Preparation and Packaging: Building a Sterile Package
What you must understand
Preparation converts clean items into an assembled, verified, packaged set. Inspection follows cleaning: check for cracks, corrosion, residual soil, missing parts, and proper function. Test hinged instruments through full range of motion, open ratchets and box locks for sterilization, and confirm scissors cut and forceps align. Lubricate only with products intended for sterilization. Assemble according to the count sheet, verify counts, and place heavy items so they cannot damage delicate instruments or puncture packaging.
Packaging must allow sterilant contact, penetration, and removal, while maintaining a barrier after sterilization. Know the common materials: woven and non-woven wraps, paper-plastic pouches, and rigid containers. Understand package configuration limits, wrap technique, tamper-evident seals, and internal chemical indicators placed where a challenge is likely. External indicators show the package was exposed; they do not prove sterilization. Labels must be legible and include sterilizer, cycle or load number, date, and preparer.
Traps that appear in questions
- Using indicator tape as proof of sterilization.
- Sealing a pouch with staples or non-medical tape.
- Overloading a tray so steam cannot penetrate.
- Placing instruments with ratchets closed.
- Forgetting internal indicators in packages requiring them.
- Incorrectly orienting pouches so the user cannot open them aseptically.
Worked example
A peel pouch should be loaded so the instrument handle is presented toward the opening end; the user can then grasp the handle and lift the item without touching the sterile contents.
Rule of thumb
If the package cannot be penetrated, opened safely, or identified, it is not ready for the sterilizer.