EFHSS Questions and Answers - Answer to Question Q00620

can anyone tell me why when we open a sterile linen pack and find a hair inside, we discard the pack [as it is considered contaminated] but if we open a pack and find a loose thread we dispose of the thread but continue to use the pack, I know that they are different fibres, but question is always asked "the hair is sterile anyway" why not just discard the hair and use the pack

Hi Trish,

Hair is considered to have a large bioburden (number of microorganisms on or in an object, fluid or air) - therefore, because sterilisation processes rely on having reduced the bioburden before sterilisation by thorough cleaning of an item - and one cannot assume this has been the case for a human hair, the pack must be considered unsterile.

As for the presence of threads -in AS 3789.2 and AS/NZS 4187, linen must be inspected prior to use for a range of different possible contaminants and particles, including loose threads. Therefore if loose threads are a continuing problem, you need to raise this with your linen service provider. However - to answer your question, one may assume that the loose thread that comes in a linen bundle has been subjected to the same cleaning procedure as the drape itself, therefore it has had its bioburden reduced, and thus maybe considered sterile - unlike the hair.

Hope that helps.

Dear Trish

Reading your question I remenbered an answer given by Dan Mayworm to this subject in his monthly column "Infection Prevention" in the Outpatient Surgery Magazin (9/2003). An answer which might help to clear up your future policies for unwanted hairs/debris in sterile/sets/packs.
I quote Dan's statement to the Question:
"If I find a hair in a sterile instrument set in the OR, should I break down the case?
Answer: Apparently breaking down the case is common, but I challenge those doing this to show why it is done. Sterilization authorities agree that anything, such as a hair on instrument that goes through a typical sterilization cycle, will be sterile. At least the surface will be sterile, if the debris is dislocated, the surface it covered would not be considered sterile, but it could be.
Given this, I don't understand the rational behind the extreme reaction to a hair. If the hair fell in the tray after the set was opened, the appropriate reaction would be to consider the tray compromised, but nothing else. Even if the hair is not sterile, it doesn't compromise the rest of the surgical set-up. Simply examining hair (head, face, arms) coverings in the OR is in order.
Examining your cleaning/decontamination/sterilization processes with your chief surgery, OR manager and sterile processing manager might also help. Check that people packing tray wear proper head covering and clean Uniforms, and inspect instruments before placing them in the set".
I fully agree with Dan's above comments. Patient safety has to be the primary consideration but let's not forget common sense and the rising cost in healthcare.

Best regards
Josy Holdener