Do a Google search on peel packs, and you will find plenty of information related to sterilization and indicator testing, packaging options and storage, but not much on how to track them. On average, most hospitals have thousands of peel pack items in their inventory, and the challenge of managing these assets can be daunting. As these items move through the perioperative loop, many sterile processing departments struggle with how to:

  1. Effectively manage inventory levels
  2. Capture the cost of missing assets
  3. Easily locate items
  4. Ensure effective repair and maintenance of instruments

An article published in the Journal of Hospital Administration by J. Mhlaba, et al, concluded that although peel packing an instrument is roughly 2x the cost of tray packing, because so many instruments routinely go un-used, re-organizing to a peel pack method could result in significant cost savings.This study not only underscores the value of peel packing but also the need to have a system in place for tracking both tray-packed and peel packed instruments in order to capture data for quality analysis.

Here are two current options for tracking peel packs:
  1. Automation: Using an instrument-level management system is a reliable solution to fix all four issues listed above without adding to staff workload.
  2. Hybrid process: For sites that have scanning capabilities and have a collaborative OR/SPD team, the staff at Sanford Health in North Dakota came up with a process for tracking peel packs to help reduce the number of missing peel pack instruments.

Susan Pfeifer, Director of CSPD at Sanford Health, describes their method for keeping up with peel packs:

At our facility, we have added a piggyback CensiTrac barcode label to peel pouched items. The end user removes the label from the pouch and adds it to a “quota” sheet. The instrumentation contained in the pouch is used and placed in a biohazard container, (pre-soak), and delivered back to CSPD. The quota sheet is returned through the clean environment and details information regarding the end-user, (who, where, when).

Once the instrumentation is processed through decontamination and is ready for assembly, we scan the barcodes on the quota sheet to pull up assembly information and reconcile what was used. If there are discrepancies between what was processed through decontamination and what barcodes are on the quota sheet, we communicate with the end-user. Ultimately our desire is to fully automate this process; until we get to that point, we have seen a considerable reduction in lost instrumentation from pouches employing this process.

In today’s healthcare environment, finding opportunities that reduce costs and maximize efficiencies are on everyone’s radar. With each success, uncovering the next tactic to reduce waste and improve efficiency gets a little more difficult. Digging into what is really going on with peel pack inventory may be challenging on many levels, but with the volume of peel packs at many hospitals, better tracking of these assets may be the key to figuring out your next cost-saving initiative.

Author: By Jennifer Zola, RN, BSN


Mhlaba, Julie; Stockert, Emily; Coronel, Martin; Langerman, Alexander. “Surgical instrumentation: the true cost of instrument trays and a potential strategy for optimization”.   Sciedu Press, Journal of Hospital Administration, Sept. 2015. Web. Jan. 12, 2016.