Archive January 2017 XVIII, No. 1

Which Is Better: Wrapped Instrument Trays or Sealed Containers?

Two sterile processing managers debate the merits of fabric and metal sterilization packaging systems.

Perry Starcovic; and Phillip Van Gorp

sterilization wrap THAT'S A WRAP Sterilization wrap is flexible and conformable around the instrument tray.

Point:
Blue Wrap

I am the sterile processing manager for the Clinics and Surgery Center located on the University of Minnesota Medical Center Campus. It's a 342,000-square-foot, 10-OR facility that opened in February — using nothing but sterile wrap to store sterilized instruments. Yes, I'm talking about tearable, rippable, puncturable sterile wrap. Here's why I stand by that decision.

Container blues
In the rigid-versus-wrap debate, we hear so much about the holes that can befall the latter. But in my experience — I was a surgical technician for 3 years before spending the last 6 in sterile processing — problems with sealed containers are the ones that most interrupt work flow.

In the surgical trenches, I often saw containers mismatched with their inner, equipment-holding baskets, which obviously creates a holdup in the OR. Or else arrows — the plastic indicators that signal whether a container has been sterilized — would go missing. Like socks from a dryer, load stickers indicating date and time of sterilization could mysteriously disappear as well. And retention plates, which hold a filter in place, sometimes came loose. Some of these issues come down to human error. Others are the result of sealed containers getting knocked around in transport. During my time working with these devices, issues were flagged in 5% of cases. That's way too many.

sealed container CLOSED CASE Assembly is a snap with a sealed container. All you need to do is close a lid and lock — 15 or 20 seconds.

Counterpoint:
Sealed Container

Would you rather fly cross country in a prop plane, or a jet? Using sterilization wrap to keep instruments from contamination is like doing the former. It may get the job done. But using sealed sterilization containers? That's the first-class experience. I am the sterile processing manager at Cleveland Clinic at Marymount Hospital. Of our instrument trays, around 1,000 (or 50%) are containerized. But like all 8 regional hospitals in this network (all of which have between 8 and 16 ORs), and like our main campus (100 ORs), we're incorporating more containers all the time. I am confident this is a move that will — might as well say it — diminish hospital turbulence.

Fear of change
While sealed sterilization containers have been on the market for more than 30 years, they are still the newer option (some may even say "newfangled"), and some people will avoid working with a tool simply because it is different than what they're used to. Many of my peers feel this way. I get it — change can be scary. But what's even scarier is overlooking flaws in the old standby equipment.

While the wrap and sealed options have a lot in common — they have the same shelf life, and both include chemical indicators that denote a clean tray — there's one major difference: Sterilization wrap punctures. It can easily get snagged on corners when an instrument tray is slid off a rack, for example. And tape can break when someone is moving quickly — an occupational necessity — and mishandles a tray. While some professionals will tell you these pitfalls can be avoided simply by putting the right process in place, I don't know of any process that removes the hole issue, well, wholly.

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