1. QA forum in HKEH HONG KONG EYE HOSPITAL QA Forum 22-3-2012

2. Sterilization Enhancement: Textile wrapper vs Non-woven wrapper Elaine Chan APN, OT

3. Objective: Background: reasons to change to non- woven wrapper Types of disposable wrapper Benefits from new wrapper Limitation Conclusion

4. Background: Surgical instruments are wrapped in double layers of textile wrappers specifically designed for sterilization Difficult to control quality of textile wrapper Less studies to support effectiveness of textile wrapper compare to non-woven wrapper

5. Video: Textile wrapper: phaco set

6. Time used to wrap a phaco set 52 seconds

7. Problems: How to monitor and maintain good quality textile wrappers? The opening between the threads however are larger than most microorganisms, and thus the fabric does not provide an adequate microbial barrier Drying takes longer time and the process will be prolonged.

8. Pack Room Standard for Textile Wrapper: Established folding methods Guidelines to control standard of textile wrapper, i.e. what is and is not acceptable with the end user Visual inspection over light table: individual room is required to sort the textile wrapper

9. Sorting Textile Wrapper →

11. Types of disposable wrapper: TypesMaterialCharacteristicSterilization method: 1. Cellulose crepe100% cellulose, paper Water repellant, 100% biodegradable, very soft Steam, Ethylene Oxide, Formaldehyde 2. Crepe with acrylate 100% cellulose added synthetic acrylate Water repellant, 100% biodegradable, use for heavy trays Steam, Ethylene Oxide, Formaldehyde 3. Non-woven 1Cellulose with 5-30% polyester fibre Water repellant, oil and alcohol resistant, good as inner wrap for containers Steam, Ethylene Oxide, Formaldehyde 4. Non-woven 2:Spunbound Melt- Blown Synthetic (SMS) Laminated in 3 layers, water repellant, for very heavy sets and trays Hydrogen peroxide, Steam, Ethylene Oxide, Formaldehyde

12. Kim Guard One-Step Sterilization Wrap: SMS

13. New wrapper features: Efficient microbial barrier: provides for pack security Virtually lint free: has a tightly anchored fiber structure Does not delaminate: can be used on either side Excellent liquid repellency: is an effective barrier against contamination of contents

14. Advantages: Benefits from new wrapper: save money, save time, save manpower, quality control, Extend expiry date : study proved new wrapper superior to textile wrapper controls in maintaining the sterility of packs exposed to normal handling and storage events, even after one year.

15. Comparison textile wrappers and non-woven wrappers: Cost implication Material Cost Laundry Cost Annual Replacement Annual Wrapped Sets Grand Total Textile wrapper $6$320007000 $6 x2000 +$3x7000x2 =$54000 Kim-Guard one step wrapper $2.2007000$2.2 x 7000 =$15400

16. Save Money: $54000-$15400=$36400 (67%)

17. Time saved from new wrapper

18. Time used to wrap a phaco set 26 seconds

19. Reuse of used wrapper: Reduce the amount of bed sheets

21. Limitation: Not enough space for storage:

26. Conclusion: New wrapper: Easy to monitor and control quality Cost effective

27. The End Thank You!