Torn Sets

[hoopleman]

Yes its the same old question how do you stop sets of instruments (particularly orthopaedic sets in containers which have feet) being torn in the autoclave or during transfer to the theatre?
I have been trying all different types of wrap to stop this problem. My next attempt is to put the container on a flat tray and wrap the whole thing so that there is a flat surface on the autoclave carriage/ and on the transport trolleys,
My question is does anyone know a source of flat trays? Either stainless steel of plastic!

Many Thanks

[rachel.poole@whittington]

Used to be a big issue here....

Have you tried paper/cardboard corners?
We got theatres to buy them! It has helped reduce the number of tears dramatically.

Oh I love this posting business!!



PS We use transportation bags as well!!

[garryhg]

Rachel,

Thanks for letting me know this has improved your issues.
We are having the same issues at the other side of the world (NZ). I have just requested samples of these, so here's hoping!!!!

What / Who's wrap are you currently using?

[rachel.poole@whittington]

Hi,

We are using the stuff from NHS logistics at the moment. Perfectly ok as long as you have very tight ground rules as to the movement of trays and cooling down times. Plus, you have to over order each week in case you don't get your full order....which is a pain sometimes.
In a recent informal trust audit, instrument trays in my hospital were shown to be moved around appox 8 - 10 times before reaching their final destination and opened up in theatres. Reducing this movement and using transportation bags has reduced the number of tears, and therefore reducing the need to use anything other than what we are using now.

This was not easy to do. The easy bit was changing practice in my own dept. Making theatres aware of manual handling issues, the results of poor handling and storage requires persistance and it is very satisfying once you see results. There is still a lot of work to be done but I can see light at the end of the tunnel.

We have a very strict 2 hour cooling down period to compliment this and is included in our turnaround time of 6 hours.

Hope my experiences help....

[garryhg]

Hi Hoopleman,

You can get autoclavable plastic trays from Kimberly Clark. We got a number of them supplied FOC as we currently use their wraps.


(Rachel, Thanks for the PM)

Garry

[Pat Oliver]

I suggest it is not the wrap, but the handling that is at fault--plus the need for cooling time before you move the device/tray.

[Lynne Adamson]

I use 'Soaker Sheets' from Clinipak underneath all heavy sets, and two SMS wraps, this has improved our tear rate, but having said that at the same time, we did look at the logistics and storage facilities, and made improvements in the way the customers and ourselves kept the sets.

Hope this helps, unfortunately until these orthopaedic companies think to consult the users during the design of these containers, and consider the processes their products have to go through to render them 'fit for purpose', we are all stuck with the problem!

Regards.

Lynne Adamson

[Steve Johnston]

Hi
You could try taking the legs off they normally come off with out too many problems. Education in handling by staff outside of SSD is normally a good start. Review of storage and transport systems. But getting people used to not having linen wraps is an up hill battle. I am now proposing to use company reps to do the handling sales pitch (in theatres)

Regards

Steve

[Lynne Adamson]

Hi

You may end up with a problem with wet sets if you use a flat solid tray. Just a thought.

We use Clinipack Soaker Sheets, which are a thick crepe paper before we wrap, and then we also use on some of the worse sets a criss cross of autoclave tape over the feet.

We also did have some removed from the containers where possible.

Regards.

Lynne Adamson

[CHANDLEP]

Dear All,
Most of us will have been through this problem, trying different trays wraps, trying to add protection to corners etc with varying degrees of success but the problem is not going to go away as instrument manufacturers come up with increasingly complex instrument systems in specialist containers.

In my last Trust, we took a multi-facted approach to trying to nail this issue.
1. I issued an internal Decontamination Safety Notice (similar to the MHRA ones, an alert system we had developed) and circulated to all clinical areas re change in policy to check all tray wraps at (a) SSD dispatch (b) theatre arrival of sets (c) when setting up trays in theatre for a case but before the patient was anaesthetised. ALong with the checks we defined responsibility - i.e. at (a) and (b) was deemed SSD responsibility provided (b) was within 1 hour of delivery. In this way, we could broadly separate out where poor handling may have contibuted so that SSD were not always the team being blamed
2. All known/ likely tear risk sets were transferred to sterilisation containers. We purchased about 150 initially which was sufficient for need, out of a total Trust tray inventory of circa 2,200 sets
3. Most importantly I wanted to stop the problem recurring, and so included in the Trust Decontamination Policy (acquisition section) the requirement for SSD to undertake a 'container assessment/validation' prior to acceptance of new sets into use. This was to check for wrap tear risk and to ensure that the set would come out of sterilisers dry (i.e. trying to avoid the plastic/ heavy metal content problem).

These actions went a long way to addressing the problem; one one occasion we received 10 new orthopaedic sets which bypassed the container check requirement and these arrived on Friday for use monday morning. I advised the supplier that these could not be used due to feet and sharp corners and that we required sterilisation containers (which dont need wrapping) to be supplied. Within 4 hours these arrived in the orthopaedic rep's car - much to my amazement!

We have to put consistent pressure on the (especially orthopaedic) instrument providers to get this right otherwise we have the double whammy of adverse perceptions of the SSD within the Trust and of course the clinical risk issues of patient cancellation due to sets being torn at the time of surgery.

Pete Chandler

[Sharon Fox]

Dear Pete

The Midlands branch is currently looking at setting up a 'working party' with Depuy with concerns of torn wrap's linked with loan trays.
Investigations and outcomes will be reported in the Midlands branch meeting notes(19.01.2010)


Regards
Sharon Fox