1. Wet Packs: Strategies for Prevention and Resolution
4/27/2017
Wet Packs: Strategies for Prevention and Resolution
Welcome to the Halyard Health Care Knowledge Network presentation entitled
Wet Packs: Strategies for Prevention and Resolution. This is one of our Excellence in Sterile Processing programs, which address critical issues in health care.
Halyard Health

2. Wet Packs: Strategies for Prevention and Resolution Program Objectives
4/27/2017
Wet Packs: Strategies for Prevention and Resolution Program Objectives
Define a wet pack and explain the consequences
Describe factors contributing to wet packs
Discuss strategies to prevent and resolve wet packs
At the end of this program, you should be able to:
Define a wet pack and explain the consequences
Describe the causes of wet packs
Discuss strategies to prevent and resolve wet packs

3. What is a Wet Pack?
Moisture present in or on a package after steam sterilization and cooling procedures are completed
A “wet pack” refers to a package that has residual moisture after steam sterilization and cooling procedures are completed. The moisture may be found on or within a textile pack, instrument tray, basin set, rigid container or containment device. How a wet pack looks depends on the type of sterilized item and the wrap or packaging materials used.
References:
Moore C. Wet packs: improved communication leads to improved response time. Biomedical Instrumentation and Technology. Sep-Oct 2008;42(5):
Spry C. Understanding current steam sterilization recommendations and guidelines. AORN J. Oct 2008;88(4): ; quiz

4. Identifying a Wet Pack
For packs wrapped with textiles (e.g., muslin reusables, cellulose-based disposables):
Water spots on wrapper
May be hidden!
In contrast, textile materials (such as muslin wrappers or cellulose-based disposables) absorb any excess condensation remaining after sterilization so that the pack appears dry even though moisture is present within the wrapper. Sometimes the moisture may be seen easily on the wrapper but in other cases, the water may appear as spots on the wrapper or not be seen at all.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Moore C. Wet packs: improved communication leads to improved response time. Biomedical Instrumentation and Technology. Sep-Oct 2008;42(5):
Spry C. Understanding current steam sterilization recommendations and guidelines. AORN J. Oct 2008;88(4): ; quiz

5. Identifying a Wet Pack For packs wrapped in water-repellant material:
Droplets on interior or exterior surface of the wrap
The type of wrap material used can make it easier or more difficult to spot a wet pack. Some sterilization wraps are water repellent, allowing steam to penetrate the wrap and sterilize the contents, and be evacuated out again. Water tends to bead up on these kinds of materials making the identification of wet packs relatively easy.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Spry C. Understanding current steam sterilization recommendations and guidelines. AORN J. Oct 2008;88(4): ; quiz

6. Identifying a Wet Pack For metal items:
Water pooled in concave or on flat surfaces
Moisture in surrounding absorbent material
Wet packs in metal basins and containers can appear as pools or drops of water inside bowls and on flat surfaces or as wet absorbent material surrounding the item.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Moore C. Wet packs: improved communication leads to improved response time. Biomedical Instrumentation and Technology. Sep-Oct 2008;42(5):
Spry C. Understanding current steam sterilization recommendations and guidelines. AORN J. Oct 2008;88(4): ; quiz

7. pathway for microorganisms
The Wet Pack Problem
Moisture creates a
pathway for microorganisms
Wet packs are a concern because the residual moisture on the package creates a pathway for microorganisms to travel from the outside environment through the packaging material.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Spry C. Understanding current steam sterilization recommendations and guidelines. AORN J. Oct 2008;88(4): ; quiz

8. The Wet Pack Problem
This drawing in or “wicking” allows microorganisms to contaminate of the package contents.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Spry C. Understanding current steam sterilization recommendations and guidelines. AORN J. Oct 2008;88(4): ; quiz
This drawing in or “wicking” allows microorganisms to contaminate package contents

9. The Wet Pack Problem
Moisture inside a sealed container after sterilization has the potential for contamination
According to the ANSI/AAMI guidelines for steam sterilization, even when the moisture is found inside a sealed container after sterilization, the potential for contamination remains.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Spry C. Understanding current steam sterilization recommendations and guidelines. AORN J. Oct 2008;88(4): ; quiz

10. Wet Packs Are Contaminated Packs
All wet packs must be
reprocessed!
Because wet packs are considered contaminated, they must be reprocessed. This creates even more work than when packages are initially prepped, packaged and sterilized, since a wet pack must first be unpackaged, then packaged again before sterilization.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).

11. Consequences of Wet Packs
Wasted staff time
Increased workloads
Higher costs
Delays in or cancellation of procedures
Wet packs have consequences both within Central Service departments and throughout the healthcare facility They cause wasted staff time, increased workloads, and higher total processing costs for the department. They can result in delays in or cancellations of procedures. Therefore, it is important to eliminate wet pack problems from occurring in Central Service departments. They are just as costly and often more perplexing than packages with tears or holes where compromised sterility is more obvious.
References:
Moore C. Wet packs: improved communication leads to improved response time. Biomedical Instrumentation and Technology. Sep-Oct 2008;42(5):

12. Wet Packs: Contributing Factors and Prevention Strategies
In order to develop strategies for preventing and resolving wet packs, it is important to understand the factors that contribute to the problem.
There are many potential causes for wet packs. In general, these causes fall into 3 categories: steam quality, sterilizer performance, and package preparation and handling.
References:
Brown JM, Bliley J. How to solve wet packs, and evaluate water issues. Mater Manag Health Care. Jul 2008;17(7):50-52.

13. Factors Contributing to Wet Pack Formation
Considerations
Steam quality &
supply
Steam dryness: at least 97% dry vapor weight
Steam dryness is the amount of WATER VAPOR relative to the amount of WATER
97% dry vapor weight is considered acceptable
Steam quality depends on 2 primary factors: steam dryness and level of noncondensable gas.
Steam dryness is defined by the amount of water vapor relative to the amount of water. Generally, 97% dry vapor weight with no more than 3% moisture content is considered an acceptable dryness factor for successful sterilization. To produce high quality steam requires functional, appropriately placed steam traps and insulated steam lines. Steam traps can remove condensate before it is introduced into the sterilization chamber. Insulated steam lines ensure that a high temperature is maintained to prevent condensation in the steam line. Any increased water load in the steam entering the sterilizer may not be adequately removed by the vacuum drying system in normal dry time settings.
The noncondensable gas level refers to the amount of air (oxygen and carbon dioxide) that is mixed with the steam. If the sterilizer steam contains more than 3% noncondensable gases, contact of the steam with surfaces inside the sterilizer can be compromised.
References:
Brown JM, Bliley J. How to solve wet packs, and evaluate water issues. Mater Manag Health Care. Jul 2008;17(7):50-52.
Moore TC. Do you know what your steam quality is? Mater Manag Health Care. May 2008;17(5):24-27.
ANSI/AAMI page and page 187

14. Factors Contributing to Wet Pack Formation
Considerations
Steam quality &
supply
Steam dryness: at least 97% dry vapor weight
Non-condensable gas content: no more than 3%
Non-condensable gas content refers to the amount of air (oxygen and carbon dioxide) mixed with steam
More than 3% can compromise contact of the steam with surfaces inside the sterilizer
Steam quality depends on 2 primary factors: steam dryness and level of noncondensable gas.
Steam dryness is defined by the amount of water vapor relative to the amount of water. Generally, 97% dry vapor weight with no more than 3% moisture content is considered an acceptable dryness factor for successful sterilization. To produce high quality steam requires functional, appropriately placed steam traps and insulated steam lines. Steam traps can remove condensate before it is introduced into the sterilization chamber. Insulated steam lines ensure that a high temperature is maintained to prevent condensation in the steam line. Any increased water load in the steam entering the sterilizer may not be adequately removed by the vacuum drying system in normal dry time settings.
The noncondensable gas level refers to the amount of air (oxygen and carbon dioxide) that is mixed with the steam. If the sterilizer steam contains more than 3% noncondensable gases, contact of the steam with surfaces inside the sterilizer can be compromised.
References:
Brown JM, Bliley J. How to solve wet packs, and evaluate water issues. Mater Manag Health Care. Jul 2008;17(7):50-52.
Moore TC. Do you know what your steam quality is? Mater Manag Health Care. May 2008;17(5):24-27.
ANSI/AAMI page and page 187

15. Factors Contributing to Wet Pack Formation
Considerations
Steam quality &
supply
Steam dryness: at least 97% dry vapor weight
Non-condensable gas content: no more than 3%
HIGH QUALITY STEAM requires :
Appropriately placed steam traps (remove condensate)
Insulated steam lines (ensure a high temperature is maintained to prevent condensation in the steam line)
Steam quality depends on 2 primary factors: steam dryness and level of noncondensable gas.
Steam dryness is defined by the amount of water vapor relative to the amount of water. Generally, 97% dry vapor weight with no more than 3% moisture content is considered an acceptable dryness factor for successful sterilization. To produce high quality steam requires functional, appropriately placed steam traps and insulated steam lines. Steam traps can remove condensate before it is introduced into the sterilization chamber. Insulated steam lines ensure that a high temperature is maintained to prevent condensation in the steam line. Any increased water load in the steam entering the sterilizer may not be adequately removed by the vacuum drying system in normal dry time settings.
The noncondensable gas level refers to the amount of air (oxygen and carbon dioxide) that is mixed with the steam. If the sterilizer steam contains more than 3% noncondensable gases, contact of the steam with surfaces inside the sterilizer can be compromised.
References:
Brown JM, Bliley J. How to solve wet packs, and evaluate water issues. Mater Manag Health Care. Jul 2008;17(7):50-52.
Moore TC. Do you know what your steam quality is? Mater Manag Health Care. May 2008;17(5):24-27.
ANSI/AAMI page and page 187

16. Wet Pack Prevention Steam Quality & Supply
Monitor and control system for generating steam
Some estimates suggest that 60% of wet pack issues can be attributed to a steam supply problem. Therefore, a formal monitoring and controlling process for steam generation is a critical part of wet pack prevention. If the boiler is priming or is set improperly, the resulting steam may have too much water content.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Moore C. Wet packs: improved communication leads to improved response time. Biomedical Instrumentation and Technology. Sep-Oct 2008;42(5):

17. Wet Pack Prevention Steam Quality & Supply
Monitor and control system for generating steam
Provide regular maintenance to steam traps and boilers
Providing regular maintenance for the steam traps, boilers, and generators is also crucial to prevent excess moisture from entering the sterilizer.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Moore C. Wet packs: improved communication leads to improved response time. Biomedical Instrumentation and Technology. Sep-Oct 2008;42(5):

18. Wet Pack Prevention Steam Quality & Supply
Monitor and control system for generating steam
Provide regular maintenance to steam traps and boilers
Evaluate fluctuations in steam quality; plan sterilization accordingly
In some hospitals, the steam line which leads to the sterilizer also supplies other needs in the hospital like the cafeteria or building heat. As steam demand rises and falls in these departments, the quality of the steam available to the sterilizers may fluctuate. Make sure you check both the steam gauge for the sterilizer jacket and for the chamber to make sure there is adequate pressure. The sterilizer manufacturer’s instructions should specify the steam requirements for your machine. It is important to run the sterilizers when the highest quality steam is available, especially if a wet pack problem exists. Ideally, a dedicated steam line should be used for the steam sterilizers to ensure consistent quality and minimize reprocessing costs associated with wet packs.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Moore C. Wet packs: improved communication leads to improved response time. Biomedical Instrumentation and Technology. Sep-Oct 2008;42(5):

19. Factors Contributing to Wet Pack Formation
Considerations
Steam quality &
supply
Steam dryness fraction: should be 97%-100% dry vapor
Non-condensable gas content: should be no more than 3%
Sterilizer
performance
Vacuum dry cycle pressure
Chamber drain line
Cycle settings
Optimal sterilizer performance is essential for the prevention of wet packs. Malfunctioning of the vacuum or exhaust systems can particularly impact drying cycles. Additionally, using incorrect settings for the load can cause wet pack formation.
References:
Brown JM, Bliley J. How to solve wet packs, and evaluate water issues. Mater Manag Health Care. Jul 2008;17(7):50-52.
Chobin N, ed The Basics of Sterile Processing. 3rd ed. Lebanon, NJ: Sterile Processing University,LLC; 2009.
Spry C. Understanding current steam sterilization recommendations and guidelines. AORN J. Oct 2008;88(4): ; quiz
Malfunctioning of the vacuum or exhaust systems can impact drying cycles
Using incorrect settings for the load can cause wet pack formation

20. Wet Pack Prevention Sterilizer Performance
Regularly empty drain line basket
Follow instructions from both the sterilizer and device manufacturers (e.g., has the correct sterilization cycle been selected ?, correct drying time?)
To ensure the sterilizer is operating properly, make sure to empty the drain line basket daily. A clogged drain line prevents steam from exiting the sterilizer, which can result in condensation inside the chamber. Additionally, be sure to consult the instructions from both the sterilizer and the device manufacturers to determine optimal settings for drying for each type of load.
References:
Chobin N, ed The Basics of Sterile Processing. 3rd ed. Lebanon, NJ: Sterile Processing University,LLC; 2009.

21. Factors Contributing to Wet Pack Formation
Considerations
Steam quality &
supply
Steam dryness fraction: should be 97%-100% dry vapor
Non-condensable gas content: should be no more than 3%
Sterilizer
Performance
Vacuum dry cycle pressure
Chamber drain line
Cycle settings
Package
preparation and
handling
Packaging materials and methods
Tray weight
Arrangement and density of items within the sterilizer
Cooling and unloading
The methods used for packaging, loading, and unloading items for sterilization impact both sterilization and drying, and improper practices can lead to wet packs.
Packaging systems are designed for specific uses, and adherence to manufacturers’ instructions for use of packaging materials will ensure that steam can enter and exit a package correctly. Proper use includes both using the correct type of packaging and the correct method for packaging the item to be sterilized.
The weight and density of the load also affects the ability to dry sufficiently. Loads that are heavy are more difficult to dry completely.
Another important factor to consider is the arrangement of items within the sterilizer. For all types of loads, it is essential to allow enough space around the items to ensure drying.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Association for periOperative Registered Nurses (AORN). Recommended Practices for Sterilization in the Perioperative Practice Setting. In: Conner R, ed Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc.; 2010:
Brown JM, Bliley J. How to solve wet packs, and evaluate water issues. Mater Manag Health Care. Jul 2008;17(7):50-52.
Spry C. Understanding current steam sterilization recommendations and guidelines. AORN J. Oct 2008;88(4): ; quiz

22. Wet Pack Prevention Package Preparation
Equilibrate packaging materials at room temperature with relative humidity 30-60% for at least 2 hours before use
A number of packaging strategies can be employed to minimize condensation and wet pack formation.
Equilibrating the packing materials can facilitate steam movement. To adequately equilibrate before use, packaging materials should be held at room temperature (20-23°C or 68-73°F) and relative humidity of 30-60% for at least 2 hours prior to use.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).

23. Wet Pack Prevention Package Preparation
Equilibrate packaging materials at room temperature with relative humidity 30-60% for at least 2 hours before use
Ensure items are dry before wrapping
Ensuring that items are dry when they are packaged and placed in the sterilizer can also help prevent wet packs. As a general rule, the sterilizer should be expected to exhaust the water (or steam) it introduces into the system, but no more.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Spry C. Understanding current steam sterilization recommendations and guidelines. AORN J. Oct 2008;88(4): ; quiz

24. Wet Pack Prevention Package Preparation
Equilibrate packaging materials at room temperature with relative humidity 30-60% for at least 2 hours before use
Ensure items are dry before wrapping
Wrap snugly enough to prevent folds that can collect liquid
When preparing items, package contents snugly to avoid spots that could collect liquid. However, the wrap should not bind contents too tightly as items within may be too snug to allow steam to move in and out of the package.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Spry C. Understanding current steam sterilization recommendations and guidelines. AORN J. Oct 2008;88(4): ; quiz

25. Wet Pack Prevention Package Preparation
Equilibrate packaging materials at room temperature with relative humidity 30-60% for at least 2 hours before use
Ensure items are dry before wrapping
Wrap snugly enough to prevent folds that can collect liquid
Use appropriate packaging for the job
Using the appropriate type of packaging for each item is critical to preventing wet packs. The size and shape of pouches impacts drying of the contents. Additionally, placing paper and plastic peel pouches inside of a container can impair drying.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Spry C. Understanding current steam sterilization recommendations and guidelines. AORN J. Oct 2008;88(4): ; quiz

26. Wet Pack Prevention Sterilizer Loading and Unloading
Minimize package weight to 25 lbs or less
A number of practices for loading and unloading the sterilizer can be employed to facilitate drying and help prevent formation of wet packs.
Remember to keep the total weight of each package below 25 lbs. to optimize drying.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Association for periOperative Registered Nurses (AORN). Recommended Practices for Selection and Use of Packaging Systems for Sterilization. In: Conner R, ed Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc.; 2010:

27. Wet Pack Prevention Sterilizer Loading and Unloading
Minimize package weight to 25 lbs or less
Leave space between items
Additionally, be sure to leave enough space between items to allow adequate drying. If items are packed too tightly on the sterilizer cart, water may become trapped within or between packages. Items should be spaced so that steam may be exhausted from every package in the sterilizer.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Association for periOperative Registered Nurses (AORN). Recommended Practices for Selection and Use of Packaging Systems for Sterilization. In: Conner R, ed Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc.; 2010:

28. Wet Pack Prevention Sterilizer Loading and Unloading
Minimize package weight to 25 lbs or less
Leave space between items
Load basins on sides or facing downward
Basins and other concave items should be placed on sides or facing downward. This will allow any condensate in the bowl to flow out. Small basins and medicine cups should be firmly secured. Most sterilizers are not capable of exhausting large puddles of water. This concept is similar to loading a dishwasher; have you ever seen puddles in bowls or glasses when the dishwasher is opened?
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Association for periOperative Registered Nurses (AORN). Recommended Practices for Selection and Use of Packaging Systems for Sterilization. In: Conner R, ed Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc.; 2010:

29. Wet Pack Prevention Sterilizer Loading and Unloading
Minimize package weight to 25 lbs or less
Leave space between items
Load basins on sides or facing downward
Place absorbent material between basins in nested sets
Place absorbent material between basins in nested sets. This not only helps steam to enter between the basins but also helps to absorb excess moisture and creates space for effective steam evacuation.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Association for periOperative Registered Nurses (AORN). Recommended Practices for Selection and Use of Packaging Systems for Sterilization. In: Conner R, ed Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc.; 2010:

30. Wet Pack Prevention Sterilizer Loading and Unloading
Precondition load for minutes
Preconditioning the load can help minimize wet pack issues. After the sterilizer is loaded, close the door and allow the load to sit for minutes prior to starting the sterilization cycle. This step allows steam that is stored in the jacket to heat up the packages in the chamber. The heating of the instruments before injection of steam can help prevent condensation from forming.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Association for periOperative Registered Nurses (AORN). Recommended Practices for Selection and Use of Packaging Systems for Sterilization. In: Conner R, ed Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc.; 2010:

31. Wet Pack Prevention Sterilizer Loading and Unloading
Precondition load for minutes
Allow adequate cooling before unloading
packages: minimum 30 minutes
Finally, be sure to allow all sterilized packages to cool completely before handling or unloading. At the end of a sterilization and drying cycle, items may still contain steam vapor. Touching a package before it has cooled completely, or transferring a package to a cooler surface, can cause wicking of moisture and contaminants through the package.
For most loads, it will take at least 30 minutes to cool, but some may require 2 hours or more depending on the environment and the load content.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Association for periOperative Registered Nurses (AORN). Recommended Practices for Selection and Use of Packaging Systems for Sterilization. In: Conner R, ed Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc.; 2010:

32. Wet Pack Prevention For High Metal Mass Loads
Divide up packs with high metal content
Metal items are more likely to cause wet packs and therefore require special attention in preparing for sterilization. Metal absorbs heat from the steam entering the sterilization chamber and in the process, reduces the heat of the steam. As the temperature of the steam decreases, the moisture condenses to the water phase. The problem can be minimized in a few different ways.
First, reduce the density of metal in the load by breaking up packs with high metal content and distributing metal mass evenly within each tray.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Association for periOperative Registered Nurses (AORN). Recommended Practices for Selection and Use of Packaging Systems for Sterilization. In: Conner R, ed Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc.; 2010:

33. Wet Pack Prevention For High Metal Mass Loads
Divide up packs with high metal content
Distribute metal mass evenly within each tray
Consider breaking up a pack containing several metal instruments into 2 or more packs, and use an absorbent material between metal components.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Association for periOperative Registered Nurses (AORN). Recommended Practices for Selection and Use of Packaging Systems for Sterilization. In: Conner R, ed Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc.; 2010:

34. Wet Pack Prevention For High Metal Mass Loads
Divide up packs with high metal content
Distribute metal mass evenly within each tray
Increase drying time for high metal mass loads
Additionally, consider increasing the evacuation/dry cycle duration for packs with high metal content.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Association for periOperative Registered Nurses (AORN). Recommended Practices for Selection and Use of Packaging Systems for Sterilization. In: Conner R, ed Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc.; 2010:

35. Wet Pack Prevention For High Metal Mass Loads
Divide up packs with high metal content
Distribute metal mass evenly within each tray
Increase drying time for high metal mass loads
For mixed loads, put metal items on the bottom
Finally, when sterilizing mixed loads, place packs containing metal items on the bottom shelves so that condensation developing on the metal does not fall to packs on the lower shelves.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Association for periOperative Registered Nurses (AORN). Recommended Practices for Selection and Use of Packaging Systems for Sterilization. In: Conner R, ed Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc.; 2010:

36. If you find a wet pack…
Most importantly, if you find a wet pack in your facility do not release it! Remember, wet packs are contaminated packs. It is critical to follow your institution’s policies and procedures for investigating and resolving wet pack issues.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Chobin N, ed The Basics of Sterile Processing. 3rd ed. Lebanon, NJ: Sterile Processing University,LLC; 2009.

37. If you find a wet pack…
Remove
If you find a wet pack at the end of a sterilization run, make sure you remove it from distribution.

38. If you find a wet pack… Information (for report) to include:
Date and time wet pack occurred
Load configuration (# of trays)
Number and description of trays that were reported as wet
Selected cycle time
Cycle temperature and exposure time
Packaging material used
Type of containment device used
Person(s) who prepared/wrapped sets
Inventory list for set
Remove
Report
Make sure you collect all relevant information about a wet pack and report it according to your facility’s procedures.
References:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Chobin N, ed The Basics of Sterile Processing. 3rd ed. Lebanon, NJ: Sterile Processing University,LLC; 2009.
Wet Packs – Proactive Solutions. Sterile Processing University, LLC.; 2009

39. If you find a wet pack…
Remove
Report
Reprocess
Make sure that all wet packs are reprocessed. The items should be repackaged and any disposable products should be thrown away.

40. Wet Packs: Strategies for Prevention and Resolution Key Takeaways
A wet pack is any moisture found in or on a package after sterilization and cooling procedures are completed
In summary, a wet pack is defined as any moisture found in or on a package after sterilization and cooling procedures are completed.

41. Wet Packs: Strategies for Prevention and Resolution Key Takeaways
A wet pack is any moisture found in or on a package after sterilization and cooling procedures are completed
The moisture in a package provides a pathway for bacteria to enter
Wet packs are a problem because the moisture provides a pathway for bacteria to enter the package.

42. Wet Packs: Strategies for Prevention and Resolution Key Takeaways
A wet pack is any moisture found in or on a package after sterilization and cooling procedures are completed
The moisture in a package provides a pathway for
bacteria to enter
Wet packs are considered contaminated and should be
reprocessed
Thus, all wet packs are considered to be contaminated packs and should be reprocessed.

43. Wet Packs: Strategies for Prevention and Resolution Key Takeaways
Factors influencing wet pack formation include
Steam quality & supply
Sterilizer performance
Package preparation and handling
Three primary factors cause wet pack formation: steam quality, sterilizer performance, and package preparation and handling.

44. Wet Packs: Strategies for Prevention and Resolution Key Takeaways
Factors influencing wet pack formation include
Steam quality & supply
Sterilizer performance
Package preparation and handling
Strategies directed towards each of these factors must be employed to successfully prevent wet packs.
Prevention of wet packs requires addressing all three factors

45. Wet Packs: Strategies for Prevention and Resolution Key Takeaways
If you find a
wet pack…
Remove
Report
Reprocess
Most importantly, remember that if you find a wet pack, remove it from it from distribution, report it according to your facility’s procedure, and reprocess it completely.

46. Wet Packs: Strategies for Prevention and Resolution
4/27/2017
Wet Packs: Strategies for Prevention and Resolution
Thank You!
This concludes our presentation on Wet Packs: Strategies for Prevention and Resolution.

47. Wet Packs: Strategies for Prevention and Resolution References
Association for periOperative Registered Nurses (AORN) (2012). Recommended Practices for Selection and Use of Packaging Systems for Sterilization Perioperative Standards and recommended Practices. R. Conner. Denver, CO:
Association for the Advancement of Medical Instrumentation, A. (2010). Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities. Arlington, VA., AAMI ANSI/AAMI ST79:2010 & a1:2010 (Consolidated Text).
Brown, J. M. and J. Bliley (2008). "How to solve wet packs, and evaluate water issues." Materials Management in Health Care 17(7):
Chobin, N. (2007) Steam Sterilization. Sterile Processing University

48. Wet Packs: Strategies for Prevention and Resolution References
Chobin, N. (2007) Selection of Packaging Materials & Methods. Sterile Processing University
Chobin, N. (2009) Wet Packs - Proactive Solutions. Sterile Processing University
International Association of Healthcare Central Service Materiel Management (IAHCSMM) (2007). Chapter 13. Sterile Packaging and Storage; Chapter 15. High Temperature Sterilization. Central Service Technical Manual., International Assoc. of Healthcare Central Service Materiel Management: ;
Moore, C. (2008). "Wet packs: improved communication leads to improved response time." Biomedical Instrumentation and Technology 42(5):
Spry, C. (2008). "Understanding current steam sterilization recommendations and guidelines." AORN Journal 88(4): ; quiz