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).