Opening Sterile Surgical Instrument Containers
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In contemporary healthcare settings, the need to balance efficiency, cost-effectiveness, and environmental responsibility has led to the widespread adoption of reusable containers for surgical instruments.1,2 This video demonstrates the advantages of employing reusable rigid containers for surgical instruments, using a laparoscopic set from Baptist Hospitals of Southeast Texas as a case study.
The external features of this container provide visual cues regarding the sterility of the enclosed instruments. A prominent feature of the container is the chemical indicator-based fluorescent orange lock, which serves as the primary mechanism for securing the instruments. Before opening the instrument set, healthcare professionals must visually inspect the lock to ensure that the seals remain intact and the chemical indicator has undergone the expected transition from white to black. This visible change in color serves as an indicator of successful sterilization.3 An additional feature of the container is a small "price tag" sticker affixed to the exterior. This sticker contains essential details about the autoclave used for sterilization, the load number, and the Julian date. The first two digits (YY) show the year of sterilization for the given item. The final three digits (DDD) show the day of the year, beginning with January 1 (001) and continuing with each day of the year in sequence. This information is important for monitoring and maintaining quality control standards.
The laparoscopic instrument set container is designed with locks on both sides, requiring a coordinated approach to prevent contamination during the opening process. Before opening the container, practitioners are advised to place a hand on either side of the locks. The locks are designed to break upon opening, with a potential for small pieces of plastic to be released in air. To mitigate the risk of contamination, practitioners are instructed to keep their hands over the locks as they simultaneously lift them. This opening approach minimizes the likelihood of plastic fragments becoming airborne. Upon breaking the locks, the container’s lid is lifted approximately 12 inches from the container. Simultaneously, practitioners rock back to create distance from the top of the set. This precautionary measure prevents the risk of fallout contamination.
After successfully lifting the lid, practitioners proceed with a detailed inspection, focusing on the chemical indicators of the filters located on the inner surface of the lid. To verify the set’s sterility, practitioners remove the cover from each filter and hold it up against a light source. This visual inspection aims to identify any potential issues such as holes and tears, which could indicate a breach in the filter’s integrity. Afterwards, the technician, having performed a hand scrub, approaches the container without touching it, to inspect the chemical indicator inside the container and confirms that the dark bar has completely traveled through the unsafe zone and has entered the safe zone.
Only then does the technician pick up the instrument set from the container and wait for the circulator to check the filters located at the bottom of the container in the same manner as discussed above. After confirming the integrity of the filters and the change in the color of the chemical indicators, the surgical technician places the instrument set on the sterile table. This meticulous process safeguards sterility and minimizes the risk of contamination in the surgical environment.
It is also worth mentioning that the establishment of sterile fields should ideally coincide with the timing of the procedure and should never be left unattended. The longer a sterile field is left open and exposed prior to the procedure, the greater the risk of contamination from airborne microbes.4
The successful outcome of surgical procedures relies on the accuracy and sterility of instruments, making the selection of instrument containers a critical aspect of OR protocols. This video provides a comprehensive tutorial on how to effectively utilize reusable rigid containers for surgical instruments.
Check out the rest of the series below:
Citations
- Keil M, Viere T, Helms K, Rogowski W. The impact of switching from single-use to reusable healthcare products: a transparency checklist and systematic review of life-cycle assessments. Eur J Public Health. 2023;33(1). doi:10.1093/eurpub/ckac174.
- Lam K, Gadi N, Acharya A, Winter Beatty J, Darzi A, Purkayastha S. Interventions for sustainable surgery: a systematic review. Int J Surg. 2023;109(5). doi:10.1097/JS9.0000000000000359.
- Centers for Disease Control and Prevention. Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008; Miscellaneous Inactivating Agents. CDC website. 2013;(May).
- Tennant K, Rivers CL. Sterile Technique. [Updated 2022 Sep 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
Cite this article
Buckner B, Romero C. Opening sterile surgical instrument containers. J Med Insight. 2024;2024(300.5). doi:10.24296/jomi/300.5.
Procedure Outline
Transcription
Surgical instruments are often contained within rigid instrument containers. The containers are reusable and keep down on the amount of trash in the OR coming from wrappers.
The set that we have here is a laparoscopic set from one of our clinical partners, Baptist Hospitals of Southeast Texas. The set is for laparoscopic surgery. It comes in a metal reusable container, and if we look at the outside, we see several big pieces of information. Number 1: you'll see the fluorescent orange lock with a chemical indicator on it. Before we would ever open up this instrument set, we would want to verify its integrity. Make sure the seals are good, make sure they haven't been popped, make sure that the indicator has turned from white to black. Also, there is a little "price tag" sticker that is going to tell us the autoclave, the load number, and the Julian date, which is the days of the year from 1-365.
There are locks on both sides of the container, and before I open them, I want to put a hand on either side. As I open them, the lock is going to break, and a little piece of plastic may fly off, so you may want to keep your hand over it. We're going to pop them at the same time, simply by lifting up right here with our fingers. This instrument set is going to come up 12 inches, and we're going to rock back. We do that to get off of the top of the set because we don't want to hang over a surgical set because of fallout contamination.
Once we do have the set, there are chemical indicators on these filters. We want to take off the cover to the filter, and we often hold it up and we hold it up to the light. What we're looking for are holes, tears, watermarks - something that could show that this filter had a break in it. Since there's two, we'll do one on each side.
The unsterile person is the one who is going to open the outside of this set. What we're waiting on, after we open up the lid, is we need the sterile surgical tech who's already done a surgical hand scrub, or used Avagard to don sterile gown and gloves, and then they are going to come up and before they put their hands inside that set, they want to look for the chemical indicator that's in there and make sure that it's already turned.
The surgical tech student will approach the sterile instrument container, making sure to leave room between their sterile gown and the outside of the container. Before they reach their hands in, they check the internal indicator to make sure that the color changed and went from white to blue or black. Once that's been determined, she will reach inside the set, and pick up the entire set, and wait for the circulator to come up and check the filters in the bottom of the set. To do so beforehand would contaminate the entire back table if the filters were shown to be bad. It's good. The surgical tech waits for the circulator to tell them it's good before they put the package on the table.