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Packaging


with packaging. MSU’s work on how packages are used in ambulances, led by Jiyon Lee, a KIIP admin, is emblematic of two of the group’s four programme pillars: aseptic presentation and the ‘last 100 yards’.


At the Informa Engineering Week conference in December 2020, Rod Patch, senior director for package engineering and product labelling at Johnson & Johnson Vision, and a lead member of the group, noted that, despite the worldwide agreement on the importance of sterile barriers and aseptic presentation, universal acceptance is yet to become universal adoption – and there is a lack of evidence and consistency in information on the best techniques. Discussing the concept of the last 100 yards, he pointed out how little information packaging designers have about how their products are used inside healthcare systems, stressing that they need to collaborate with their customers to truly meet the needs of patients and healthcare practitioners. It’s in investigating how packages are actually used that MSU’s work is most significant. Bix’s team fills in the knowledge gaps with a whole range of high-tech and multidisciplinary approaches, from eye tracking (to establish exactly what people are looking at) to ‘change detection’ (a technique used in cognitive psychology to assess how people process different images). A lot of the research that already exists around healthcare packaging is focused more on the issues posed by low health literacy and non-native readers, but the Michigan team is taking that one step further and looking at attention as much as comprehension, in order to establish how people can most easily use devices and medication in the safest way. Health literacy is clearly not a problem for ambulance crews, but nor, in a straightforward sense, is attention. They’re fully focused on giving patients the care they need – and that’s a clue.


Preventative action


Wherever it might be used, the point of sterile packaging is to prevent healthcare-acquired infections. But the outside of a sterile package, by definition, is not sterile: people touch it all the way through distribution to the point of its use. “The provider has to get the contents on to the field without it coming into contact with them, or the outside of the package,” Bix says. “So, you are supposed to have the [non-sterile] circulator touching the outside and the sterile scrub touching the inside.” In practice, however, this may not happen – especially in emergency situations, when packages are handled by people whose focus is on getting the device out as quickly as possible. While


Medical Device Developments / www.nsmedicaldevices.com


products are assessed in a very controlled and well-lit perioperative environment, they may not necessarily be used in one. As part of her PhD research with the team at MSU, Lee, now a packaging engineer at Amgen, took a closer look at how exactly ambulance staff work and the pressures they are under.


Lee and her colleagues built a simulated ambulance (using genuine ambulance parts) and mounted it on a vibration table to replicate the kind of driving conditions that ambulances experience. With some difficulty, they recruited paramedics to help with the study and mounted a camera on the wall of the ambulance to film them in action. Watching the film afterwards, they found that in two out of the nine cases, paramedics opened the sterile packaging for medical devices by ripping it apart with their teeth. At other times, they used their trauma shears for all kinds of purposes, from opening tricky packages to cutting off blood-stained clothes.


“[An ambulance] is a very time-critical environment, and [paramedics’] most important thing is to stabilise the patient. They use one hand to hold the bars, or to hold the patient, because there is a lot of vibration.”


Jiyon Lee “They clean and disinfect the ambulance, but that


doesn’t mean that everything is sterile,” says Lee. This is not, she points out, because the paramedics are not doing their job – on the contrary, they are doing their job as effectively as they can. “This is a very time- critical environment,” she explains, “and their most important thing is to stabilise the patient.


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Inappropriate packaging can create extra hazards in emergency situations.


i viewfinder/Shutterstock.com


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