Chapter 2: Table of Contents
Opening the Instrument Pack
A hat and mask are worn while opening the instrument packs. Packs can be opened either by opening a single layer or by opening both layers. If only the first layer is opened, the second layer will be opened by a sterile gowned and gloved surgeon and thus an assistant is needed to open any blades, suture, extra gauzes or extra instruments. Opening both layers initially can be more efficient as the surgeon is able to open their own blades and sutures. During junior surgery, there is a lot of traffic in a small area and thus initially only the single layer is opened.
Before the pack is opened, one should ensure that the pack has not expired and that tapes have changed colours indicating sterilization. All sterility indicator tapes must be removed completely. Unfold one corner of the pack at a time preventing the cloth or paper from recoiling and contaminating the sterile materials. While opening the pack, your unsterile fingers should only touch the outside of the wrap or the very edge (often coloured) of it. The pack is opened lengthwise first and the edges of the drapes are then used to determine which way the drape opens up. That side is then opened and the opposite side is opened by walking around the table. The surgeon or technician should never reach over a pack and should rather move around the pack to prevent contamination.
Opening Extra Blades, Sutures and Instruments
Once both layers of the pack have been opened, extra instruments can be opened by separating the paper and plastic that contains the instrument and opening it over the edge of the pack and avoiding contamination.
When Things Go Wrong:
If the instrument package tears during opening, then the instrument is not considered sterile as it may have touched the outside edge of the paper, which is unsterile.
If the instrument is contaminated (i.e. touches a finger) as it goes onto the table, then the entire pack is considered contaminated and needs to be replaced.