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Hi Kathy,
I would like to share my experiences with occasional wet packs and trays.
I found that some technicians determined the cooling time for steam sterilized items by the clock (20 minutes), rather than by the actual temperature of the items on the cart. Loads that contain primarily Orthopedics sets are heavier and take longer to cool than other sorts of loads at my hospital. Some of my staff were putting hot trays on cool shelves which caused the condensation inside the trays. They were fully convinced that it was safe to unload the sterilizer cart because 20 minutes had passed on the clock, not realizing it was the act of putting hot and cold metal together that caused the condensation of the humidity inside the tray. Now I ask all trainees to touch the autoclave cart with the inside of the wrist, in the same manner as you might test the temperature of a baby's milk bottle. If the cart is too hot to touch with your wrist, it is too hot to unload! This is a more reliable technique to determine the temperature of the load than using a fixed waiting period.
The dryness of the load at the end of the cycle is related to the initial moisture in the load. If an instrument tray is placed into the sterilizer wet, or it becomes wet because of low quality steam, it can come out of the sterilizer wet. Improper drying of containers or instruments before placing the instruments in the container can cause wet trays.
Clogging of the chamber discharge line can cause the lower portion of the load to dry improperly. This was frustrating because the trays on the top and middle shelves were dry and the trays from the bottom shelf came out wet. The location of the wet tray on the cart can help identify this problem. This can be a very tricky problem to actually identify if you don't record when debris is actually found and removed from the drain by each autoclave operator. For example, an autoclave sticker / load cycle / expiration date sticker can get caught in the drain strainer causing this sort of problem. Actually, one sticker has never been the source of problems for me, but 3 stickers in the drain screen has been enough to cause me problems. When the autoclave operators routinely clean the drain without documenting the cleaning, they are destroying the evidence that can point to the source of an occasional, very rare, problem with wet packs on the bottom shelf of the load.
The simplest method of drying items at the end of an autoclave cycle is to exhaust the steam pressure to zero, open the door about 1/4 inch or 1 centimeter, and allow the chimney effect to pull cool dry air in at the bottom and exhaust moist hot air at the top of the door. 15 - 20 minutes is enough to dry a load of linens with this technique. Older gravity displacement steam sterilizers used this method without compromising the sterility of the trays, sets, and packs. This puts all the humidity from the sterilizer chamber into the work area around the sterilizer which might cause problems with your department a/c system and humidity levels. If your modern steam sterilizer uses a venturi suction device (old) or a vacuum pump to dry the load and you must resort to adding an extra 15 minute drying time after the load is supposed to be dry, you are covering up a problem. Yes, you have a dry load, but the source of the problem has not gone away. I don't see adding an extra 15 minute manual dry time as a good practice, but as an emergency stopgap procedure to use while you solve the real problem.
Using towels or linen can assist in drying loads. They act as a wick, spreading the water out, increasing the surface area, allowing the items to dry quicker. Heavy, dense instruments and sets that create lots of condensation dry faster and more reliably when you use wicking material.
Wet packs / trays are always a serious problem because microbes pass right through wet paper or linen wrappers and filters for rigid containers. If a wet tray is placed on a nonsterile shelf, and the wrapper or filter is wet, the tray can become contaminated. If the water dries later, it does not change the fact that the tray is contaminated, it only hides the contamination.
If you are unable to identify the source of the wet packs and trays, don't hesitate to contact your maintenance group and the sterilizer manufacturer. They can have a wealth of ideas and resources to identify the problems. At one hospital, we found that the quality of the steam would vary throughout the day in proportion to how much demand for the steam there was by other departments, and on external weather factors (rain water effect on underground steam lines!). The problem was worst one hour after a rain began, during the busiest times of the day! Rain at night (low demand for steam) was not a problem. It took several months of brainstorming and testing to identify this sporadic problem. Without all of us working together, we would have probably never identified the source of the problem.
Solving a problem with wet packs / trays without a recognizable pattern is always difficult, so I wish you strength and courage to see this issue through, and I hope my experiences might help you in solving your mystery.
Regards, Pete Bobb
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