To Match or Not to Match: The Rigid Container Workflow Debate
By Hank Balch
I’m going there. I’m going there because many of us have been engaging in these intramural debates for some time now, and the arguments are worth laying out there for all to see. I’ll report, you decide. And like any good jury, I’m willing to be convinced either way. At the root of it all is trying finding an answer to the following question: Should rigid containers be married to their internal baskets? Let’s take a look at the two perspectives that dominate the debate.
The Bobby Perspective: every tray for itself
In one corner we have what I’ll call the Bobby Perspective, in honor of one of the first proponents of this point of view I met in the industry. Folks in this camp do not believe in marrying internal trays to dedicated rigid containers; instead, they see their containers as interchangeable and able to be used for any instrument set which may need it. Proponents of this perspective argue that matching or marrying trays and internal baskets is a waste of time and effort in a number of ways.
Wasted time to label: All dedicated rigid containers would have to be individually labeled prior to initial use.
Wasted time to maintain labels: All container labels would have to be maintained in a visible condition, and labels must be replaced when lost or damaged.
Wasted time to locate correct container: Staff cannot simply find any container of the proper size; instead, they would have to search for the one container in the inventory that matches their internal basket, thus taking valuable time out of the processing workflow.
Issues with incorrectly labeled container going to the OR: If a staff member inadvertently grabs the incorrect container to package the device, it can cause substantial confusion and frustration to customers in the OR who may read the tray label and expect the internal contents to match.
Issues with mismatched trays going invisible: Once a tray and labeled container are mismatched, the internal contents become invisible to an instrument tracking system, making it difficult to locate these trays in the future.
Wasted time waiting for specific containers to be washed: Because instrument trays typically go through instrument washers and rigid containers are normally routed through cart washers, there can be substantial lag time between one or the other being ready for final packaging. Technicians may have trays ready to process but have to wait until the particular rigid container comes through the cart washer.
Unequal wear and tear on high-turn containers: If rigid containers are dedicated to specific instrument trays, this means that high-volume instruments will receive unequal wear and tear on their particular rigid containers, as opposed to lower-volume items which are rarely used. Eventually, this means you will have a percentage of container inventory in need of repair, with others that are still like new.
In general, this every-tray-for-itself perspective emphasizes the efficiency of a container workflow, believing the inherent flexibility of container choices is a winning combination. Now let’s take a look at the other side of the container coin.
The John Perspective: I now pronounce you Tray & Container
In the other corner we have the John Perspective, in honor of one of the most ardent proponents of this point of view that I’ve met in the industry. Folks in this camp dobelieve in marrying internal trays to dedicated rigid containers, often identifying particular containers with engraved labels, tags, and color-coded lids—Minor Set #3 would have a permanent sterilization home in Minor Set #3 Rigid Container. Proponents of this perspective argue that matching or marrying trays and internal baskets have a number of important impacts.
Removes the guesswork related to size: Labeled rigid containers mean technicians do not have to try to guess the dimensions of the tray they are processing, including length, width, and height. The becomes important if smaller trays are placed in unlabeled larger containers, leaving no available container for those larger trays once they come through the workflow.
Removes the guesswork related to manufacturer and modality: Since many facilities own a diversity of rigid containers, it can be difficult for technicians to automatically know whether their internal tray can fit in an Aesculap vs. Genesis container, for instance. Other times it may be important to know the difference between a validated low-temperature container and one that is only validated for steam sterilization.
Removes the guesswork related to filter validation and weight: Labeled rigid containers ensure that instrument sets which were validated in a four-filter container (two filters on the top, two filters on the bottom) are actually processed in one. These dedicated rigid containers also protect against using an unnecessarily heavy container that may push particular trays over a facility’s 25-lb weight compliance policy.
Provides secondary identification of inventory: If an external count sheet is inadvertently removed or lost from a case cart, dedicated and labeled rigid containers still allow SPD and OR personnel to identify and potentially use needed instrumentation, without opening the tray.
Provides a simple means of accounting for currently unprocessed sets: When dedicated rigid containers are used, staff can quickly identify which instrument sets are currently unprocessed by simply counting the empty containers staged for packaging.
Easier damage and repair tracking: Without uniquely identifying rigid containers, and marrying them to specific trays, tracking of damage to and repair of rigid containers can become difficult. If these two are married, when a Major Tray #4 is sent out for repair, so is its associated rigid container. When damage is found on a particular container, a department will have a way to identify the recent lifecycle of the device to better determine root causes.
Unlike the first view, this “tray + container = 1” perspective emphasizes the accuracy of a container workflow, believing the additional specificity and traceability gained by marrying an internal basket to a dedicated, labeled rigid container is worth anything that may be lost in ease or efficiency of processing.
Ultimately, this container issue may not be a debate between right or wrong, or even good or better. Like many practical disagreements we have in our departments and across our industry, it might be a matter of critically thinking through our workflows together, of being willing to hear each other out, and taking what we learn from each other to make our individual processes cleaner, safer, and more cost efficient. Whether you’re a Bobby, John, or Susan, the takeaway from this debate is that every aspect of our departments can and should be improved. And we owe it to ourselves and our patients to talk, listen, and learn.
Keep fighting dirty.
Feature articles exclusively for Ultra Clean Systems by Weston “Hank” Balch, BS, MDiv, CRCST, CER, CIS, CHL
Weapon of Mass Microbial Destruction * Professional Clean Freak * Podcast Host * Safety Addict * CS/SPD Consultant
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