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Archive December 2020 XXI, No. 12

Thinking of Buying Rigid Containers

Invest in these durable and versatile cases to improve instrument care.

Nancy Chobin

Nancy Chobin, RN, AAS, ACSP, CSPM

BIO

SIGNED, SEALED, DELIVERED
SIGNED, SEALED, DELIVERED Properly loading instruments into sealed sterilization containers eases the burden on sterile processing personnel.

I'm a big proponent of rigid sterilization containers for numerous reasons. They're reusable and therefore eco-friendly, they protect your instruments from damage much better than blue wrap does and many models are stackable for easy storage. But not all containers are created equal. Here are the various factors to consider when evaluating these innovative but complex products.

  • Check the specs. Flashy promotional brochures often don't paint the entire picture of a container's usefulness. Get technical data from vendors and hold them accountable to the instructions for use (IFU). The onus is on you to read through the technical data of each container carefully, and make sure you understand whether you can actually use it for the instruments you need to reprocess. Also, consult standards such as the Association for the Advancement of Medical Instrumentation (AAMI) Steam Sterilization and Sterility Assurance in Healthcare Facilities (ST-79) 2017 and the Association of periOperative Registered Nurses (AORN) Guideline on Packaging Systems.

The predominant cycle in use today is prevacuum steam sterilization, which involves four minutes of exposure at 270ºF, but some instruments need to be sterilized at 270ºF gravity or 250ºF gravity cycles. Learn about each container's validated cycles and ensure they were properly tested and approved by the FDA for the cycles your facility needs to run. You don't want to purchase containers and then find your facility uses instruments that require sterilization at temperatures the containers can't handle. It's also important to verify if the container has been validated to hold silicone mats, surgical towels, lumens or power equipment.

Some rigid containers are made of all plastic and others are metal-plastic hybrids, which tend to have more problems with drying compared with more commonly used all-metal containers.

Also check the IFU of instruments that undergo immediate use sterilization. Make sure both the instruments and the rigid containers they're placed in are validated for immediate use cycles. Get this information in writing from the container manufacturer.

  • Inserts and accessories. The container you buy needs to match up with the instrumentation and devices you use regularly. For example, expensive, delicate video cameras need to be placed in specialty containers with sprockets that keep the camera and its cable secured, so they aren't damaged while the container is moved. Many vendors offer specialty-specific trays and inserts that help you line up and organize the instruments, cords and cables. Specialized inserts are especially important for containers purchased for eye centers that use delicate and expensive microsurgical instruments.
  • Ease of use. Make sure OR staff members and sterile processing techs sign off on the designs of the containers you purchase. How easy is it for surgical team members to open a container and remove the contents aseptically? Can sterile processing techs easily disassemble the components, remove filter plates and clean them between uses? Purchases of these containers require input from both the ORs and SPD.
  • Cleaning requirements. Containers must be disassembled, the filter plates removed and internal components washed before they're used again. Refer to the IFU of each container for information on proper cleaning methods, which typically involves treatment with a neutral pH detergent and water. This can be done manually or in an automatic washer, so consider how much workload and time are involved in cleaning each container.
  • Instrument identification. Facilities with an electronic instrument tracking system can place a barcode label for the instrument set on the outside of a container to track the status of the sets within. Many facilities don't have access to this technology, however, and rely on instrument identification tags placed on internal baskets and on the outside of the containers. Make sure the tags are durable and easy to read and find out how long it takes to get replacements from the container company if the tags become dislodged and lost or damaged.
  • Sterilization testing. Run containers through cycles with biological vials and chemical indicators in place to verify sterilization parameters are reached. Manufacturers test their containers in a controlled lab setting, but you need to confirm the containers work effectively in your facility. You don't need to test every container, and the test isn't that involved — you can use a protocol called rigid container testing outlined in AAMI ST79. After purchase, reperform the test annually.

Staff need education on the quality checks a container manufacturer recommends after each use. Components of the container can become damaged over time, so make sure your staff gets in-serviced on proper upkeep, with competencies verified.

  • Smart shopping. If you don't get competitive pricing, how do you know you got the best deal? Your facility might not be positioned to put every item you sterilize in rigid containers. If your budget is limited, start with delicate and high-expense items that you need to protect from damage. Of course, remember to ask about payment plans and other ways to bring down the upfront cost of the containers. OSM
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