Are containers more efficient and cost-effective than a single-use sterile wrap for surgical
instrument sets? Accurately answering that question has major implications for SPDs.
In today’s healthcare environment, it’s a business imperative to identify ways to save money and boost productivity – without compromising quality. At St.
John Providence Hospital in Southfield,
Michigan, we set out to do just that by
challenging a longstanding and widely held
assumption – an “urban legend,” if you will
– that containers are a more efficient and
cost-effective solution than single-use sterile
wrap for surgical instrument sets. What we
learned has implications for sterile processing departments (SPDs) everywhere.
In my 30 years of working in hospital
sterile processing departments, there has
always been a problem meeting operating room set demand with containers. Intuitively, I felt containers slowed us down, and my hypothesis
was that it takes less time to package an instrument set in sterile wrap
than in a container. I also believed that containers added unnecessary
non-value-added time to the processing area, and that unnecessary time
was spent in the decontamination area breaking down containers to
rewash them for future use.
Yet assumptions among staff and administration persisted:
What We Did
• It’s faster to process a set into a container
• Containers increase set through-put
• Containers cost less in the long run since they can be used multiple times
• Containers are the best solution to holes and, therefore, a safer packag-
These assumptions continued to drive purchasing decisions and
SPD operations. As a result, meeting set demand – especially in
high-volume departments like the facility where I previously worked –
continued to be a challenge.
Using Lean Six Sigma methodology, we decided to prove – or disprove
What We Found
– these assumptions by conducting head-to-head trials timing the com-
pletion of the same instrument set in a container and a wrap:
• Both instrument sets were complete and ready for packaging
• Container packaging involved placing the set in the container, adding
filters to the lid, locking the lid to the base, inserting two arrows to
lock the set, and adding a data card and barcode label
• Wrapper packaging involved placing sterilization wrap on the table,
placing two towels under the set, wrapping the set, taping the set, and
placing two barcode stickers on the set
The trials were performed by staff doing their regular jobs, and I timed
them with a stopwatch. We conducted 70 time trials, found the mean for
wrap and containers and, taking the difference in mean, extrapolated the
outcomes for a facility that processed 300, 600, or 900 sets per day. We
also analyzed the time involved in the container decontamination process.
Our analysis of container versus sterile wrap demonstrated that using
sterile wrap is the faster process, with a 14-second difference between
the means of each method (mean for containers was 68.286 seconds vs.
54.386 seconds for sterile wrap).
We also timed the breakdown of containers in the decontamination
area, a process that entails receiving the container, removing the data
card, removing two arrows, two filters and the bar code label, and racking the container for cart washing. The mean time to complete container
breakdown was 30 seconds.
When you combine container disposables costs ($1.33) with labor
costs ($. 26), the total cost per container was $1.59. When you multiply
the savings in minutes per day by the total cost per container, you get the
total cost savings an SPD could achieve by eliminating containers and
the required decontamination process, based on container volume:
Our analysis effectively “busted” the long-held assumptions about containers:
• Based on real-world testing, it’s not faster to process a surgical instru-
ment set into a container. We found a difference of 14 seconds and that
didn’t include the container gasket inspection required by the vendor,
St. John Providence
300 150 minutes $238.50 4,770.00
600 300 minutes $477.00 9,540.00
900 450 minutes $715.50 $14,310.00
Containers per Day x Difference in Mean = Savings in Seconds:
300 4,200 seconds 70 minutes 1,400 minutes
600 8,400 seconds 140 minutes 2,800 minutes
900 12,600 seconds 210 minutes 4,200 minutes
Decontamination Area Labor Savings by Switching from Containers to Wrap:
300 9,000 seconds 150 minutes 3,000 minutes
600 18,000 seconds 300 minutes 6,000 minutes
900 27,000 seconds 450 minutes 9,000 minutes