Proper wrapping of surgical instruments forms a protective shield, ensuring that devices sterilized in an autoclave remain uncontaminated until they are presented for use in a sterile environment. The process serves as the final barrier against microbial recontamination. Wrapping is necessary because steam sterilization only guarantees sterility at the point of processing. The goal is to create a package that allows for the complete penetration of the sterilizing agent while maintaining the contents’ sterility over time.
Pre-Wrap Preparation and Inspection
Before any instrument is placed into a wrapper, it must undergo preparation steps to ensure the sterilization process is effective. The first step involves thorough cleaning to remove all organic debris, tissue, and fluids, because residual soil can shield microorganisms from contact with the sterilizing steam. Instruments must then be completely dried, as even small amounts of water can create steam pockets that prevent the sterilant from reaching the surface.
Following cleaning and drying, a detailed inspection is performed on each device to check for functional damage, such as cracks, burrs, or corrosion, which could compromise the instrument’s performance or puncture the sterile barrier. For hinged instruments, a specific, surgical-grade lubricant, often called instrument milk, is applied to the joints if required by the manufacturer. This lubrication ensures the smooth operation of the instrument after sterilization and is designed to withstand the high temperatures of the steam cycle.
Instrument Placement and Hinge Positioning
The correct positioning of hinged instruments, such as forceps, clamps, and scissors, is necessary for successful steam sterilization. These instruments must always be placed in the package in an open or unlocked position, never closed or tightly latched.
Keeping the instrument open, sometimes using the first or second ratchet setting, ensures that the sterilizing steam can fully access the box lock and all internal joint surfaces. If a hinged instrument is locked closed, the metal-on-metal contact creates a dense barrier that inhibits the steam from reaching the inner surfaces, leading to incomplete sterilization. To maintain this open position without risking the integrity of the wrapper, specialized instrument holders, silicone mats, or stringers are used to secure the devices within the tray. These accessories keep the instruments organized and open, allowing for maximum exposure to the sterilant without creating sharp points that could tear the sterilization material.
The Sterile Barrier Wrapping Technique
The act of wrapping involves creating a multi-layered barrier that protects the contents while allowing sterilant penetration. The “envelope” or diagonal fold is the standard technique used for instrument trays and individual packs, as it creates multiple layers and facilitates an aseptic presentation. This method involves placing the instrument set diagonally on the wrapper, bringing the bottom corner up and over the contents, and then folding the side corners across.
The material used, often non-woven wraps or medical-grade paper, must be durable and resistant to tears, yet permeable enough for steam to pass through. Wrapping is typically performed using two layers of wrap or a single double-layered wrap, which provides a redundant barrier against contamination. A small corner is folded back to form a “tab” on each fold, allowing the package to be opened without the user reaching over the sterile contents (aseptic technique). The package must be wrapped snugly, but not so tightly that the material is stressed, which could compromise the barrier integrity.
Package Sealing, Labeling, and Integrity Checks
The final steps secure the package and provide necessary information for tracking and quality assurance. The wrapped package is secured using sterilization tape, which serves as an external chemical indicator. This tape changes color upon exposure to sterilization conditions, providing visual confirmation that the package has been processed. An internal chemical indicator or integrator must also be placed within the pack, typically in the area most challenging for the steam to penetrate, to confirm that the physical conditions for sterilization were met inside.
The package must be clearly labeled with details that ensure traceability and proper inventory management. Required information typically includes:
- The date of sterilization.
- The specific sterilizer used.
- The cycle number.
- The initials of the person who prepared the package.
Before the package is released for storage or use, a final integrity check is performed to look for any tears, punctures, or signs of moisture that would indicate a compromise to the sterile barrier. Any package that fails this visual inspection must be reprocessed entirely.