Page 82 - JSOM Spring 2024

at 6 and 12 weeks were different (Tables 1 and 2). In addition, of larger actual surgical instruments in high-temperature and
the growth characteristics of the bacteria were also different. high-humidity environments with continuous monitoring. In
Another possibility is that transport conditions varied between addition, culture sensitivities should also be performed for bet-
groups sent for culture at 6 and 12 weeks. Continuous moni- ter microbial characterization.
toring of temperature and humidity were not recorded during
the transport of specimens. Therefore, exposure to more or Author Contributions
less extreme conditions could have resulted in differences in NL, DM, and LM conceived the study design. NL, DM, LM,
bacterial growth. Lastly, the differences in bacterial growth and AW coordinated and collected the data. NL and CM an-
could simply reflect differences observed in non-contaminated alyzed the data and drafted the manuscript. All authors read
specimens despite exposure to different environmental vari- and approved the final manuscript.
ables. However, this explanation wouldn’t account for the dif-
ferences in the amount of bacterial growth. Nevertheless, the Disclosures
bacteria in the present study compare similarly to the organ- The authors have nothing to disclose.
isms previously cultured in long-term storage of small surgical
instruments in another study. 9 Funding
No funding was received for this work.
Limitations
There are several limitations of this study. First, none of the References
gram-positive species were identified, yet they were the ma- 1. Bruna C, Graziano K Pinto FG. The influence of environmental
jority of the bacteria cultured. Antibiotic sensitivity of bac- temperatures and air humidity in the maintenance of the steril-
terial species was also not performed on isolated bacteria. ity of materials sterilized in different wraps. BMC Proc. 2011;5
(Suppl 6):P311.
While gram characterization and coagulase negativity provide 2. Bruna CQ, Graziano KU. Temperatura e umidade no armazena-
useful information, specific resistance and susceptibility pro- mento de materiais autoclavados: revisão integrativa [Temperature
files would be more informative in understanding the clinical and humidity in the storage area of sterile materials: A literature
risk of the contaminating bacteria. Second, no spore load was review]. Rev Esc Enferm USP. 2012;46(5):1215–1220.
used to verify that the autoclave reached appropriate con- 3. Association of Perioperative Registered Nurses (AORN). Periop-
ditions for the necessary amount of time. However, sterility erative standards and recommended practices. AORN; 2008.
indicators were used, and time-zero sterility was verified by 4. The Joint Commission. Temperature and Humidity Requirements –
Guidance for Storage of Sterile Supplies. Published 11 April
sending a small sample of specimens for culture immediately 2016. https://www.jointcommission.org/standards/standard-faqs/
after autoclaving (group 1), which were negative for micro- ambulatory/environment-of-care-ec/000001275/. Accessed 26 De-
bial growth. Third, continuous monitoring of temperature cember 2022.
and humidity was not recorded during the transport of speci- 5. Japp NF. Packaging: shelf life. In: Reichert M, Young JH, eds.
mens. Therefore, it is possible that conditions could have been Sterilization technology for the health care facility. 2nd ed. Aspen
Publishers; 1997:99–103.
more or less extreme than the storage conditions, leading to 6. Association of Perioperative Registered Nurses. Sterilization
an under- appreciation of the actual conditions the specimens packing systems. Published 1 October 2019. Updated 19 Decem-
were exposed to. Fourth, study sample sizes were small and ber 2023. https://www.guidelinecentral.com/guideline/308646/#
therefore limited robust data analysis, which may have altered section-335872. Accessed 27 December 27 2022.
the results. Lastly, this study used small stainless steel screws 7. Tille PM, ed. Bailey & Scott’s diagnostic microbiology. 13th ed.
to represent small, lightweight, low-profile instruments. Thus, Elsevier; 2014.
results for larger, more complex, and heavier instruments may 8. Weinstein MP, Mirrett S, Van Pelt L, et al. Clinical importance of
differ. identifying coagulase-negative staphylococci isolated from blood
cultures: Evaluation of MicroScan rapid and dried overnight gram-
positive panels versus a conventional reference method. J Clin Mi-
Conclusion crobiol. 1998;36(7):2089–2092.
9. Bhumisirikul W, Bhumisirikul P, Pongchairerks P. Long-term stor-
In conclusion, bacterial growth was demonstrated when sterile age of small surgical instruments in autoclaved packages. Asian J
peel packaging was used for sterile instrument storage in a Surg. 2003;26(4):202–204.
high-temperature and high-humidity environment. No growth 10. Curless MS, Bow L, Lentz T, Trexler P, Maragakis LL. Manage-
ment and mitigation of temperature and humidity events in the
was observed in any specimen sterilized and stored with ster- perioperative setting. AORN J. 2021;114(6):563–571.
ile cellulose wrapping. Gram-positive rods and two common 11. James LA. Single versus double wrap. AORN J. 2006;84(3):
nosocomial Staphylococcus species were cultured. Our study 367–368.
findings support using sterile cellulose wrapping over sterile
peel packing for surgical instruments in austere environments. PMID: 38412526; DOI: 10.55460/EB2S-XTB5
Future studies should consider evaluating the sterile storage

80 | JSOM Volume 23, Edition 1 / Spring 2024