Sterile barrier systems
as to energy consumption. The report refers to a study published by Rizan et al.21
that looked
at minimising the carbon footprint and the financial costs of the steam sterilisation and packaging of reusable surgical instruments. The Rizan paper was published in the British Journal of Surgery (BJS), one of the top six22
periodicals
in the world (the “Rizan Study”). The Rizan Study unequivocally found that the carbon footprint of reusable rigid containers is higher than that of single-use tray wraps (721g CO2
e per set for containers vs 387g CO2 set for flexible wrap).23 e per According to the Rizan
Study, this is principally due to the additional washing required for rigid containers (which is inefficient due to their bulkiness). On average, it is accepted that 10 litres of water per container per washing cycle is used. By no means are we saying that the carbon
footprint of sterile wraps is better than that of reusable rigid containers but that calculating a product’s actual footprint can vary according to the database, method and reporting used.
Calculating costs Another key factor that drives any purchasing decision is costs – and SBS are no exception. In fact, according to the Krohn Study, hospitals should monitor the costs of all direct and indirect processes to achieve efficiency and safeguard financial sustainability.24
One
neglected process with significant costs is the processing of reusable medical devices and their packaging performed in the central sterilisation supply department (CSSD) and the operating theatre. Looking at the real cost of reprocessing and sterilising surgical instruments, the Krohn Study concluded that sequential packaging results in the highest cost (EUR 3.87), followed by one-step sterilisation wrap packaging (EUR 3.44). The lowest cost was allocated to reusable containers without inner wrap (EUR 2.05).25
However, such an analysis
fails to consider the costs of maintaining reusable sterilisation containers which, following EN 868-8, should be done every 100 cycles.26
the amount of manual work required to properly maintain them.29
Space and user friendliness While patient safety, sustainability and costs are often the main driving factors behind one’s SBS purchasing decisions, other factors – including space – should be considered as well. One manufacturer of storage units for sterilised products has calculated that sterilisation wraps, with appropriate storage like a basket-in-basket system, require 50% less space within the CSSD than their reusable rigid container counterparts.30
Another very
important element to consider is feasibility and staff satisfaction. A simple survey conducted at the Hôpital FOCH31
found that 47% of CSSD staff
were satisfied with sterilisation wrap, compared to 25% with containers. The surveyed workers specifically noted flexible packaging’s ease of use, comparative lightness and decreased risk for burns when unloading the sterilisers. That same survey found that 42% of operating
theatre staff preferred containers compared to 26% who preferred sterlisation wraps, with many expressing their belief that containers are easier to store and require less precaution. The study does not indicate whether the staff were storing the containers in accordance with EN 868-8,32
According to researchers at the Hôpital
Pitié-Salpêtrière, the costs of such preventative maintenance is estimated to be around EUR 72 per container.27 Researchers at the Hôpital Pitié-Salpêtrière
also evaluated the costs of maintaining 3,900 containers versus the cost of replacing them with flexible packaging. What they found was that the use of flexible packaging resulted in annual savings of EUR 19,356 starting from the second year onwards.28
This finding has been
confirmed in a paper by Diallo et al, which found that the higher cost of reusable containers stems not from the initial investment, but from
50
www.clinicalservicesjournal.com I April 2024 be stacked two high.
A win-win-win Making an informed SBS purchasing decision starts with knowing all the facts, and the fact is that both sterilisation wrap products and rigid containers have their own pros and cons. For instance, while reusable containers require
regular maintenance, inspection and washing, flexible packaging needs to be inspected carefully. Furthermore, while properly using containers requires that a facility have the staff, space and budget, the use of flexible sterilisation wrap also comes with its own infrastructure demands.
As such, the debate should not be about
which packaging is best but about how we can make both options better. This means helping and training end users to identify and separate materials that can be recycled. It also means working with waste management companies to spark their interest to set up collection and recycling schedules. If we do this, then both flexible wrap and rigid containers can be a viable way to help reduce one’s environmental footprint without sacrificing patient safety, impacting employee wellbeing, or making a significant capital investment – which, in our book, is what we call a win-win-win. CSJ
About the author which states that containers should only
Karina Engels works as a Consultant Product Manager, Sterilisation, at O&M HALYARD. Karina trained as a general nurse and worked in Bordet Institute in Brussels; after which, she went into medical sales and product management. As Product Manager for sterilisation products, Karina has been a member of Edana (non-woven manufacturers) and DIN TC198/WG7. More recently, she represented HALYARD in the environmental working group of the SBA. She initiated a sterilisation wrap recycling pilot study in 2018 and is passionate about bringing recycling solutions and new technologies to end-users.
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