How Should You Deal With Instrument Trays From Outside Of Your Facility (Part I) As surgical instrumentation has become ever more complex it has also become significantly more expensive. Not every healthcare facility can afford the large investment required to continually purchase the ‘latest and greatest’ in new surgical instrumentation. This is leading to more ‘sharing’ of complex, expensive instrumentation between hospitals and healthcare facilities within a given geographical area. The increase in the cost and complexity of new surgical instrumentation has also led to another form of ‘sharing.’ There are a growing number of hospitals that have surgery centers or some form of out-patient facility attached to or associated with them. In an effort to reduce the total investment in surgical instrumentation and to reduce reprocessing time and expense, many facilities are now reprocessing all of the surgical instrumentation that is used in these various locations in their CS/SPD reprocessing department. While the sharing of instruments can be more cost effective than purchasing new instruments, the practice of transporting sterile trays to different facilities and locations raises a host of issues. Additionally, the problem of how to deal with contaminated trays coming from outside of your facility raises a number of issues as well. This important topic recently generated a lot of questions, comments, observations and suggestions on AAMI’s Members Discussion Group. The first question on this interesting topic was about using trays that were sterilized at another hospital: “I was wondering if it is good practice to take clean wrapped trays to another hospital to get sterilized and then bring them back to use in procedures in the O.R.?” -Deborah, Certified Central Sterile Supply Tech¹ Deborah’s question prompted this response: ​“I will never use a tray from another facility or rep without cleaning it and sterilizing in my facility. You never know what these trays have been exposed to outside of your center. And if a tray is used here I want to know it has been properly sterilized and stored to protect myself and the patient it is being used on.” -Megan² Deborah’s question also prompted this response: “No, this is not a good practice as you cannot verify their cleaning process. Anything that comes into our facility we unwrap, we wash, we check over the instruments then we re-sterilize.” -Jen, Lead Tech CSR³ Not all responses to Deborah’s question were negative. There are several ways to have surgical instruments reprocessed and sterilized at another facility and then safely used in surgery in your facility. One such solution is the use of travel packs for the trays. Specifically: “I know that my site has had issues in the past when our sterilizers are down due to facilities and steam lines. Our SPD staff will run our instruments over to a neighboring hospital to get them washed and sterilized and then they put them in travel sterile packs that allows for travel and keeps the instruments sterile. They are special bins that they put the packs in and they bring them back over to our site. Not sure of details about these travel packs and bins but they seem to work as our SPD manager is so very strict on her sterilization.” Angela⁴ Recommendations for the transport of sterile instrument trays from the CDC, JACHO, AAMI and the AORN all focus on the need to maintain and protect the packaging material from being compromised. They all emphasize that sterilized instrument trays must be protectively packaged and transported in a manner that maintains the integrity of the packaging material and prevents contamination from any source, both human and environmental. It is very important that sterilized, wrapped instruments are transported in a clean, dry, environmentally controlled vehicle and that they are subjected to minimal handling during the transportation process. In addition to having your sterile instrument trays protectively packaged for transport between facilities, you must also have a good tracking system for those trays. As Mark pointed out: “I am in a facility where we are the CSR for our hospital and outlying facilities. We bring in instruments from these other facilities, clean, sterilize and return them. We have a tracking system so if a surveyor comes in, the end user has access to the same information we have. But, if you are having a rep or other another person bring in a sterile tray to be used, can you track their sterilization records, can you speak to the sterilization process? If you cannot track the tray from one patient to another, it is better to reprocess before use.​” -Mark, Manager Surgical Services⁵ In Part II of this blog we will address additional issues and solutions to deal with surgical instrument trays from outside of your facility.

1. “AAMI Members Discussion Group” February 12, 2019
2. “AAMI Members Discussion Group” February 14, 2019
3. “AAMI Members Discussion Group” February 14, 2019
4. “AAMI Members Discussion Group” February 18, 2019
5. “AAMI Members Discussion Group” February 21, 2019