On containerized systems and masked by muslin

Healthcare Purchasing News, Jan, 2003 by Ray Taurasi

Editor's Note: CS Questions, CS Answers is a feature of Healthcare Purchasing News in which we offer practical solutions to questions and problems that are common to many central service and sterile processing departments. HPN welcomes your participation in this interactive feature. To ask a question, e-mail it to cwerner@nelsonpub.com, phone it in to Curt Werner, HPN editor, at (941) 966-9521, or mail it to HPN CS Questions, 2500 Tamiami Trail North, Nokomis, FL 34275. Names and hospital identification will be withheld upon request.

CS Question: Recently, we began utilizing a container system for our surgical instrument sets. Ever since we made the switch, we have been experiencing significant amounts of moisture trapped inside the containers. At times, there is actually water in the containers when they are opened in the operating room. Some of the OR staff will not use the instruments because they question their sterility even though the OR supervisor and the container sales representative say that any water in the containers would be sterile and not pose a breach in technique. Since I never had the problem when we wrapped instruments in muslin, I think that the product must be at fault, and I want the manufacturer to take them back and return to using cloth wrappers. The OR supervisor and my boss do not want to revert to the old ways and suggest that I find another way to resolve the problem. What advice could you give me to convince them that I am right?

CS Answer: Containerized systems have many advantages including potential cost savings and enhanced sterility maintenance. They have become quite popular and are used with great success in many hospitals. That being said, your question raises many issues, which I will address.

Prior to making such a monumental change in packaging technique and capital expenditure, a lot of legwork should be done to explore and obtain literature on all potential products on the market. After reviewing the data, it is wise to contact the manufacturers whose products interest you and have them come in and do a presentation of their containerized system. You may want to narrow your selection down to few products that you will actually bring in for a full evaluation. Be sure to select vendors that will provide you with enough product, supplies and technical support to conduct a thorough evaluation. It is a good idea to establish an evaluation team consisting of representation from sterile processing, operating room, infection control, distribution and fiscal services. This team should be involved in the evaluation of each product selected to allow for continuity in the evaluation process. The team should establish an evaluation tool that will identify performance criteria standards and outcome. A thorou gh evaluation and selection process can obviate situations such as you are now confronting.

Whether water entrapped in a container would be sterile or not would depend on many variables including the type of filtering system on the container or used in conjunction with it. At any rate, moisture on a sterile field, sterile or not, can lead to compromises in sterile technique, such as strike through. Every effort to minimize moisture on a sterile field should be employed.

Over the years I have worked with many clients to resolve moisture and wetness problems in containerized systems. In almost all cases, the fault did not lie with the manufacturer or the container. Often getting to the root of the problem is quite complex and time consuming. The statement that the problem did not exist when you were using muslin may not be totally accurate. Without your knowledge, you may very well had a moisture problem that the muslin masked. Because of the breathability of cloth wrappers and wicking the moisture may have dried after removal from the sterilizer while in storage. Strike through contamination may have also occurred. Because of the potential advantages a containerized system may offer, I would suggest that you strive to find the real cause of your wetness problem. Here again, I would suggest that you solicit the assistance of OR, infection control, sterilizer service representative, hospital facility management, maintenance and the container manufacturer.

* Areas to explore: equipment sterilizer programs, cycle times, proper functioning, records, steam quality and operator handling.

* Procedures: kit contents, assembly, arrangement, proper use of containers, sterilizer loading techniques, positioning, sterilizer unloading, product cool-down, product release and daily sterilizer maintenance.

* Environmental control: proper temperature, relative humidity control and surveillance, maintenance of HVAC vents, storage conditions and placement of sterile goods, location of vents, traffic flow entrances and exits. HPN

Ray Taurasi is an independent consultant for surgical support services, supply processing and distribution and materials management with offices in Boston and Washington, DC. His healthcare career spans over three decades as an administrator educator technologist and consultant. He is a past president of IAHCSMM and has served on and contributed to many national committees with a myriad of professional organizations, manufacturer, corporations and prestigious healthcare networks. Taurasi has been a faculty member of numerous colleges teaching in the divisions of business administration and health sciences. In addition to this column he has authored several articles and has been a featured speaker on the international scene.