Time to take storing sterilized surgical instruments seriously

Forget about flash UV and other tricks to compensate for the fundamentals

By James Schneiter

The proper storage of sterilized instruments is extremely important to protect them from contamination prior to their use on patients. According to the Centers for Disease Control and Prevention (CDC), one of the major sources of contamination of surgical instruments is airborne bacteria and viruses that settle on instruments that are not properly shielded from needless exposure. Instruments that must be sterile at the time of use must be properly stored at all times to ensure patient safety and minimize the risk of a surgical infection.1

Sterilized instruments must be stored in a manner that maintains the integrity of the packaging material and prevents contamination from any source, including both environmental and human contamination. Sterile packs and trays must not be stored in ultraviolet cabinets or in any type of disinfectants as these processes will compromise the sterility of the packs and the instruments. It is very important that sterilized, wrapped instruments are stored in a clean, dry area, and that they are subjected to minimal handling before use on patients in surgery. 2?

Recommendations for the storage of sterile instruments from the CDC, The Joint Commission (TJC)3, the Association for the Advancement of Medical Instrumentation (AAMI)4, and the Association of periOperative Registered Nurses (AORN) 5 include:

1. Wrapped packs should be allowed to dry in the sterilizer prior to handling so that the integrity of the sterile pack is not compromised by condensation.
2. Sterile instrument packs must be stored in a clean, dry, dust and lint free environment.
3. It is strongly recommended that you use closed or covered cabinets for sterile packs.
4. Sterile packs and materials should be stored at a height of 8 to 10 inches above the floor and at least 18 inches beneath the ceiling.
5. Similar items should be kept together (sterile with sterile and clean with clean).
6. Sterile packs should be used in the chronological order in which they were sterilized in. This is easily accomplished by using the oldest items first and the newest items last.
7. Do not store or place sterile packs on the floor, under sinks or in any location that is prone to become damp, moist or wet.
8. Do not place sterile packs in any storage area other than cabinets or shelving that is specifically designated for sterile storage.
9. Sterile packages should never be stored with items that are not intended for clinical use (i.e., paper goods, cleaning supplies, etc.).
10. Non-sterile shipping cartons, containers and packaging materials must never be allowed in a sterile storage area.
11. Shipping cartons, containers and packaging materials should never be used as storage containers within sterile storage areas. Corrugated cardboard boxes harbor dust and bacteria in their grooves and are frequent sources of fungal contamination and bacterial spores.
12. Sterile packages should not be handled unnecessarily so as to minimize the possibility of damage to the sterile barrier. Every time a sterile package is handled, the risk of damage to the sterile barrier increases exponentially.

Contamination of sterile instrument packs can occur during storage from a variety of different events. Given that sterility is event-related, it is important to avoid any event during storage that can be a source of contamination. Possible contamination causing events include, but are not limited to:

1. Excessive transferring from one place to another (over-handling)
2. Contamination during the physical rotation or transfer of instrument packs from one storage area to another.
3. Bundling packs together using rubber bands
4. Exposure to moisture (water, other liquids or aerosols)
5. The physical degradation/failure of the packaging material
6. The package being penetrated by instruments breaking through the surface of the pack?

It is very important to remember that a sterile pack or package is considered to be nonsterile the moment it:

1. Is opened or damaged
2. Emerges from the steam sterilizer wet or is placed on a wet surface
3. It is dropped or placed on a dirty surface. 6

?The No. 1 goal of any sterile storage program must be to eliminate the risk of contaminating an instrument and potentially causing patient harm. An instrument that is correctly cleaned, packaged, sterilized, stored and handled will maintain its sterility until used, thus eliminating the risk of patient harm from an instrument contaminated during storage.

1 https://www.cdc.gov/

2 Ibid “CDC”

3 https://www.jointcommission.org/

4 https://www.aami.org/

5 https://www.aorn.org/

6 Ibid “AORN”