.
Internal CI’s should be used within
each pouch or package, tray, or container. Class 5
Integrators should be used in conjunction with
physical monitoring and biological indicator
testing for verifying the efficacy of a
sterilization system. (See AAMI ST79:2006)
Recordkeeping is a must for all
sterile processing departments. This ensures
accountability and allows operators to trace
errors to their source. Tips on sterilizer
maintenance and technical advice are included with
each book.
