As we’ve all learned the in recent years, the logistics of getting goods to the right place at the right time in the right way is often as important as purchasing the right product in the first place.

The same could be said for the internal logistics within the hospital when transporting sterile instrument trays to and from the Operating Room. All the careful work and rigorous processes used to prepare sterilization trays by Central Service/Sterile Processing & Distribution (CS/SPD) is immediately undone if effective surgical case cart management isn’t hard-wired into the hospital’s system.

And, if the right equipment isn’t in position to provide transport, the wheels can come off real fast. To a surgeon and an Operating Room team, just up the hall may as well be on the other side of the world if the surgical trays aren’t ready and waiting in pristine and sterile condition.

For those looking to up their sterile tray cart game, here are three key questions to consider.

1. What types of procedures are being performed in the hospital or location?
   Evaluate the type of procedures that are performed and the number of trays or sets that are needed for these procedures. Are you using a lot of small sets or a lot of loaner trays? Do some of the doctors have specific instruments that they prefer? Are you equipped to accommodate a surgical schedule that can fluctuate day to day?For instance, orthopedic cases require a lot more trays as compared to an ENT procedure or eye surgery. If most of your cases do not require a lot of sets you may be wasting room in a large surgical cart. So right size your instrument trays and your surgical case carts accordingly.After all, it’s inefficient to push a surgical cart that is half empty. Conversely, if you are pulling trays for robotics or an ortho case, this will require a sterile transportation cart that accommodates the large number of instrument trays and supplies. Some of these trays are extra-long to hold scopes, and you must have a surgical case cart that can contain them.To revisit the logistics comparison, best practitioners often think in terms of a “fleet” of surgical case carts in a variety of size and shapes so that they always have the right case cart for the job at hand.
2. What is the weight of the cart itself and how easy is it to maneuver once filled?
   Staff safety is just as important as patient safety when it comes to using surgical case carts. And maneuverability is critical to ensure staff gets the instrument trays to the Operating Room or staging area safely, while also maintaining case sterility.The AAMI has long recommended that tray weight should be limited to 25 lbs., but internal surveys routinely demonstrate that those guidelines are not frequently followed. Moreover, the number of trays needed for many procedures has increased over time. Consequently, when the staff pull for cases, the weight of the trays and carts can really add up.The design of a case cart should ensure even weight distribution, as well as offering features that make a full loaded cart easy to push. The ideal case cart must be lightweight on its own but sturdy enough to support multiple trays and stand up to the inevitable bangs and bumps that occur in a busy hospital during sterilization and transport. Ergonomically designed casters and handles placed at the right height also make transportation easier for staff.Since the CS/SPD is usually pressured to turn trays around quickly, an often-unsung design element that can save time is the inclusion of “cool touch” cart handles. When a case comes out of the washers, such handles can help staff can safely begin handling it right away.
3. Do you have closed carts or covers to accommodate transportation back to the SPD?
   The ANSI/AAMI ST79 6.4 clearly states expectations: “Contaminated items should be contained during their transport from the point of use to the decontamination area. …Containers, devices, or carts must be marked with a biohazard label or other means of identifying contaminated contents.”The sterile processing department, case cart staging area and OR can sometimes be separated by hallways and even floors. Preventing contamination in the hospital environment requires both the right equipment and processes during crucial hand-offs between departments.“I’ve seen hospitals using trash bags as covers for transport when they lack closed carts,” attests Cory Ezell, North American Sales Director for Belintra. “While technically covered, it doesn’t provide the protection needed and can potentially expose patients and staff alike to harmful substances, including pathogens.”

In Summary

The quality of the case carts designed for the transport of sterile trays can have a major impact on infection prevention. Finding the right fit for your hospital starts with asking the right questions to help uncover the right equipment.