ASC infection control: Sterilization wraps vs. rigid containers — Which is best?

Rigid containers and sterilization wraps are two major sterilization packaging types for sterile instruments used in the healthcare setting.

Rigid containers are reusable and come in various sizes and materials, many of which have a filter mechanism to allow sterilizing agents to enter and exit the container; sterilization wraps are a three-layer laminate made of meltblown polypropylene bonded on both surfaces with a layer of spunbonded polypropylene.

A recent study published in the American Journal of Infection Control examined the efficacy of rigid containers and sterilization wraps and found almost all — 97 of 111 — rigid containers failed to prevent bacterial ingress post-sterilization. All 161of the trays wrapped in sterilization wrap maintained sterility.

"The failure of rigid containers to protect surgical instruments post-sterilization until use in the OR increases the likelihood of introducing bacteria to the surgical instruments and, ultimately, increasing the risk for surgical site infection," says Peggy Luebbert, MS, MT, CIC, CHSP, CBSPD, infection preventionist at Nebraska Orthopaedic Hospital and owner of Healthcare Interventions. "Moreover, the study found that rigid containers become less effective the longer they are in use."


The rigid containers and sterilization wrap were tested in hospital-like conditions, but ASCs are also noting the results given their high case volume and increasing "wear and tear" on containers.

The rigid containers and sterilization wraps are designed to protect surgical instruments from contamination, but these findings challenge previously-held beliefs that the rigid containers are effective to maintain sterility of their contents. The study also showed the unused containers failed to maintain barrier performance under the study's test conditions.

"Infection preventionists and others working in this field may be unsettled to learn that the equipment they rely on day-to-day may not be protecting their patients from risk of infection," says Ms. Luebbert. "This new evidence should prompt everyone within the ASC to take a closer look at the sterilization packaging systems used and determine whether they can trust the equipment to get the job done."

Infection preventionists in the hospital and ASC setting are staying abreast of new scientific data to make the best decisions for their patients. Their job is to minimize SSI risk and ensure sterility.

"This recent scientific study clearly demonstrates the ability of trays wrapped with sterilization wrap to maintain sterility of their contents post-sterilization and prior to use in the OR," said Ms. Luebbert. "Even more compelling is the fact that this is the second study in a decade to produce these findings. This is information that cannot be ignored."

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