Storage of Sterile and Non-Sterile Supply within clinical areas - Guideline

1. Guiding PrinciplesPurchased clinical supplies, including sterile and non-sterile items are to be stored and handled in a manner that maintains the integrity of packaging and prevents contamination from any source. This requirement also applies to items sterilised in the health care facility. The environment and planning of supply storage areas and systems is integral in ensuring that sterile and non-sterile stock maintains its integrity, is fit for purpose, and safe for patient use.

WA Country Health Service (WACHS) has multiple healthcare facilities across several regions which vary in age, size, and service provision. Areas nominated for the storage of clinical supplies can be inconsistent with respect to location, allocation of space, availability of space and general maintenance of the facility. Therefore the application of standards and guidelines are required to ensure that the integrity of the sterile supply is maintained to the highest standard achievable.

2. Guideline This guideline applies to storage environments and controls where purchased clinical supplies (sterile and non-sterile), reprocessed sterile items and non-sterile stock are stored within clinical areas in healthcare facilities throughout WACHS. This includes community health, mental health and aged care.

Please note this guideline does not apply to: Imprest Central Sterile Services Department (CSSD) and Theatre Endoscopy units Warehouse and supply/stores department Transportation (external) and loading dock

2.1 Guidelines for sterile and non-sterile supply

Purchased clinical supply sterile, non-sterile and healthcare facility sterile goods

Non-sterile stock may be stored in the same area as sterile supply but should have clear segregation from sterile supply by cleanable barrier or partition.

Dividers in storage containers should ensure no mixing of stock and allow differentiation of same items and different sizes.

Sterile supplies to be stored on open shelving (at least 250mm from the floor and 440mm below ceiling fixtures).

Integrity of the sterile supply packaging is safeguarded by allowing space for stock of various shapes and sizes that will not compromise packaging and contents.

Adjustable/ flexible shelving is preferred to allow for changes in size and shape of products stored.

Do not facilitate dust collection.

Effective 11/12/2019

Storage of Sterile and Non-Sterile Supply within clinical areas - Guideline

Permit systems for stock rotation. Have manufactured shelving from non-porous material with smooth surfaces, that is

easily cleanable and will not damage packaging e.g. stainless steel, not “plated” with another material.

Prevent sterile supply from coming in contact with walls.

General considerations

Easily accessible hand hygiene facilities e.g. access to alcohol-based hand rubs (ABHR).

Clear labelling. Standardised storage systems throughout all clinical areas. Consider Occupational Health and Safety hazards such as height of shelving,

storage, and accessibility to stock. Design ensures correct storage of products e.g. catheters not folded but stored flat. Secure storage areas to limit access to clinical personnel only There is evidence of environmentally controlled temperature and humidity (either

individual control for each room or centrally controlled via air conditioning) which maintains temperature 19°C - 24°C and relative humidity 40% - 60%. This will prevent condensation on internal building surfaces.

Wall, floors and work surfaces are to be smooth, non-porous and easily cleaned. Joins and hard to clean corners should be minimised or avoided. Lighting should be fitted flush into ceiling to reduce dust entrapment. Adequate space is required around sterile product to enable air circulation. The area or stock will not come in contact with water. Sterile storage area is not to be used as a shared equipment storage space e.g.

wheelchairs, trolleys, specialised equipment etc. Stock should be decanted onto a clean trolley prior to entry into the store room

3. Definitions

Sterile Supply Refers to sterile reprocessed items and purchased sterile consumables (commercially prepared sterile items)

Healthcare Facility Sterile Supply

Reprocessed sterile supply processed through Central Sterilising Services Department.

Purchased clinical supply

Commercially purchased supply – sterile or non-sterilee.g. gauze (sterile) v bandages (clean, non-sterile)

Non-Sterile Stock

Non-sterile stock includes equipment and medical consumables (e.g. bandages, oxygen masks) classed as single patient use only.

De-boxing / Decant

To remove commercially prepared items from their shipping boxes including both purchased sterile and non-sterile supply.

Storage of Sterile and Non-Sterile Supply within clinical areas - Guideline

4. Roles and ResponsibilitiesThe manager for the clinical storage area is responsible for the sterile stock process e.g. available space for stock of various shapes and sizes and maintaining integrity of packaging and contents. A suitable staff member may be delegated this responsibility with education on the standards and practice for storage of sterile stock and non-sterile stock.

5. ComplianceIt is a requirement of the WA Health MP 0031/16 Code of Conduct Policy that employees “comply with all applicable WA Health Policy Frameworks”.

The Code is part of the Integrity Policy Framework issued pursuant to section 26 of the Health Services Act 2016 (HSA) and is binding on all WACHS staff which for this purpose includes trainees, students, volunteers, researchers, contractors for service (including all visiting health professionals and agency staff) and persons delivering training or education within WACHS.

WACHS staff are reminded that compliance with all policies is mandatory.

6. Evaluation

Compliance of this document is to be reported to local quality and safety committees and or relevant governance body. Audits for each site are to be carried out annually.

Appendix 2: Audit tool for Sterile and Non-Sterile Supply - storage within clinical areas

7. Standards

National Safety and Quality Health Care Standards Preventing and Controlling Healthcare -Associated Infection Standard v2.

3.10 Invasive medical devices3.12 New and existing equipment, devices and products used in the organisation3.14 Reprocessing reusable medical devices

8. References

Australasian Health Infrastructure Alliance 2016, Australasian Healthcare Facility Guidelines, Part D: Infection Prevention and Control, North Sydney, NSW

Australian Standards AS/NZS 4187:2014 Reprocessing of Reusable Medical Devices in Health Service Organisations

Building Guidelines Western Australia Health Facility Guidelines for Engineering Services 2017, Department of Health, West Australia

Storage of Sterile and Non-Sterile Supply within clinical areas - Guideline

Centre for Healthcare Related Infection Surveillance and Prevention & Tuberculosis Control 2013, Guideline – Storage Design for Sterile and Non-Sterile Stock Storage for New and Refurbished Healthcare facilities, Department of Health, Queensland

National Health and Medical Research Council (NHMRC) 2019, Australian Guidelines for the Prevention and Control of Infection in Healthcare, National Health and Medical Research Council, Commonwealth of Australia.

9. Related WA Health Policies

WACHS Environmental Cleaning Policy

WACHS Infection Prevention and Control Policy

10. Appendices

Appendix 1: Sterile Stock Storage System: Examples

Appendix 2: Audit tool for Sterile and Non-Sterile Supply - storage within clinical areas

Appendix 3: WACHS Action Plan

11. Acknowledgements

WACHS Midwest Infection Prevention and Control WACHS South West Infection Prevention and Control

This document can be made available in alternative formats on request for a person with a disability

Contact: Clinical Nurse Specialist Infection Control (M. Pirrottina Midwest) and Clinical Nurse Consultant Infection Control (M. Godsell South West)

Directorate: Nursing and Midwifery Services TRIM Record # ED-CO-17-61917Version: 3.00 Date Published: 16/12/2019

Copyright to this material is vested in the State of Western Australia unless otherwise indicated. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the provisions of the Copyright Act 1968, no part may be reproduced or re-used for any purposes whatsoever without written permission of the State of Western Australia.

Storage of Sterile and Non-Sterile Supply within clinical areas - Guideline

Appendix 1: Sterile Stock Storage System: Examples

Option 1 Option 2

YES (Preferred) YES (Preferred)

Option 1: stainless steel “wire” or Option 2: plastic/polypropylene baskets with perforated bottom are recommended as these will still provide the same storage solution and flexibility, but are less prone to dust and contaminant collection and can be put through washer disinfectors and sterilizers. Option 3: solid plastic container systems are prone to collecting dust and contaminants and are not recommended.

Figures 1 Figure 2 Figure 3

Acceptable Outer packaging should not be in the sterile store

Sterile wrapped packs should not be stacked

Figures 1, 2 and 3 demonstrate acceptable storage systems but due to the way in which the system is used (Figures 2 and 3) to store reprocessed sterile stock there is a potential for damaging to the packing system, as well as storing packaging boxes in the sterile store room ( source: Department of Health, Queensland).

Storage of Sterile and Non-Sterile Supply within clinical areas - Guideline

Appendix 2: Audit tool for Sterile and Non-Sterile Supply - storage within clinical areas

Methodology: To be conducted as an observational audit in clinical store rooms throughout WACHS sites. Re-audit annually and review recommendations from previous audit

Audit Details1 Audit Date

3 Ward/Department

4 Hospital

5 Region

6 Auditor

1. Environmental requirements for clinical supply storage areas:

1.1 Hand washing facilities or ABHR are available and easily accessible. Yes ☐ No ☐

1.2 The area is secured to allow access to healthcare personnel only. Yes ☐ No ☐

1.3

There is evidence of environmentally controlled temperature and humidity (either individual control for each room or centrally controlled via air conditioning) which maintains temperature between 19°C - 24°C and relative humidity 40% - 60% (as per engineering controls).

Yes ☐ No ☐

1.4 Area layout limits difficult to clean corners and areas for dust to collect. Yes ☐ No ☐

1.5 Wall, floors and work surfaces are non-porous, smooth and capable of easy cleaning. Yes ☐ No ☐

1.6 Lighting is be fitted flush into ceiling to reduce dust entrapment. Yes ☐ No ☐

1.7 There is adequate space around sterile product to enable air circulation.

Yes ☐ No ☐

1.8 Sterile stock storage area is constructed so that there is no risk that clinical supplies do not come into contact with water. Yes ☐ No ☐

1.9 Stock should be decanted onto a clean trolley prior to entry into the store room. Yes ☐ No ☐

1.10 Corrugated cardboard is not stored in the sterile storage area. Yes ☐ No ☐

1.11 Original packaging (single sheet cardboard) only is allowed in the clinical supply storage areas. Yes ☐ No ☐

1.12Commercial dispenser boxes are not ‘topped up’ or reused. Containers/boxes may be opened once and items removed individually until empty, and then disposed of.

Yes ☐ No ☐

1.13 Storage containers comply with Option 1 or 2 (see Appendix 1). Yes ☐ No ☐1.14 Stainless steel “wire” or plastic/polypropylene baskets with perforated Yes ☐ No ☐

Storage of Sterile and Non-Sterile Supply within clinical areas - Guideline

bottom are used for ‘unpackaged’ sterile goods where available. (These should replace plastic containers as a long term solution).

1.15 The storage area is free from dust, insects and vermin. Yes ☐ No ☐

1.16 The area is free of ‘breakables’ that may shatter upon impact (e.g. glassware/ china). Yes ☐ No ☐

1.17The area is for clinical use items only. No other items are stored in this area (wheelchairs, trolleys, crutches, filing cabinets, Christmas decorations, chemicals).

Yes ☐ No ☐

1.18 Sterile supply does not come into contact with walls. Yes ☐ No ☐

1.19 Sterile supply is stored on open shelving and is at least 250mm from the floor and 440mm below ceiling fixtures. Yes ☐ No ☐

1.20 Shelving systems are adjustable (not fixed) to facilitate product sizes and shapes (adjustable wall baskets are OK). Yes ☐ No ☐

1.21Shelving is manufactured from non-shedding material, easily cleanable and has a smooth surface that will not damage packaging such as stainless steel; not “plated” with another material).

Yes ☐ No ☐

1.22 Metal shelving, baskets and fittings show no visible rust/ flaking. Yes ☐ No ☐

1.23 Sterile items are protected from sunlight. Yes ☐ No ☐

1.24 Shelving takes into consideration OSH requirements such as height of shelving and storage, and accessibility to stock. Yes ☐ No ☐

1.25 The integrity of the sterile stock packaging is intact (no visible damage/ breaks). Yes ☐ No ☐

1.26 There is evidence of inventory management and stock rotation (e.g. clearly marked / visible barcodes and expiry dates). Yes ☐ No ☐

1.27 Reprocessed, purchased sterile supply and commercially prepared clean stock if stored in the same area are clearly segregated by a barrier or partition.

Yes ☐ No ☐

1.28 Hoists, trolleys, carts and containers used to transport supply are dedicated for that purpose. They are kept clean and not used for the collection of used items, food or refuse.

Yes ☐ No ☐

Storage of Sterile and Non-Sterile Supply within clinical areas - Guideline

Appendix 3:

Action Plan – Sterile and Non-Sterile Supply - Storage within Clinical Areas

Clinical Audit Action Plan Template