Count sheets

[CSGIRL]

Hi everyone, We are having a problem with the count sheets that we place in our sets. After we are done filling them out we fold them in half. When the OR opens the count sheet, they are finding that all the ink from the print is smearing together. We have tried to fold it the opposite way also and the ink went on to the instruments. How do you place your count sheet in your set?

[CSS TECH]

Hi everyone, We are having a problem with the count sheets that we place in our sets. After we are done filling them out we fold them in half. When the OR opens the count sheet, they are finding that all the ink from the print is smearing together. We have tried to fold it the opposite way also and the ink went on to the instruments. How do you place your count sheet in your set?
I don't think the problem is how the count sheets are folded nor how they are placed in the sets. I believe the problem has to do with the kind of ink, paper or the printer used to make your count sheets. I would suggest you fold your count sheets at least three times and neatly though.

[Harvey Johnson]

We fold in thirds and place inside a paper sterilization pouch from healthmark, never had a problem with ink running.

[cpdguy]

Please contact me off line.
I can share some ideas with you

[Sheri]

we place them along the side outside of the tray. No problems here either.:)

[CSGIRL]

Thanks to all of you. Help like this makes my job so much easier.

Doreen

[Ray Taurasi]

The use of and placement of count sheets continues to be a controversial issue. There is no known or documented case involving an adverse patient outcome or incident resulting from count sheets placed inside an instrument set. We do however know that inks can and do leach and seeing evidence of this on sterilization containers is quite common. I don’t know of any hospitals that are using any special medical grade papers, printer inks or ribbons for count sheets. In fact in my research I have found no source or manufacturer that can supply medical grade printer paper or inks. It appears that most hospitals are using regular printer paper, inks and ribbons. Manufacturers of toners, inks, ribbons and printer paper who routinely sell to hospitals could provide no information on issues of toxicity because they have never tested their products in any sterilization method. Since there is no available research regarding the safety of toners, inks and printer papers placed inside of instruments sets and subjected to sterilization methods the safety of this practice is an unknown. To date none of the professional associations or regulatory entities have published any written document, standard or recommendation regarding the placement of count sheets in instruments sets or product specifications for papers, toners or inks. Still the general consensus amongst healthcare professionals is that chemicals in the paper can pose a theoretical risk of reaction in some sensitized patients. Since there continues to be some concerns relative to the use and placement of count sheets in instrument sets it would make good sense to avoid and or minimize any intimate contact with the count sheets and surgical instruments. It is the responsibility of each hospital to establish a rationale policy and procedure, which addresses this issue and meets their individual and unique needs. Many hospitals are placing the count sheets on the outside of containers and wrapped sets, which eliminates their concerns. If it is essential to place your count sheets inside you can take the following measures to minimize the direct contact of the count sheet with instruments and the likelihood of leaching of chemicals and inks. Fold the count sheets either in thirds or half with printed side in and place in a medical grade paper sterilization pouch. When using a sterilization container system the folded count sheet can be place on the internal side between the container wall and instrument basket.

[Ray Taurasi]

On March 30 I entered a post relative to the use and placement of count sheets in instrument sets. The content of that post is valid and I still hold to what I wrote but wish to add the following note. AORN Standards, Recommended Practices and Guidelines 2007 edition, IV. 3. states, that count sheets should not be placed inside wrapped sets and or rigid containers. To date no other professional entity including AAMI has made such a statement. There continues to be no evidence or reports of adverse affects to patients related to the placement of count sheets in sets. Likewise there is no research or evidence relative to the safety of paper; inks or toners used in association with count sheets and their exposure to the sterilization process. So the position AORN has taken is solely a precautionary measure based on the theoretical and perceived risk that paper and ink chemicals may pose a risk in some sensitized patients. As with any non regulatory standards published by non governing professional entities the information should be taken into consideration and used to aid health care professionals in establishing practice policies which are rationale and appropriate for the products they use and their particular environment. Technology is ever changing and it is not possible for entities such as AORN to address the uniqueness of all products and environments. For that reason users must consult manufacturers for instructions and validations. As health care professionals we are often confronted by situations that are not completely black and white and or have gray areas. In such instances we are required to make the best decisions considering our unique situation. It is important to gather all available information including standards, recommendations and relative documents to aid us in making logical, rationale, sound and defensible decisions.

[cpdguy]

Well put Mr.Taurasi. Just for the record thier are standards concerning paper. European EN 863-3:1999 has requirements for paper that is suitable for steam and gas sterilization processes. You find this in your peel pouches. that paper is medical grade as well as certain paper bags. This is medical grade paper. Hopes this helps.

[davidds91]

The Department of Veterans Affairs "VA Handbook 7176" addresses the issue of using ink on countsheets by stating that only "indelible felt-tip markers" should be used. As far as the printer ink goes, I have seen where it has transfered to the container and instruments after sterilization. So, to solve that problem we have started wrapping count sheets in a lint free towel and placing that towel inside the tray on top of the instruments, effectively illiminating any chance of anything leaking on to the instruments or tray. The VA has stopped using peel pouches inside trays. Also, for legal reasons, the count sheet should be sealed inside the tray with the instruments so as to prevent any tampering with the count sheet after sterilization.