Pack prep room design 101

Instrument processing is referred to as pack prep in the veterinary industry because its sole purpose is to prepare packs to be used during a surgical procedure. A pack is a package of instruments that have been carefully bundled together based on what is needed for a specific procedure. Packs are cleaned, sterilized, and appropriately stored until they are needed for surgery. These tend to be forced into a corner of the treatment area, in whatever space is left. Given the importance of disease transmission prevention and creating spaces that are easier for your staff to use, a properly laid-out pack prep room is a key component to a well-functioning hospital.

Upstate Vet Specialty + Emergency Care – Greenville (Image courtesy of Tim Murphy | Foto Imagery)

The key to a well-designed pack prep area is to keep the flow of instrument processing moving in a circular path from dirty to clean.

Your focus should be on allowing your technicians to move the instruments along the processing path without taking more physical steps than necessary. Key elements required for this process are plenty of counter space, storage, and power. You want all items to be within easy reach. The circular flow can be broken down into 7 basic steps or stations.

Graphic courtesy of Animal Arts

Organize the dirty packs

• Laundry, such as the wraps on the packs and reusable gowns, is separated out and put in the washer. It is convenient to have a stackable washer/dryer in the pack prep room, but it is not 100% necessary. If the washer/dryer is not in the pack prep area, you may want to consider having a second set of washers and dryers so surgery linens can be kept separate from the washing for the rest of the hospital.
• As trash items are discarded, trash cans must be accessible.
• Counters that are 2-to 3-ft wide are helpful in this zone to allow technicians to set down dirty packs.
• A mop sink is also helpful in this dirty zone.

Clean the instruments

• Cleaning is typically done in a sink. Although most of your surgical instruments are small, there are also items like anesthesia tubing and fluid containers that are bulkier. A deeper sink is useful for these items. Some facilities benefit from both a shallow basin sink and a deep sink to allow for variation in instrument/item sizing.
• A drying rack for tubing is a nice idea and could be placed on the wall near the sink with a simple pegboard design.

Use the ultrasonic cleaner

• After gross cleaning, the instruments are typically placed in the ultrasonic cleaner to get rid of smaller debris. They are then rinsed again before being treated with instrument milk.
• Different hospitals have different protocols as they relate to the initial cleaning process. In general, if you have your ultrasonic cleaner near your sink(s), you should be in good shape.

Lay the instruments out to dry

• A minimum of 2 to 3 ft of counter space is useful for drying instruments. All instruments are left in the open position and cannot be touching each other, so they tend to take up a lot of counter space while drying. If you have a busy surgery practice and multiple surgeries going on simultaneously, additional drying space will be needed.

Wrap the packs

• After instruments are clean and dry, they are then packed back up. This needs additional counter or layout space. The wraps for the packs are on rolls and can be stored underneath a center island used for wrapping the packs. If you don’t have the luxury of a built-in island or are tight on space, you can design your cabinetry to have a pull-out counter that tucks away when not in use, or you can use a mobile stainless-steel cart.
• Heat-sensitive tape and heat sealers are used in this area. Storage and power are needed.

SAGE Veterinary Centers – Concord, (Image courtesy of Tim Murphy - Foto Imagery)

Sterilize the packs

• After packs are wrapped, they are placed into the appropriate sterilizers depending on the instrument. For example, the gas sterilizer is used for things that would melt in the high-temperature steam sterilizer.
  • Make sure you have appropriate clearance around the sterilizer, as well as proper power (usually dedicated), plumbing (floor drains are required for larger steam sterilizers), and ventilation (gas sterilizers require ventilation). Always try to get your hands on the specifications for the machine you will be using or plan for the worst-case scenario. Making decisions early about what equipment you will be purchasing and providing this information to your design team is crucial to not incur costs for changes later in the construction process.
  • Technology changes, so it’s best to build in flexibility to the sterilizer area of your pack prep space. Provide deeper counters and additional power for future potential equipment needs.

Ethos VERC ( Image courtesy of Tim Murphy | Foto Imagery)

Store the packs away

• Discuss storage needs with your team. Some people prefer pass-through windows into each surgery suite, whereas others may prefer 1 group storage area in a sterile hallway or even in the pack prep room.
• There can be cloth packs with multiple instruments in them, as well as individual envelopes that contain 1 instrument each. Individual instruments are packaged to supplement a surgical procedure. Generally, these individually prepared instruments are most accessible when stored in a more common area, such as a sterile corridor or in the pack prep room itself.

Image courtesy of VCA Animal Emergency & Referral Centre

Tips and tricks

• Pack prep areas need quick access to the surgery suites, the sterile corridor, surgery recovery areas, and surgery induction. The technicians preparing the packs are usually the same team members who care for animals throughout the surgical process.

Graphic courtesy of Animal Arts

• Consideration should be given to work surface heights. The typical standing work height is 36 in; however, if you want to provide a few options for your team in terms of heights—or better yet, an adjustable-height work surface like a desk—this will allow for better ergonomics.
• You can never have too much storage in this part of your hospital. You want to maximize undercounter and uppercabinet storage. If you have drills with rechargeable batteries, you will need a spot to station the chargers. Power and a deck space will also be needed.
  • Inventory management systems, like an Omnicell or Cubex system, are helpful to track the use of surgical equipment in your facility. These units can be large or small, and they require floor space, power, and data.

SAGE Veterinary Centers – Redwood City

If you focus on the step-by-step process needed to properly care for, clean, sterilize, and store your instruments when designing the pack prep area of your hospital, you will create an efficient and effective space that will help your team provide the best care to your patients while also protecting the health and safety of your team.