Surgical Packs Research Articles

Microbial contamination associated with routine aseptic practice

We have studied the rate of fortuitous contamination associated with routine aseptic technique under operational conditions. Stainless steel strips, as simulators of surgical instruments, were contained in sterilized surgical packs and assayed by nursing personnel during surgical and other invasive procedures at three different hospitals. The rates of contamination observed for the 36 investigators ranged from 0% to 11·3%, with an overall rate of 2·7%. Assays conducted in a clean room environment, under conditions approaching industrial sterility standards, showed a contamination rate of 0·16%. We concluded that aseptic practices, as routinely performed without any noticeable breaks or transgressions, do not guarantee sterility. The concept of surgical sterility implies low level, but measurable, microbial contamination.

Effect of long-term storage on sterile status of devices in surgical packs.

We investigated the effect of the following on the sterile integrity of surgical packs: four wrapping materials (two-ply reusable, nonbarrier wovens, both new and previously used; disposable, barrier nonwovens; and polypropylene peel pouches), dustcovers, two storage locations, and storage times ranging from 2 to 50 weeks. Two hundred sixty-three packs containing stainless steel coupons were prepared, wrapped, sterilized, and stored. Half of the packs were dustcovered prior to storage. At monthly intervals for a year, packs of each type were opened in a laminar flow hood, and the coupons inoculated into trypticase soy broth. The coupon contamination probabilities were 0.019 for reusable, woven packs; 0.017 for disposable, nonwoven packs; and 0.016 for peel pouches. These differences were not significant. The probability of finding a contaminated coupon in any pack after 50 weeks was 0.018. No trend toward increased probability of contamination over time was observed for any of the pack types studied.

Interhospital Transportation: Monitoring Sterility of Instrument Packs

The Minneapolis-St Paul area is currently experiencing an increase in health care mergers among hospitals. As new facilities are acquired, whether through merger or the building of satellite hospitals, economic considerations often instigate the consolidation of certain departments and services. Thus, hospitals are confronted with a new set of management problems. One such problem might be determining if the probability of contamination increases when a sterile pack is transported from the central sterile supply department of one hospital to the operating room of another hospital. This study indicates that interhospital transport of surgical packs, using a specially designed transfer system, can be accomplished without compromising the sterile status to a significantly greater degree than that associated with transport within a hospital. Many more samples would have to be assayed before these results could be considered conclusive. This study proposes a simple, reproducible, microbiologically sensitive and statistically satisfactory test to monitor the sterile integrity of surgical packs. In the past, different sterility monitoring methods proposed have required either special equipment, specially trained personnel, or complicated procedures. The assay method described here can be easily used by central sterile supply department personnel to monitor the sterile status of transported or stored surgical packs.

The importance of local hemostatic procedures in dental extractions and oral mucosal bleeding of hemophiliac patients

Deficient coagulation factor replacement therapy is often indispensable for dental extractions and oral mucosal bleeding in hemophiliac patients. High concentrates are often infused in large amounts of volume, until complete hemostasis is achieved. Considering the various side effects of replacement therapy the volume infused should be reduced to a minimum. Several aspects associated with replacement therapy for the control of oral bleeding are studied. Our conclusion is that local hemostatic procedures are even more important than replacement therapy. The use of surgical packs and band retainers proved to be of benefit in this study.

Why do surgical packs cause peritoneal adhesions?

Our experiments in the Porton rat have shown that the foreign debris from surgical sponges left in the peritoneal cavity after use is not the cause of peritoneal adhesions. Instead, the abrasive effect of introducing the sponge produces mesothelial trauma. This is the stimulus for an inflammatory response, followed by adherence of adjacent involved peritoneal surfaces. Adhesions formation did not occur between the abraded peritoneal surfaces of mobile intraabdominal viscera, which suggests that intestinal motility in the early postoperative period is important in the prevention of adhesions.

DO SURGICAL PACKS CAUSE PERITONEAL ADHESIONS?

In spite of the growing variety of materials being used in the manufacture of intraabdominal packs (sponges), no data have been published on their adhesion-producing properties. We have shown that the Porton rat will reliably produce peritoneal adhesions in response to ischaemia and glove powder. In a randomized control trial using this rat model, we tested the adhesogenic potential of two commercially available surgical packs. Both brands of pack were shown to cause a significant incidence of postoperative peritoneal adhesions (P is less than 0.005), irrespective of whether the packs were used wet or dry. It is recommended that the adhesogenic potential of all products for use within the peritoneal cavity be established in an animal model prior to marketing.

Surgical treatment of hydatid disease: prevention of complications and recurrences.

Eleven cases of hepatic and hepatic-pulmonary echinococcosis illustrate both the complications of the disease and modern surgical treatment. Complications encountered were spread of disease, persistent fistulas, severe wound infection, severe shock probably due to the use of formaldehyde for cyst injection, and death after lobectomy for a recurrent cyst. Principles of effective surgical treatment derived from this experience are as follows: Avoid percutaneous needle puncture, biopsy, or aspiration of any cystic mass of the upper part of the abdomen. Obtain hepatic scans and arteriograms to outline the dimensions of the cysts and to guide incision and access to the lesions. Meticulously isolate the operative field with multiple layers of surgical packs. Hypertonic saline for cyst injection is as effective as other agents. Radical resection is the only effective therapy for large cysts.

Sterility preservation of surgical dressing packs wrapped in gumstick lining material

Background: Post-sterilisation contamination is the ability of the organisms to penetrate through the wrapping material and settle on the enclosed instruments. Safeguarding the sterility of sterile dressing packs during transportation and storage is an important requirement of a sterile supply packaging system. We evaluated the use of locally available and affordable tailoring lining material popularly known as gumstick. The objective of this study was to ascertain the efficacy of gumstick lining material in safeguarding the sterility of wrapped surgical dressing instrument. Materials and Methods: The post-sterilisation sterility was confirmed by culturing the sterile packs and then exposed to contaminants by leaving the packs on a microbiology working bench. The wrapped packs were then contaminated with suspensions of control strains of some selected bacteria, then swabbed and cultured. The surgical packs were also exposed to environmental contaminants, swabbed and cultured. Results: All cultures yielded no growth proving that the wrapped surgical instruments are bacteriologically sterile and gumstick provides the needed protection against contamination of surgical packs. Conclusion: Gumstick lining material is therefore recommended as packaging material for surgical instrument particularly in resource-constrained settings.

Wrapping Surgical Packs in the Laundry

Wrapping Surgical Packs in the Laundry