double packing..3 months or 6?

Re: double packing..3 months or 6?

Harrie Phillips RVN AVN DipVN (Surgical) TAE — Wed, 19 Oct 2011 11:38:24 GMT

For my 2 cents worth (and I have a human hospital level qualification in sterilisation as well as being a vet nurse), its more about how you store your packs to maintain their integrity than whether you have them on the shelf for one month or three. This is whether it commercially sterilised or in house sterilised.

Time is NOT the factor for sterilisation, its all about pack integrity. I cannot stress that enough. If you routinely rustle through a stack of wrapped instruments (whether double or single) to find the right one, you can cause microholes/tears to appear. So your supplies might only have decent pack integrity for a week or day! If you have decent storage and sorting system you can get 3, 6, 9 months out of it etc. Also, a pack that is not sealed properly, or came out of the autoclave wet, or has water splashed on it is not sterile. So the whole time factor with them is null and void. You wouldn't leave them on the shelf for 3 months just because that is what the date says!

Double wrapping is advantageous for presentation of the instruments to the surgeon more than ensuring your contents are safer/remaining sterile (especially multi-part instruments which should be sterilised apart). To protect the pack integrity you are better off using proper dust covers, not double wrapping and assess your storage and 'filing' methods.

If your outer wrapper has microholes, then your inner wrap you are handing to your surgeon is not sterile, so therefore you are contaminating them. Yes the instruments are more likely to be sterile, but the contaminated surgeons hands are touching them! I am unaware of any studies that actually show double wrapping is much more reliable and beneficial than single wrapping, especially when you factor in cost differences.It is however common practice in specialist centres and human CSS departments.

When double wrapping, it is VITAL to ensure that you have paper to paper and plastic to plastic. Do not occlude the paper side with the plastic of the inner pouch - I commonly see this when people fold the inner pouch over to make it fit. Steam does not penetrate the plastic! Or its not sealed properly (There should be NO holes at the corners where you fold the paper up and stick or tape/use the self seal).

However, in saying all of that, having a set routine for the packing and resterilising is not a bad thing, you will be ensuring your supplies are going to be routinely checked for integrity and you can help limit the chance you are going to have massive amounts of microholes. So I do recommend a regular resterilisation process. Whatever works well for your clinics surgery turn over is fine. I am not familiar with any RCVS guidelines on this however, so if they have some, follow them:)

You should NEVER reuse a bag or disposable wrap. They are not designed for it and the sterilisation process does degrade them, so repeat processing degrades them further. Always completely repack your kits and instruments when resterilising.

From a personal opinion as someone who spends a large chunk of her time in veterinary clinics teaching about sterilisation and adjusting clinics protocols - around 95% of clinics I visit are using either packing & wrapping methods for kits and instruments, or an autoclave without validation that mean their supplies are not truly sterile. Some common processes I see are so far from correct that I doubt their supplies were ever sterile, just clean.

I think as a profession we are quite lucky we don't get more post operative infections and whether that is attributed to good prophylactic ABs, or great animal immune systems, or sheer luck, I don't know. Most common mistakes I see are simply corrected with the right techniques and not a huge expense to clinics. Here in Australia, proper techniques are just not taught when nurses are learning, and emphasis is on learning from the vets and nurses you work with. And trust me, their knowledge level can vary hugely! We don't have approved training practices here.

The other important factor is the actual way you pack the autoclave for proper steam penetration, there are right and wrong ways to ensure your kits are sterile - just because the indicator changed colour doesn't mean its sterile.... but that is a whole other discussion!

Re: double packing..3 months or 6?

Sal the 1st — Fri, 02 Sep 2011 17:01:21 GMT

yes the above link is interesting

If I can just chuck this in the pot? - I have been given some ex NHS supplies which are packed in seal and peel bags, single bagged not double bagged (and have never been double bagged), they were steam sterilised on site and they clearly show a sterilisation date and an expiry date on a sticky label attached to the bag- which is 12 months apart, I purposely doublechecked yesterday to make sure before I posted this.

Re: double packing..3 months or 6?

Rachael_24 — Fri, 02 Sep 2011 13:01:56 GMT

Double bagging is considered 'good practice' in many places as it adds additional protection. For example, if any miniscule holes occur in storage (that you won't notice), the inside bag is likely to remain intact.

With regards to how often they need to be re-sterilised, the following link is quite interesting.....

http://www.nursinglibrary.org/Portal/main.aspx?pageid=4024&pid=26331

Re: double packing..3 months or 6?

Juliet Drummond DAVN (med) RVN D32/33 — Wed, 31 Aug 2011 22:46:58 GMT

see this previous thread for more.

http://www.vetnurse.co.uk/forums/p/12484/108278.aspx#108278

Re: double packing..3 months or 6?

Nick Shackleton — Wed, 31 Aug 2011 22:01:07 GMT

We used to double bag everything and we used to re-autoclave every three months

Re: double packing..3 months or 6?

Tracy Windler RVN — Wed, 31 Aug 2011 19:58:58 GMT

I'm pretty sure RCVS practice standards say 3 months, but not aware that they have a different policy on double-baggig, or at least they didn't 2 years ago.

Re: double packing..3 months or 6?

sisterscope1 — Wed, 31 Aug 2011 18:57:18 GMT

Google "Event related shelf life" and "Event related sterility maintenance" for some pointers.

Re: double packing..3 months or 6?

Amanda Cockell — Wed, 31 Aug 2011 18:12:34 GMT

In our practice we double bag pretty much everything except dental equipment and a few random instruments (crocodile forceps etc). We routinely restock everything every 3 months though. If you use ethylene oxide with tyvek roll material then you can leave these sterile for up to a year.

I was taught that you could double bag any instrument and leave it for longer than 3months and it'll still be sterile provided that it hasn't be rummaged through excessively/damaged or contaminated by heat or moisture.

I hope that helps? I can have a look in a few theatre textbooks I have and see if there is anything official in there.

Re: double packing..3 months or 6?

Susan Jackson — Wed, 31 Aug 2011 17:58:08 GMT

I qualified in 2004 and double bagging was never mentioned. The first time I heard about it was when I started assessing in 2008 so thats a new ..ish concept.

I don't think there is any sudies or literature as to how long autoclave bags last. I would check what the RCVS standards are and then what practice policy is. I think you will find it is a varing difference from practice to practice. If the practice is accredited then they should use the RCVS guidlines, which off the top of my head I believe says nothing about double bagging or on how often they should be re-sterilised. I believe it just wants a policy on how often it is checked and maintenence schedules on all equipment.

Re: double packing..3 months or 6?

Cloudy Weather — Wed, 31 Aug 2011 17:45:26 GMT

At our practice we were told 2months if packed single and 2 years if double bagged?!