Wet Pack Troubleshooting Guide - Digestive Health

KIMBERLY-CLARK* KIMGUARD*
Sterilization Wrap
CONFIDENTIAL
For K-C Representatives Only
Wet Pack Troubleshooting Guide

TABLE OF
CONTENTS
■
Process Overview
■
Inner Wetness
■
Outer Wetness
■
Short-Term Solutions
■
Reference

COVER
LETTER
Dear Health Care Sales Representative:
This Wet Pack Program is provided to you in
a format that positions you as the expert in
solving wet pack problems. This program is
intended for Sales Representative use only. It is
not intended to be given to the customer.
■ The format covers:
1) Five questions to ask regarding
inner wetness.
2) Five questions to ask regarding
outer wetness.
The following section (Short-Term Solutions)
covers “band-aid,” or short-term, actions the
customer can take to get sterilized items to the
O.R. until the problem is resolved.
■ Don’t forget, KIMBERLY-CLARK* wrap
does not cause wet pack problems.
Wet packs are caused by any number
of the following:
1) Steam Quality
2) Sterilizer Function
3) Loading Techniques
In the July 1984 issue of Laundry News, Jim
Hickey of American Hospital Company (formally
American Hospitex) stated that “there
can be a 20% moisture content in cotton
before it feels wet.”
In the Reference Section, we have included
diagrams of Steam Sterilization Systems and
Loading Techniques.
Please review these, and begin familiarizing
yourself with the process overview. Then, take
the customer through the program format.
Remember to make clear to the hospital that
information about “wet packs” provided by
K-C, whether in writing or verbally, is NOT
TO BE CONSIDERED BY THE HOSPITAL
AS ADVICE TO TAKE ANY PARTICULAR
ACTION. The hospital should conduct
its own analysis and determine what action
is appropriate.
IMPORTANT INFORMATION REGARD-
ING PERSONAL SAFETY. In conducting
this program, please keep in mind that you
should take all usual precautions for your
safety in the hospital. You can give all of the
information in this guide to the hospital
WITHOUT having to enter any areas of the
hospital where you are not authorized to be
present, or where you normally would not be
present in the course of your sales activities.
Remember, WHEN IN DOUBT, STAY OUT.
■ One sterilizer manufacturer stated:
“The occurrence of water droplets
has increased significantly with the
increased use of water-repellent wraps.
Although these wraps do not create the
droplets (unlike 140-thread-muslin
which absorbs and disperses steam
condensate that may fall on the wrap
surface), they do retain them as droplets
of moisture.” 1
1
Edna Kirkland, RN, “Guidelines for Preparing and Sterilizing Wrapped
Packs,” in AMSCO Technical Manual, eds. Karle and Ryan, (American
Sterilizer Co, 1983), pp. 2-4.
1

PROCESS
OVERVIEW
■ Step-by-Step Instructions for Handling a Wet Pack Problem.
1
Make an appointment with the
customer to discuss the problem. If
you are unable to meet face-to-face,
explain the problem-solving process
over the phone.
2
Begin the process by allowing the
customer to tell you all they know
about the problem. This will allow
the customer to vent any frustrations
or complaints about the situation and
allow you to gain customer insight
and information.
3
Gain credibility with the customer
by letting the customer know that
based upon 20 years of experience,
Kimberly-Clark can offer assistance
with wet pack problems, including
working with an independent
outside source.
4
After taking the customer through
the program, follow-up with
calls to the customer to help
ensure resolution.
2

INNER
WETNESS
■ Gather specific information by asking the following questions:
A. Are you seeing the wetness on the inside
of the package? If yes, then…
■
3. What is the dry cycle temperature half
way into the dry cycle?
■
■
1. Have the traps directly behind the
sterilizer been checked to ensure the
traps are working properly?
RATIONALE: If the trap is running
“hot”, it could be stuck open. If the
trap is stuck open, steam could be
escaping out of the trap resulting in
steam pressure loss.
ACTION REQUIRED: Ask the
hospital engineer to assess whether
the traps behind the sterilizer are
working properly.
2. Is the vacuum pull during the dry cycle
26 Hg (inches of mercury) or greater?
RATIONALE: A good vacuum pulls
out excess condensate that remains in
the load when the drying cycle begins.
The maximum possible vacuum is
30 Hg.
ACTION REQUIRED: Ask the
hospital engineer to monitor the
vacuum reading during the sterilizer
dry cycle. If the vacuum falls below
26 Hg, take action to increase the
vacuum. The most common way to
increase the vacuum is to increase the
“water ejector pressure” that causes
the vacuum phenomenon.
RATIONALE: During the dry cycle,
a vacuum is pulling steam and residual
air from the chamber. After about
10 minutes into the dry cycle, the
temperature in the chamber should
drop below 205° F. This drop in
temperature is a phenomenon that
occurs when the chamber experiences
negative pressure due to the vacuum.
A temperature above 205° F after
10 minutes into the dry cycle indicates
a solenoid valve leak above the steam
inlet. Such a leak can draw steam
(moisture) back into the sterilizer
chamber during drying, causing
wet packs.
ACTION REQUIRED: Ask hospital
personnel to read the chamber
temperature in the sterilizer 10
minutes into the dry cycle. If the
temperature exceeds 205° F, ask the
sterilizer manufacturer maintenance
representative or the hospital sterilizer
maintenance employee to explain the
high temperature. The high temperature
is a direct indication that the
solenoid valve above the steam inlet is
opening up and leaking steam during
the dry cycle.
3

INNER WETNESS
(continued)
■
■
4. Is the steam inlet pressure adequate in
the steam line prior to the point where
steam enters the sterilizer?
RATIONALE: Steam is generated at a
boiler under high pressure, then as the
steam travels through the line (pipes),
the pressure is stepped down, usually
in the middle of the line, then at the
sterilizer. If the pressure in the middle
of the line is at 60 pounds per square
inch gauge (psig), and the pressure
delivered at the sterilizer is at 30 psig,
the pressure difference would be 30
psig, (i.e., 60 psig- 30 psig = 30 psig).
The bigger the pressure difference,
the better the evaporation of water
droplets in the chamber during the
sterilization process. (The sterilizer
manufacturer typically presets this setting
between 30-35 psig.)
ACTION REQUIRED: The hospital
engineer should provide the steam
pressure reading in the steam line
prior to the point where steam enters
the sterilizer. The reading should be
60-80 psig.
5. Is wetness isolated only in basin sets?
RATIONALE: Basin sets are the main
culprit when it comes to loading problems
that cause wetness. The potential
for wetness to occur is high because
there are so many items in the basin
that can trap water, such as emesis
pans, bowls, and medicine cups.
ACTION REQUIRED: If wetness is
primarily in basin sets, Central
Service/SPD staff should check the
positioning of items inside the basin.
To make sure basins are loaded properly,
perform a test using an unwrapped
basin set. Take the unwrapped basin
set to a sink. Run water over the items
in the basin. With the assistance of a
Central Service/SPD employee, tilt
the basin as it would be positioned if
it were in the sterilizer. Notice how the
water drains off the basin contents.
Does any pooled water remain inside
or outside the basin set? If pooled
water remains, there are two options
for solving the problem:
a. Reposition the item where pooled
water is noted so water drains off the
item when tilted above the sink.
b. If the item cannot be repositioned
(i.e., the “lip” on the outer rim of the
basin), add an absorbent towel to wick
away pooled water.
Make sure there are no un-anchored
items (like medicine cups) which may
tip back upwards when the basin set is
loaded, and then tip over, spilling
water into the set when the set is
unloaded.
4

OUTER
WETNESS
■ Gather specific information by asking the following questions:
B. Are you seeing the wetness on the outside
of the package? If yes, then …
■
■
1. Have the traps directly behind the
sterilizer been checked to ensure the
traps are working properly?
RATIONALE: If the trap is running
“cold”, it could be stuck closed. If the
trap is stuck closed, excess water
gathering along the inside of the pipes
could fill the trap, so the excess water
in the trap would have no place to
evacuate. Since the trap would be
filled with water, the result is water
flowing out of the trap and pouring
into the sterilizer, causing water to
“rain” on the outside of the packages.
ACTION REQUIRED: Ask the
hospital engineer to assess whether
the traps behind the sterilizer are
working properly.
2. Is the vacuum pull during the dry cycle
26 Hg (inches of mercury) or greater?
RATIONALE: A good vacuum pulls
out excess condensate that remains in
the load when the drying cycle begins.
The maximum possible vacuum is 30
Hg.
ACTION REQUIRED: Ask the
hospital engineer to monitor the
vacuum reading during the sterilizer
dry cycle. If the vacuum falls below
26 Hg, take action to increase the
■
■
vacuum. The common way to increase
the vacuum is to increase the “water
ejector pressure” that causes the
vacuum phenomenon.
3. Is the “check valve” below the sterilizer
chamber working properly? Is there
even a “check valve” installed below
the drain?
RATIONALE: A “check valve”
installed below the chamber drain
helps prevent an upspray of
water from the drain during the
sterilization cycle.
ACTION REQUIRED: Especially
if water is present on the lower
portion of the load, ask the sterilizer
maintenance person to verify function
of the check valve.
4. Is the sterilizer shelving unit a cause of
outer wetness?
RATIONALE: Sometimes moisture
droplets on the outside of the package
follow the outline of the sterilizer
shelving unit configuration. This type
of outer wetness is due to one of the
following:
(1) Excess air in the chamber cools the
metal shelving unit and causes moisture
droplets to form on the shelving unit.
This excess air in the chamber usually
occurs in all linen loads where air pockets
exist between the stacks of cloth. The air
5

OUTER WETNESS
(continued)
creates a cooling effect on the metal
shelving unit, causing condensate to
form.
(2) The shelving unit has been
designed in a configuration that traps
water so that when the shelving unit is
removed from the sterilizer, the water
splashes onto the packages below.
ACTION REQUIRED: (1) Discuss
extending the drying time on linen
loads only, and (2) ask the hospital
engineer/sterilizer representative
whether or not it would be a good idea
to “bend down” the metal on the
shelving unit where water is getting
trapped, or to drill holes in the problem
area if rust formation on the shelving
unit is not a concern.
■
5. Has the hospital engineer evaluated
the design of the steam line to look
for “U-shaped” pipe configurations
or “dips” in the piping?
RATIONALE: Sometimes the pipe
configuration in the steam line can be
improved to prevent water from pooling
inside the pipes and being pushed
into the sterilizer.
ACTION REQUIRED: The hospital
engineer can evaluate whether pipes
behind the sterilizer are suitably configured
and whether pipes are dipping
in the middle. Actions the engineer can
take include reconfiguration of the
pipes or placing “traps” on the area of
the pipe that is collecting water.
6

SHORT-TERM
SOLUTIONS
■
Here is a list of solutions the customer may
consider in the interim. Keep in mind that
these are only short-term solutions.
■
Be sure to follow up with the customer to
ensure that the customer is taking actions
to solve the wet pack problem.
■
■
■
■
Pre-heat items in the sterilizer
for 10 minutes prior to starting
the cycle.
If inner wetness is occurring, add
absorbent towels to the inside of
the package to wick moisture.
If outer wetness is occurring,
drape the items already loaded
on the sterilizer cart with a large
piece of absorbent material, (i.e.,
a large cloth wrapper or sheet).
Extend the drying time.
7

AT KIMBERLY-CLARK, OUR MISSION IS
TO DELIVER CLINICAL SOLUTIONS
THAT YOU CAN DEPEND ON TO MEET THE
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FROM SURGICAL SOLUTIONS TO PREVENTING
HEALTHCARE-ASSOCIATED INFECTIONS,
WITH KIMBERLY-CLARK YOU’LL
ALWAYS HAVE ONE LESS WORRY.
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© 2006 KCWW. All rights reserved.
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