If it is practice to use plastic/paper pouches for instruments, what is the prope usage? For example, I have always been instructed to double bag, which I agree with. But what is the correct space between pouches? Lately I have seen associates folding the tops and bottoms of one pouch to fit the other of same size. I am not comfortable with this. Should these pouches ever be folded on ends and sides to fit? In my opinion, I think this breaks down a barrier. Please help! :) thanks

Hi Kikokitty,

The proper way to package a pouch within a pouch is to have them sized so that one fits inside the other without folding the inside one. This has to do with the stresses the inner pouch undergoes during the sterilization cycle. If you are uncertain by problem like this, make tests with chemical and biological indicators on different spots in ans between the pouches. So you get proof if the technique you us is o.k. or not.

Best wishes, Josy Holdener, Switzerland

The primary functions of plastic/paper pouches are

1. have a closure that can not be opened and reclosed,
2. to allow sterilant inside to sterilize the contents,
3. to allow removal of sterilant after sterilization,
4. to maintain sterility of contents until opened, &
5. allow aseptic presentation of sterile items.

Plastic/paper pouches are made of two separate types of material. Plastic allows light to penetrate, but does not allow the sterilant to penetrate. You can see through plastic, but the sterilant can not pass through plastic.

Paper is the opposite because you can not see through paper, but the sterilant goes right through paper with no problem. When you fold a plastic/paper pouch, you decrease the area where sterilant can enter the pouch and sterilize the item inside. If you fold a pouch in half, so the plastic is on the outside and the paper on the inside, the area where the sterilant can enter becomes almost zero. In reality, folding of the inner pouch inside a larger pouch will always decrease the sterilization process effectiveness. But, the question is, will we meet all the primary functions of the pouch; including allowing the sterilant to reach the item we want to sterilize and allowing the sterilant be removed from the package after sterilization?

A 4 cm fold on a 20 cm wide pouch is probably insignificant. A 2 cm fold on a 5 cm wide pouch is inviting disaster. So long as fully-trained and certified sterilization technicians keep the five primary functions of plastic/paper pouches in mind, SMALL folds on LARGE pouches does not stop the sterilization of items, and allows items to be stored more compactly and effectively.

Double bagging plastic/paper pouches;
This wasteful practice must be examined closely whenever encountered! This practice does not increase sterility maintenance of properly handled items. This practice may even increase the number of infections surgical patients catch. Remember, the sterilant does not go through plastic. When an item is double bagged, the plastic from the two pouches touches. There is a small chance that bacteria at the point where the plastic from both pouches touch will be protected from contact with the sterilant, and will survive the sterilization process. The outside of the inner pouch may have live bacteria on it. If the user treats the inner pouch as sterile, an infection can start because the outside of the pouch may still be contaminated! Double bagging should only be used when absolutely needed for containing small items, such as bone screws. Also, plastic/paper pouches must never be re-sterilized. If the sterility of the contents of a plastic/paper pouch is compromised, the contents must be transferred to a new pouch for re-sterilization.

Regards, Pete Bobb