A common concern in healthcare facilities – whether dental offices, medical practices, or surgical settings – is: “How early is too early to set up for my next patient or procedure?” Another frequent question is: “How early can I open a pouch of instruments and set up trays?”
Research has shown that the earlier you open a pouch of instruments, the greater the risk of contamination.
Most staff who set up early say they’re trying to save time. They want to avoid extra steps and stay ahead of schedule. Others explain that they’re short-staffed and team members have multiple responsibilities, so they feel they don’t have time to set up immediately or at the point of use. While opening packs early may save a few steps, it can also jeopardize patient safety.
Early setups are a common problem, and practices must find ways to address it. One major concern is aerosols, which are present in nearly every healthcare environment – especially in dental practices. These aerosols can carry microorganisms and other contaminants that may settle on exposed instruments.
Once instruments are opened and exposed to the air, they are no longer considered sterile. Instruments left open on a tray are also at risk of being touched accidentally, falling off the tray if bumped, or even being contaminated by insects. Yikes!
Surgical trays should also be set up at the time of the procedure, as this is considered best practice. The Association of PeriOperative Registered Nurses (AORN) recommends preparing the sterile field as close as possible to the time of use. This recommendation is based on the increased risk of airborne and environmental contamination over time. Items in sterile packaging will remain sterile as long as the integrity of the packaging is maintained.
Several studies have demonstrated how quickly contamination can occur. Some research has shown contamination on sterile trays in operating rooms just 30 minutes after being opened. Another study found that implants and instruments left exposed continued to accumulate bacterial contamination over time. Additional studies showed that bacterial air contamination of sterile fields in controlled operating room environments began as early as one hour after opening, with contamination rates steadily increasing.
Research has also compared covered versus uncovered trays. In these studies, uncovered trays showed contamination sooner and at higher rates. Covered trays remained sterile longer, approximately 4 to 8 hours. However, by 24 hours, both covered and uncovered trays showed contamination.
Because of this, covering trays should not be used as a routine convenience. This method should only be used in emergency situations or when a procedure is unexpectedly delayed. Opening instrument packs and covering them for later use should not be standard practice.
The CDC also provides key recommendations regarding opening instrument packs before procedures. These recommendations apply to all healthcare settings, including but not limited to:
The standard of care is to open instruments at the point of care. Instruments should remain bagged or pouched until they are needed to prevent contamination.
If your team feels they don’t have time to wait until the point of use, it may be time to reevaluate your workflow. Consider whether additional instrument sets are needed or whether team routines should be adjusted.
The CDC encourages a “just-in-time” approach to opening instruments rather than preparing them early. In other words, instruments should be opened when they are needed, not beforehand.
Patient safety must always come first. Establish clear standard operating procedures and eliminate the practice of opening instruments early.
