double bagging

Re: double bagging

Claire Bloor — Tue, 29 Mar 2011 23:01:30 GMT

Double bagging instruments etc is standard good practice as per the RCVS OSCE tasks, which are evidence-based, well researched tasks.

Re: double bagging

Beth Quance — Thu, 10 Mar 2011 08:28:34 GMT

Hi, yes I double bag our equine instruments and orthopaedic ones as they are so heavy. However also use the bags on a roll as they are slightly stronger for the horse kits, so first put it in a paper bag and then protect it in the other bag from the roll, more hassle but the kits stay sterile!

Also just been on clinical coach course and one of the tutors said all instruments must be double nagged - not sure how true this is.

Hope this helps!

Re: double bagging

Nick Shackleton — Thu, 10 Mar 2011 07:10:40 GMT

for really heavy equipment just as saws, screw boxes etc we have boxes that are double wrapped in disposable drape (double wrapped). And for THR equipment boxes these are triple wrapped (the third layer acts as a dust sheet and is removed prior to taking into theatre). This equipment is usually kept unsterile and only sterilised a few days before the procedure.

https://shop.jakmarketing.co.uk/product_detail.php?prod_id=904&catid=31 available in various sizes

Re: double bagging

Phrin Vernon RVN — Wed, 09 Mar 2011 23:41:30 GMT

Juliet - I wish I could have recommended too!

I did give 5 stars though

Great post sisterscope!

Re: double bagging

sisterscope1 — Wed, 09 Mar 2011 23:32:01 GMT

A single layer of pouch is sufficient in terms of maintaining sterility, double pouching/wrapping offers further protection in handling and storage - the outer layer is considered protective the inside a barrier. Double wrapping was initially introduced as a way of eliminating dust/debris accumulated during storage from entering the clean area, essentially the outer layer was removed before entering the clean area and presentation to the sterile field. However, it is common place for double wrapping to occur with presentation of the inner pouch to the sterile field which facilitates aseptic transfer, particulary with small or multiple items.

Regardless of however many layers of packaging there are, the packing should be checked for integrity before presentation and 'if in doubt, throw it out' rules apply.

If double pouching occurs, the inner pouch should not be folded in such a way that it reduces 1/3 of the paper side surface area, this will impede efficient sterilisation. Also, nylon film that is sealed with BD tape is not sufficiently permeable to steam to allow for adequate sterilisation - air can only be removed and steam enter through the tape seal. It is a very useful protective layer, once items have been sterilised, dried and cooled they can be placed in nlyon film bags to increase protection, however, the pouch remains the barrier.

If you use a process challenge device then it isn't necessary to put a TST strip into every pouched item. You can make your own process challenge device, it represents worst case scenario and can be altered to suit using a single TST strip in the centre of various loads - check the device and if OK the result is inferred accross the whole load.

Re: double bagging

Phrin Vernon RVN — Wed, 09 Mar 2011 23:05:24 GMT

As far as I am aware, I am the only nurse at work who double bags ortho equipment.

never had any problems mind, but that isn't an excuse not to do it!

I usually use pouches for the initial layer, and the reusable (to a point) nylon? film and dickie tape for outer layer - mainly cause we have a huge stack of both nylon film and dickie tape, and I don't want to be told that double bagging ortho equipment is costing the practice money - I'm happy that I found a way I can do it without causing issues.

Nick - Interesting (but not surprising) to learn that double bagging is standard for NHS - I'll remember that

Re: double bagging

nikki84 — Wed, 09 Mar 2011 22:52:15 GMT

Hi,

We do alot of TPLO's, spinal surgery and general orthopaedics but we no longer double bag our equipment

We have used the thick plastic sterilisation bags which can be cut to size and sealed at both ends for items such as large pin cutters, plate presses etc.

Things we are scared of dropping however can be put in a normal autoclave bag and put inside a metal instrument tin. Screw tins and ASIF kits can just be placed inside.
They have holes in the top which can be opened and closed to allow the steam to penetrate the bags inside etc.
Once sterile the tins should be removed from the Autoclave immediately and the top and bottom holes closed.
At least this way we just have to open the tin and can't really drop the expensive TPLO saw!

We normally sterilise our equipment and put a 3 month expiry on them.

Re: double bagging

Claire Cameron — Mon, 21 Feb 2011 10:33:13 GMT

[quote user="Nick Shackleton"]

[quote user="Flick Tett RVN, MBVNA"]

Hello!

I work in orthopaedic referrals - we double bag everything!! All equipment for autoclaving has a TST strip in too - unless it is going through the Anprolene (ethylene oxide) > that has different indicator stickers.

It is good practice to double bag - safest too. Also allows the instruments/implants a 'second' chance to be handed over to VS if you accidently touch the 'inner' packaging as it is still sterile.

[/quote]

Glad it ain't jsut me then

[/quote]

Snap here too

Re: double bagging

Nick Shackleton — Sun, 20 Feb 2011 20:58:40 GMT

[quote user="Vicky SVN"]Sterility is too important to mess with isn't it?

[/quote]

you would think so.......

Re: double bagging

Vicky RVN — Sun, 20 Feb 2011 20:39:38 GMT

Sterility is too important to mess with isn't it?

Re: double bagging

Nick Shackleton — Sun, 20 Feb 2011 20:36:28 GMT

[quote user="Flick Tett RVN, MBVNA"]

[quote user="Nick Shackleton"]

[quote user="Flick Tett RVN, MBVNA"]

[/quote]

Glad it ain't jsut me then

[/quote]

Haha - it always happens when the vet is in a rush, you are rushed and it's a split moment of "oh crap!!!! I cant believe that just happened"

[/quote]

been there done that got several t shirts

Re: double bagging

Felicity Caldwell — Sun, 20 Feb 2011 20:35:24 GMT

[quote user="Nick Shackleton"]

[quote user="Flick Tett RVN, MBVNA"]

[/quote]

Glad it ain't jsut me then

[/quote]

Haha - it always happens when the vet is in a rush, you are rushed and it's a split moment of "oh crap!!!! I cant believe that just happened"

Re: double bagging

Nick Shackleton — Sun, 20 Feb 2011 20:29:30 GMT

[quote user="Flick Tett RVN, MBVNA"]

Hello!

It is good practice to double bag - safest too. Also allows the instruments/implants a 'second' chance to be handed over to VS if you accidently touch the 'inner' packaging as it is still sterile.

[/quote]

Glad it ain't jsut me then

Re: double bagging

Felicity Caldwell — Sun, 20 Feb 2011 20:27:11 GMT

Hello!

It is good practice to double bag - safest too. Also allows the instruments/implants a 'second' chance to be handed over to VS if you accidently touch the 'inner' packaging as it is still sterile.

Re: double bagging

Nick Shackleton — Sun, 20 Feb 2011 19:55:19 GMT

[quote user="Toadster"]

it doesn't make economic sense to have to re-sterilise anything does it; wasted bag and the cost of running the autoclave again?! Not to mention the wasted nurse time involved when you could've been doing something else more productive. Plus what do you do if you discover the instrument you need is no longer sterile because the bag has been pierced?

[/quote]

Personally, I would rather ensure my items remain sterile and the only way this can be achieved is by re-sterilising them. I am going on not only what I have been taught at college, but also what I have read in books.

[quote user="Toadster"]

Oh, yeah and if we tear a bag we can sometimes repair it with Bowie Dick tape and still use the same bag...

[/quote]

Think that repairing bags is bad practice as this causes a weakness in the bag and therefore the bags sterility is likely to be comprised. So more times you are likely to have to re-sterilise the item.

Re: double bagging

Alison Clare Hickman — Sat, 19 Feb 2011 20:36:56 GMT

Yes, for steam vacuum auoclaving we do the majority of our orthopaedic instruments in double bags for the very reason you've highlighted... it doesn't make economic sense to have to re-sterilise anything does it; wasted bag and the cost of running the autoclave again?! Not to mention the wasted nurse time involved when you could've been doing something else more productive. Plus what do you do if you discover the instrument you need is no longer sterile because the bag has been pierced? We also use rubber tips on sharp ends - again, helps to prevent bag piercing. The rubber tips are really cheap although if you're pushed use an old 4mm or smaller ET tube cut to size...We also wrap some of the instruments/equipment in a towel before placing it into the autoclave bag - the towel protects both the instrument and the bag... Plus, and this might(?) persuade your bosses, I believe that the RCVS standard for Practical examinations is to double-bag EVERYTHING...even soft plain drapes... Oh, yeah and if we tear a bag we can sometimes repair it with Bowie Dick tape and still use the same bag...

Hope some/any of this helps? Good Luck!

Re: double bagging

Vicky RVN — Sat, 19 Feb 2011 13:43:16 GMT

We do 3 month single bagged.

Re: double bagging

Nick Shackleton — Sat, 19 Feb 2011 13:02:17 GMT

I would say shelf life of single bagged items using an autoclave is 3 months. As we used to double bag everything we re-sterilised after 3months, but it may be extended.

With regards to opening. the non-sterile (circulating nurse) opens the outer bag, being careful not to touch the inner bag. the Scrub assistant/surgeon takes the inner bag containing the sterile item. That's the way we used to do and how I have been taught.

Re: double bagging

clairebear . — Sat, 19 Feb 2011 12:42:24 GMT

thanks everyone, youve all been fab, the next questions that need answering are::

what are your sterility times on double and single bagging?

who opens the inner bag (when double bagging); a scrubbed assistant/vet or the nurses who is passing???

thanks again xxx

Re: double bagging

Juliet Drummond DAVN (med) RVN D32/33 — Wed, 16 Feb 2011 23:57:11 GMT

all our ortho stuff is double bagged- or if heavy stuff double wrapped in a disp paper drape, then an old cloth drape(found a use for them lol)

the stuff we use really often, e.g.mosquitos we single bag.

single wrap= 2 month expiry

double drape wrap = 2 month expiry

double paper/plastic wrap = 1 years expiry.

Re: double bagging

Fuzzyduck — Wed, 16 Feb 2011 22:23:07 GMT

Most of our equipment is double bagged but particularly our ortho stuff, its not work risking it from a sterility point of view

Re: double bagging

Nick Shackleton — Wed, 16 Feb 2011 21:48:54 GMT

[quote user="Susan Jackson"]

I think the students are taught to double bag now. I don't, but I find the equipment is fine and the seals are all good. I work in a new practice so there's only me to stuff it up and I don't have ortho kit, but I would double bag these if I did. It seems to be a newer concept, I wasn't taught to double bag, do the NHS do it or is everything thrown away?

[/quote]

I have just asked the OH who says that generally in the human field (used to be theatre manager) double bagging is the standard.

I was referring to when I worked in the veterinary industry. I now work in radiography

Re: double bagging

Susan Jackson — Wed, 16 Feb 2011 21:15:41 GMT

Re: double bagging

Nick Shackleton — Wed, 16 Feb 2011 16:06:39 GMT

I used to work in multi-disipline referral centre. Every item was double bagged and a TST strip placed inside with the item

Re: double bagging

Charlotte Fitzgerald — Wed, 16 Feb 2011 13:28:54 GMT

Hi,

I used to work at an orthopaedic referral centre and any items that you have mentioned above would always be double bagged. Like you say if things are breaking the seal of the bag you probably waste more money and time re-sterilising thatn just being saf and double bagging to start with.

Hope this helps.