Michael Matthews, MBA, CRCST, CIS, CHL
Manager, Sterile Processing/OR
Baptist Health Medical Center-Conway, AR


Few things strike fear into the hearts of sterile processing staff quite like holes in wrapped items. Holes in wraps seem to appear without discrimination and always at the most inconvenient time possible. To make matters worse, the most critical instrument sets (like those for orthopedic trauma), are almost all wrapped. While an almost universal problem, there is a very clear solution to the problem of holes in wraps:  the use of rigid containers. However, this solution will require hospitals, vendors and even regulators to collaborate.

From a hospital’s perspective, the idea of transitioning to rigid containers can be very daunting. High startup costs will typically cause any hospital administrator’s blood pressure to rise. What most administrators do not realize is that they are losing money every time the wrapping of an instrument set is damaged. To sterile processing professionals, it can be shocking to know that most hospital administrators have no concept of the cost to reprocess a single instrument or set of instruments. It seems that most administrators are content with the knowledge that whatever reprocessing costs, it is cheaper than the use of disposables. That, of course, is often true, but it does not mean that reprocessing is free.

Wrapping a single instrument usually costs between $6-8 for the wrap itself. Not included in that cost are any other products a facility may use to help instrument drying or to provide protection against holes. For a single instrument set, it may not be much, but many orthopedic procedures require several instrument sets. For example, a single total joint procedure may require between 5-12 sets, depending on the vendor, and a total joint revision may require more than 30 sets. On the other hand, the cost of filters and locks for rigid containers are much more economical and usually cost less than 50 cents each.

Now for the vendor’s perspective. Vendors have perhaps an even greater financial incentive to provide rigid containers for their instrument sets, as described in the following situation. Recently, a regional hospital had to delay a case due to a hole in the sterile wrap of an orthopedic set. There were no available backups, as the inventory of trauma instrumentation was managed by the vendor directly. The surgeon was obviously displeased and demanded that the vendor begin keeping additional sets on the shelf to prevent such an event from happening again. Afterwards, the rep was asked just how much accommodating the surgeon’s request would cost. The answer:  close to $25,000! Furthermore, this ‘solution’ would still not solve the root problem that could be fixed by spending a fraction of that cost on rigid containers.

None of the benefits of rigid containers can be realized if regulators do not allow facilities and vendors to transition to rigid containers. Using their influence, regulators should clear lead the path by easing any obstacles that may hinder such a move. Regulators should be primarily concerned with protecting patients and delays in care are a known threat to patient safety. For example, even if a patient is healthy, the longer a patient must wait to be taken into an OR, the greater the effects of anxiety and stress have on the body. These effects can include increased difficulty with anesthesia, increased recovery time and decreased patient satisfaction. Obviously, the effects of a delay in an emergent or trauma situation can be much more severe.

A move to greater use of rigid containers will not be without difficulty. The startup costs can be significant and several manufacturers and suppliers would be affected, and not all positively. However, we should not allow these obstacles to hinder us as caregivers from doing what is best for patient safety. Holes in critical instrumentation wraps are a threat to patient safety and we must address the root cause rather than settle for half-measure solutions.


This article was originally published in ReadySet Review, a newsletter intended to help educate Surgical Service Professionals on important, topical issues.  The views and opinions in this article are those of the author and do not necessarily reflect those of ReadySet Surgical.