Inventory management – first in first out, expiry dates
Handling Sterile Supplies
Common MDRD policies will state that:
The shelf life of a sterilized package is “event-related” rather than time related. The sterility of a package is maintained until the package is opened, damaged or contaminated.
This means that the packaging materials we use can keep items sterile unless an “event” happens to them. Events can happen in many ways:
- Holes or tears in the packaging
- Wetness or moisture
- Dust on the package.
- Dropped on the ground or on a dirty area such as the floor of a truck.
- Handling with dirty hands.
- Unsealed package
- Some items will have an expiry date on the package because of the materials used to manufacture the item. If an expiry date on a package has passed then the item cannot be used.
- Rough handling, tight storage areas, sharp tools used to open boxes of single use items, or sharp edges on shelves can all be causes of holes and tears.
- If wetness of any sort gets on any type of packaging we have to consider the package unsterile. Even a tiny amount of moisture will damage the package and can seep through to the item inside. Microorganisms travel in the moisture and contaminate the item.
- Dust might not contaminate the inside of the sterile package but it can fall into sterile items or even a patient as the package is opened. Sterile packaging must be opened in a very special way to ensure the item stays sterile. If there is dust or dirt on the outside it cannot be used.
- There is no 5 second rule or even a 3 second rule! The rule is if it falls on the ground or into a dirty area then the item is not sterile. This is similar to having dust on a package. Any dirt on the outside compromises the item inside because it can’t be opened in a sterile fashion.
- All the rules that apply to wet packages or dust apply to dirty hands. If your hands are wet or dirty then you will contaminate the outside of the package. Wash and carefully dry your hands before handling sterile items.
- If the package looks open at all, even partially opened, it cannot be used. Sterility can only be assured if all seals are intact.
- Do you know how to find an expiry date on a package?
- Just because an item has a date on it does not mean that it is necessarily an expiry date. Most sterile items we work with expire only after suffering an event that makes them unsterile. So the date you see may be a manufacture date.
- Many manufacturers use an hour glass symbol to indicate the expiry date.
You may also see a date beside a symbol that looks like a factory. This date is the date the item was manufactured.
Be careful not to mix up these dates. Using a product past its expiry date is very dangerous for patients and staff. Throwing out a product because you have mistaken the manufacture date for an expiry date can be very wasteful.
There are different ways of indicating an expiry or manufacture date and you should make sure you understand how to find them. If you are unsure about any date you see on a package contact the supplier or the manufacturer for clarification.
Do not use, or allow to be used,
any package whose sterility is in doubt!
Sterility maintenance
At point of use
— Inspect integrity of packaging
¡ Sterile supplies are considered contaminated if:
÷ Moisture or watermarks are present internally or externally.
÷ Package is torn, has holes, or seal is broken.
÷ Item is passed expiry date (if present).
÷ Item appears soiled or dusty.
÷ Item is dropped on floor.
÷ Item is placed beside a sink.
÷ Either external or internal chemical indicator missing or results unclear.
— Inspect equipment for cleanliness or discolouration
¡ Remove visually contaminated item from service and contact SPD (if affiliated) or supplier.
If in doubt, consider unsterile and dispose of or reprocess
Handling Sterile Supplies
We need to handle sterile supplies in such a way as to protect the sterility of the package. We must “prevent events”.
Here are some guidelines for safe
“Event Prevention”
- Clean hands are vital. Follow proper hand washing procedures before handling items especially sterile ones
- Carry items away from your body. No matter how good you were at football you cannot carry items under your arm! That is where moisture, dust and even chemicals from deodorants can gather and contaminate items. Carrying many items at once can force you to hold items close to your nose or mouth. Again moisture and contaminates gather here.
- Avoid talking, coughing or sneezing over a sterile package. All of these actions spread moisture droplets over the item. If you do cough or sneeze make sure you are away from sterile packages and wash and dry your hands carefully before handling any items.
- Do not bundle items together with elastic bands or staples. This can cause tears or holes in packaging
- Always check packages for damage or wetness before placing them on shelves. A damaged or contaminated package can contaminate packages around it
- Only use clean, dry carts and containers to transport items. Items must be covered and protected from dust, moisture or any other contamination during transport. Corrugated cardboard boxes commonly used as exterior shipping containers must be considered contaminated, and are not to be used as sterile storage bins. They should never be brought into a sterile storage area. They should be unloaded outside of sterile storage areas.
Preventing Events
is our goal
and
intent!
Sterile Storage
Sterile storage locations should be protected from public access and walkthroughs. Restrict traffic flow to authorized staff only by clearly identifying the restricted area.
Sterile storage should be in a clean, dry location away from heating, ventilation, air conditioning systems, windows and utility pipes.
Sterile storage should be within closed cabinets or on open shelving that is non-porous, non-shedding, free from sharp or rough edges and easily cleanable. Top and bottom shelves must be solid.
÷ Shelves must be:
¢ At least 25 cm (10″) above the floor, clearance from floor can be reduced to 10 cm (4″) if using plastic pallets
¢ 5 cm (2″) from outside wall
¢ 46 cm (18″) from ceiling sprinkler heads
Doors and windows in storage area must remain closed.
Portable fans and heaters must not be used in storage areas.
Understand your dress code requirements if entering the sterile core.
Maintain temperature 18 to 26◦C (64 to 79 ◦F) and humidity 30-60% at all times through life cycle, transportation and distribution of sterile packages.
If temperature or humidity falls outside of these ranges, such that the packages become damp or wet, the integrity of the package may be compromised and the device or equipment must be reprocessed before use or disposed of.
A system to monitor and document temperature and humidity is required (this will be site specific).
— Store in moisture-resistant, reprocessible container.
— Provide adequate space to ensure packages not crushed or damaged.
— Ensure no external shipping containers (corrugated cardboard) used or kept in area.
¡ Pre-packaged sterile products from manufacturers must have the outer shipping carton removed prior to entering the sterile storage area.
¡ Stock rotation:
¡ FIFO – First in First Out
¡ Stock from Right – Take from Left
¡ Stock from Back – Take from Front
¡ Stock from bottom – Take from Top
¡ Infrequently used items shall be placed inside a dust cover, marked as ‘dust covered’ and sealed.
Housekeeping of sterile storage areas
— Develop a housekeeping schedule for cleaning and disinfecting sterile storage areas.
¡ Counters must be cleaned daily.
¡ Damp mopping of floors must occur at least weekly, dry mopping should never occur.
¡ Shelves must be cleaned every 3 months at a minimum.
¡ Shelves must be allowed to dry prior to replacing supplies.
¡ Light fixtures, sprinkler heads and fixtures must be cleaned every 6 months.
¡ Walls must be cleaned every 12 months.
In Sterile Core:
¡ The above scheduling applies except shelves must be cleaned monthly.
As with handling, our goal with sterile storage is to maintain sterility and prevent events.
- Items should be stored at room temperature of 21 C and at a humidity of 30-60% These are the best conditions for maintaining sterile packaging without becoming too hot or too moist.
- Room air exchanges shall be a minimum of 12 times per hour. This helps keep the room air circulating which prevents mould and mildew.
- Shelves shall be at least 5cm (2″) to 10cm (4″) from the wall; 25cm (10″) from the floor; 45cm (18″) from the ceiling. Never store items on the floor or touching the walls or ceiling.
- Portable fans are not allowed in areas where sterile items are stored. Fans blow dust, moisture and even bugs around.
- A regular cleaning schedule must be established and followed. Dust can build up over time even in the cleanest sterile storage area. Make sure that shelves are properly dried after cleaning.
- To keep your sterile supplies happy and event free store them:
- in a clean and dry area away from overhead pipes, wiring or air ducts
- where traffic flow is restricted to staff who are assigned to work there
- where windows and doors are kept closed
- where exterior shipping containers are not allowed
- in an area that is free from dust, moisture and vermin. (bugs and rats!)