SELF-STUDY SERIES
surface burrs/irregularities can catch and cut the wrap. Items used to carry or protect wrapped packages from damage, such as trays and shelf liners, should also be reviewed for compatibility with the new wrap. Storage methods. Ensure that wrapped items are not stacked or positioned in a way that could create punctures or tears. Storage shelves should be free of burrs and snag points. Shelf liners may help protect wrapped packages from damage. Wrap inspection. Sterile processing and operating room staff should be trained on how to properly inspect wraps. Before wrapping and after sterile packs have been moed to the sterile fi eld, each sheet of wrap should be inspected for holes, tears, abrasions, and cuts. Some sterilization wraps now recommend the use of light- boxes for inspection in sterile processing departments. Others recommend holding the wrap up against a light source such as an inspection light or ceiling light. The ability to see holes in a wrap depends on several factors. One study looked at the ability of OR staff to detect holes within the thickest single-use polypropylene two-ply sterilization wrap available. Holes ranging in sizes from 1.1 to 10 mm were evaluated. The study demonstrated that only the 10
Damage Description Straight-line cut with clean edges
Snag cut: Straight line or many smaller cuts or holes in a straight line. Ragged edges
Pressure hole less than 2 mm, typically along tray edges Triangular snag hole with loose fi bers on the edge
Puncture hole penetrates package and has ragged edge with fi bers Small pin hole that may or may not go through both sheets A fuzzy surface or fuzzy perimeter with a hole in the middle
Staining and discoloration
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mm hole could be consistently detected by OR staff.2
A similar study evaluated a
medium-weight wrap with hole diameters between 0.86 and 5.0 mm. The results indi- cated that holes of 2.5mm and higher were readily detectable by the naked eye.3
How-
ever, both studies concluded that the ability to detect holes was not related to experience, the OR light source, or inspection time, and others have suggested that the pattern on these specifi c wraps may hae contributed to the inability to fi nd holes.
In the real world, wrap damage is rarely due to the manufacturing process. Instead, it is more likely to be due to an event that occurred during transport, handling or storage. The tables below summarize some types of damage and their causes for the two primary categories of wrap products.
Assure a positive sterilization wrap conversion
Pin holes, rips, and tears in wrapped surgi- cal sets create havoc in the OR and cause more work and critique for the sterile processing department. Changing wrap products may solve the problem, but only if all functional, process, and human factors are taken into consideration before making the selections. Rather than being reactive, the evaluation and selection process should
be systematic and should meet the needs of both the surgical and sterile processing departments. This will lead to a successful conversion experience. HPN
References:
1. Association for the Advancement of Medical Instrumentation (AAMI). (2020). ANSI/AAMI ST79:2017 Comprehensive guide to steam sterilization and sterility assurance in health care facili- ties. AAMI. Accessed June 1, 2022.
2. Waked, W., Simpson, A., Miller, C. Magit, D. and Grauer, J. (2007). Sterilization Wrap Inspection Do Not Adequately Evaluate Instrument Sterility. Clinical Orthopedics and Related Research. 462, 207-211. Accessed June 1, 2022.
3. Rashidifard, C., Mayassi, H., Bush, C., Opalacz, B., Richardson, M., Muccino, P., and DiPasquale, T. (2018). Looking for Holes in Sterile Wrapping: How Accurate Are We? Clinical Orthopedics and Related research, 476, 1076-1080. Accessed June 1, 2022.
4. Kimberly -Clark. (2015, April 29) Sterilization wrap tear identifi cation & handling technique in-service [Video]. Youtube.
https://www.youtube.com/watch?v=FQcjCzKH6vw. Accessed June 1, 2022.
5. Stoller, Julie. (2000, November 1). What You Always Wanted to Know About Wrapping Materials. Infection Control Today.
https://www.infectioncontroltoday.com/view/what-you-always- wanted-know-about-wrapping-materials. Accessed June 1, 2022.
Jamie Zarembinski is the clinical educator for sterile processing at Key Surgical. She speaks on sterile processing top- ics at medical facilities and educational seminars around the United States, while also working with sterile processing staff to develop and implement best sterile processing practices. In 2018 Jamie was the recipient of
Table 1: Common damage found on woven sterilization wrap Cause
Knife cut from opening shipping packaging with a box knife Tray pulled or pushed on rough surfaces
Dropped packages, or from packages stacked on top of the wrapped tray From being pushed or pulled against a bur on a sterilizer cart or rack surface Typically, from instruments within the tray puncturing the wrap Loosening fi bers due to repeated laundering
Caused by repeated pulling and pushing over a hard surface. If frequent enough, it can create a hole.
Minerals within steam or water supply such as copper or iron. Use of bleach or other unapproved cleaning agent
Damage Description Straight-line cut with clean edges
Straight line cut with compressed edges, typically found at bottom tray edges or top tray edges
Snag cut: Straight line or many smaller cuts or holes in a straight line. Ragged edges
Pressure hole less than 2 mm, typically along tray edges Triangular snag hole with loose fi bers on the edge
Puncture hole penetrates package and has ragged edge with fi bers Small pin hole that may or may not go through both sheets Large round or irregular hole with hard melted edges. A fuzzy surface or fuzzy perimeter with a hole in the middle
48 July 2022 • HEALTHCARE PURCHASING NEWS •
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Table 2: Common damage found on nonwoven sterilization wrap Cause
Knife cut from opening shipping packaging with a box knife
Heavy wrapped package is moved along a smooth hard surface Heavy package is stacked on top of the wrapped package
Tray pulled or pushed on rough surfaces
Dropped packages, or from packages stacked on top of the wrapped tray From being pushed or pulled against a bur on a sterilizer cart or rack surface Typically, from instruments within the tray puncturing the wrap Manufacturing defect or physical damage from a sharp instrument Contact with a hot instrument or light bulb
Caused by repeated pulling and pushing over a hard surface, if frequent enough, it can create a hole.
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