AAMI News October 2018

Asked & Answered: Peel-Pack Instrument Storage

With this edition of AAMI News, we introduce a new feature in which we showcase questions and answers from professionals participating in AAMI’s online discussion groups, collectively known as AAMI Connect. AAMI does not endorse specific practices or advice. Participants in these forums are sharing their own experiences and insights.

Q: In a recent Joint Commission survey, our surveyor cited us on his observation of one peel-pouched instrument stored in surgery that appeared to be in the locked position. The instrument was not locked when opened, but he felt we need to use a device on all hinged instruments to keep them in the open position even after sterilization. He recommended a paper device to do this. We use vented plastic instrument protectors, which will work on some but not all items. Using plastic instrument protectors on all hinged items would increase our processing costs significantly, and the paper sounds more economical. Does everyone use a device to keep hinged instruments open in a peel pouch? Does anyone use a paper device that works well to keep all hinged instruments open in a peel pouch when they are stored on their sides?

A: I have never heard of any Joint Commission surveyor making that leap before. The IC.02.02.01 standard, Reducing infection risks from medical devices, equipment, and supplies, section 8.2, paragraph d), states: “Ratcheted instruments should be unlatched. Racks, pins, stringers, or other specifically designed devices can be used to hold the instruments in the unlatched position.”

“Should be unlatched” is the requirement. The rest are suggestions that can be used if you choose, but I would not read this as requiring their use. To go one step further, paragraph e) states: “Sharp items should be protected from damage.” This would be read as a requirement. So the question could revolve around what is considered “sharp.” I wouldn’t use tip protectors on Kelly clamps, but I might consider their use on Kocher clamps or single-tooth gynecology tenaculums, as examples. If you choose to use something to keep the instruments from becoming accidentally latched, be sure they are specifically designed for that use and compatible with the sterilization method you are using per the device instructions for use.

Kimberly Smith, MS, RN, CNOR, CRCST, KAS Sterilization Solutions, independent sterile processing department consultant

A: Thank you, and yes, we gave him a copy of that standard and explained that information. However, his actual final finding was: “In 2 of 10 instruments identified in peel packages, it was noted that these two instruments were in closed position. One clamp was in a package too narrow to allow the instrument to be held open for sterilization.” However, I was not with him when he made this discovery. So this was an item that he found in storage and since it was stored on its side, the top handle fell down and “appeared to be closed.” (When opened, it was not ratcheted.) I feel like he needed to find something to file under Joint Commission’s most cited standard, IC.02.02.01. This was all he could find related to sterilization and high-level disinfection. Everything else was in place, and he commented about us going above and beyond in other areas. He was not aware of the change to daily monitoring of cleaning equipment and was not educated on that change. I believe this was an opinion since he could not see how it was when it was actually sterilized and was determined to find a citing under the IC.02.02.01 standard.

Becky Stidham, Central Service manager, Wauseon, OH

A: We were actually questioned on the same thing. We started utilizing paper tip protectors on all hinged instruments when peel pouching. We were also using the plastic tip protectors, but they found some that had actually fallen off while inspecting. We were not cited on this, but we did change the process to use the paper tip protectors.

Julian Martinez, CSPDT, CRCST, manager of the Sterile Processing Department, Hawaii Pacific Health, Honolulu, HI


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