Infection Prevention

Infection Prevention

By: Dan Mayworm

Published: 10/10/2007

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Clarifying the Expiration-Date Debate


Dan Mayworm Q You've made a point of saying that we shouldn't use expiration dates on our sterilized packages. Are dates ever relevant?

A While it's true that expiration dates have no meaning regarding the loss of sterility of the contents, they could have a meaning if there is something inside the package that could expire with age, such as drugs, rubber, gaskets and seals.

Dan Mayworm Q I would hate to think that we could be using something that has been on the shelf for years. How can we know how old some of these packages are?

A I agree that you don't want to use something that's been on the shelf for years. And labeling the outside of each package with a date processed is a good way to help ensure first-in, first-out inventory rotation.

But I want to bring up another point that is relevant to this discussion of expiration dates. Why are you cleaning, packaging and sterilizing any packages that are not going to be used within the next week? You'll find that much of what you're sterilizing are packs and trays that have been used. Shouldn't you instead be sterilizing what needs to be used? There's a difference, and it can greatly affect your costs, inventory turns, space requirements, planning and more.

Q What kind of schedule should we follow for sterilization of packs?

A Instead of sterilizing everything that comes out of the OR, clean and store the items in a relatively protected environment. Then take a look at the next day's (or week's) schedule and put together the packs and trays needed for that schedule. That way, you can put up trays according to surgeon's preferences (you will always know who the physicians will be for each procedure) and nothing will be sitting around on a shelf waiting to be used.

This just-in-time inventory-control approach has several advantages:

  • You'll be spared the embarrassment of not having the correct trays on hand when they are needed because planning for the next day becomes part of the routine.
  • You won't clean and sterilize the same instrument repeatedly, even though it is never used.
  • You can more easily schedule preventive maintenance of surgical instruments.
  • You can reduce expensive instrument inventory.
  • You can reduce sterile storage space requirements.
  • You no longer have to be concerned about expiration dating or stock rotation.
  • Your supply management will be more professional.

Real vs. Arbitrary Sterility Concerns

We can no longer afford to blindly follow arbitrary rules that add cost (time and money) but no real value when it comes to traditional OR aseptic practices. We need to examine the concepts of what is or is not sterile in the surgical setting in the light of scientific evidence and sound theory. This is especially true when common practices that have been handed down from generation to generation are proving too costly and do not result in better patient care. Indeed, many often compromise the patient needlessly.

The focus of patient and healthcare-worker safety should be those standards that both good science and good sense support. For example:

  • Do you insist on and check to see that the OR suite is under positive pressure? How do you monitor this?
  • Is the air being brought into the suite filtered? Are the filters and ductwork routinely inspected and cleaned?
  • Are only persons who are needed for the surgery allowed in the room?
  • Is the humidity kept at the recommended levels?
  • Are recommended air exchanges followed?
  • How many times are the swinging doors opened and closed during a procedure and for what reasons?
  • Are the persons responsible for sterilization of reusable supplies professionally trained and certified by appropriate outside schooling?
  • Are OR suite cleaning procedures written in a procedure manual and monitored for compliance?

These concerns are far more important than arbitrary lines drawn between what is sterile and what is not.

- Dan Mayworm

Q We can't always predict what our procedure schedule will look like. What should we do if that's the case?

A I realize that OR scheduling is not like industrial scheduling where manufacturing controls are set well in advance. In healthcare delivery, in addition to just-in-time inventory, you also need just-in-case inventory. This is inventory that you'll identify as being back-up or emergency supplies.

In this case, your supply manager or another nurse manager should decide what these items should be based on experience and projections. After sterilization, put them in a sterility maintenance plastic bag (dust cover) and label it with an expiration date one year from that day. Nothing is going to expire at the end of that year, except, perhaps, the reason you stored it as just-in-case in the first place. If you find at the end of a year you haven't needed it, maybe you don't need it at all.

I realize this suggestion is going to require a sea of change in attitudes about sterile supplies. It's going to require thinking, planning, discussion and commitment. So think about it and talk about it - just don't dismiss it out of hand. It really makes a lot of sense.

Q I am preparing suture trays to sterilize and need a way to keep my iris scissors open for autoclaving. I am wrapping them up so I will not be able to see the set.

A I have seen a variety of ways to do what you want to do. The most common method is to place the scissors in a small folded towel. Or you can use reticulated foam that is available from a number of manufacturers - often called something like sharp protectors or tip protectors. You might also check with Spectrum Surgical Instruments Corp., which sells a variety of rings/accessories, if you want to go in that direction.

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