Q & A

Thank you for your interest in Case Medical, Inc.^® We are a FDA registered, ISO 13485 certified manufacturer of sterilization cases and procedure trays with the CE Mark for international distribution and 510(k) pre-market clearance for our products.  Below you will find the answers to some of the most frequently asked questions.

Question #1:

What sterilization methods are we approved to use with the SteriTite^® container system?

Answer: We have 510(k) pre-market clearance for steam prevac & gravity; EO and STERRAD^® gas plasma sterilization. See attached Summary Statements of Safety and Effectiveness.

Question #2:

What guarantees are on the container systems, and their parts?

Answer: Case Medical’s product line is guaranteed to be free of functional defects in workmanship and materials when used as directed for its intended purpose. Lid gaskets and filter ring gaskets are under warranty for three years.  MediTray^® products are under warranty for one year. See attached Product Warranty Statement.

Question #3:

What validation studies on the sets do we have?

Answer: Studies included testing with maximum and minimum load, surfaces and lumens, ability to stack containers three high in the autoclave and EO sterilizers.  Validation testing demonstrated effective sterilant penetration as well as barrier properties. SteriTite containers as well as inserts were validated for safety, effectiveness and material compatibility. See attached Summary Statements of Safety and Effectiveness.

Question #4:

What are the event related time related studies we have done?

Answer: Case Medical focused on event related sterility.  SteriTite containers were validated under event related sterility conditions.  This included weekly handling events at a hospital healthcare facility for a 90-day period.  Daily handling events were simulated at an independent laboratory for a total of 30 days.  Real time was used, not an extrapolated model based on a formula.  Independent laboratories conducted the testing.

Question #5:

Can the containers be put in a mixed load with wrap and peel pack? Any restrictions?

Answer: Yes, our containers can be put in a mixed load with wrap and peel pack. An independent laboratory conducted the validation. Items packaged in container systems can be sterilized safely in the same load with other supplies that require a common exposure cycle. Container systems should be placed on shelves below absorbent items.  AAMI ST 33

Question #6:  

            Can we use peel pouches in sealed containers?

Answer: We do not recommend using peel pouches in sealed containers.  New guidelines for Preparation and Packaging from ASHCSP recommended that “Peel pouches should not be used inside wrapped or containerized trays since they cannot be kept on their side for sterilization.” Use our I-Cases and accessory boxes instead.  It is important to keep the pathway into the container clear of obstruction.  Peel pouches can be sucked into the vent in vacuum cycles.

Question #7

Moisture problems-must towels be used?

Answer: No, moisture has not been a problem with our container system. Towels should not be used. Dense, heavy loads may require extended dry time or extended exposure time.

Question #8:

     Are the containers compatible with these solutions and automated washers? (Steris^® chemicals: Klenz, Pre-Klenz, lubricant for cleaning in automated washers as well as some Ruhoff Endozyme for hand washing.) Should they maintain their metal integrity in these processes?

Answer: Our containers are compatible with these solutions and for use in automated washers as long as these products have a neutral pH and the products are properly diluted. Yes, they should maintain their metal integrity in these processes.  Case Medical has recently introduced Case Solutions^®, a line of neutral pH detergents and multi-tiered enzymatic cleaners for pre-soak and washing.  These products under the Case Solutions label are highly recommended for surgical instruments and our container systems.

Question #9:

What can be done to reduce bio-burden and bio-film?

Answer:   Rinsing off bio-burden with water in the OR is an important first step.  In any event utilizing an enzymatic pre-soak foam can facilitate the cleaning process.  Case Medical has introduced an enzymatic pre-soak foam called PentaPrepÒ as part of its Case SolutionsÒ line.   Case Solutions are highly effective cleaners that work in concert to eliminate bio-burden and bio-film.  The enzymatic products consist of five enzymes to breakdown organic contaminants, including blood, fat, tissue, mucus and feces.  

Question #10:

      What type of payment systems do you offer hospitals?

Answer: The types of payment systems that we offer to hospitals are direct sell, net 30; credit card; lease; and fee per use.

Question #11:

      If a container system were approved, what would be the time from ordering to receiving?

Answer: Most stock items are available within 5 working days. For large volumes of a particular item or a back ordered item, lead-time may be up to eight weeks.

Question #12:

      What size containers does Case Medical, Inc. have?

Answer: There are eleven sizes of SteriTite Sterilization Containers. This includes endo or quarter size, half-size, mid or three-quarter size, and full-length containers. The endo container is rectangular in shape and comes in two lengths 12 inches and 18.5 inches and is 3” high.  All other SteriTite containers are 4, 6, and 8 inches in height. Each model comes with a solid bottom or a perforated bottom to cover all major methods of sterilization.

Question #13:

      Are there color-coded covers for different services?

Answer: Color-coding is available through colored metal ID plaques, tamper- evident seals, and silk screening. If color-coded covers are required, they can be specially ordered.   For STERRAD use clear anodized parts only.

Question #14:

      Is 16 lbs. of instruments still the standard for maximum load in sealed containers?

Answer: According to the ANSI/AAMI ST33 revised in 1996, “There is no magic number for instrument set weight.” Regardless of the packaging method used, the weight of the instrument set should be based on whether staff can lift the set safely, on the design and density of the instruments and on the distribution of mass and sterilizer load. Always validate the load in your autoclave.  In addition, larger and denser sets may require additional dry time.  Case Medical has validated its containers with loads up to 22 lbs.

Question #15:

      Is it necessary to disassemble container components, such as filter retention rings from the positioning pin, for washing and decontaminating?

Answer:  It is most important to disassemble all components including the cover from the base, and the filter retention plates from cover, and base in perforated bottom units.  The filter retention plate can be placed in a washing basket and then processed in the washer-decontaminator.  Always remove the disposable filter beforehand.

Question #16:

      Our sealed container appears to be heavier than some of the competitions, yet when we weigh the container and contents it is about the same and in some cases weighs less.  Please explain.

Answer:  First, SteriTite containers are heat-treated and have been designed for strength.  Thus they appear to be stronger and heavier. Second, our container walls are .030” thicker to achieve a better standard of durability.  The filter retainer is made of stainless steel, instead of aluminum and plastic for higher durability and ease of cleaning and handling. These features add some weight to the case.  However, when used with its respective inserts the total weight is equivalent.   Case Medical uses highly perforated aluminum trays that are strong yet light in weight as inserts.

Question #17:

Do we have any latex in our products? 

Answer:  There is no latex in any Case Medical product.  We use FDA food grade silicone for all gaskets, mats, and silicone brackets.

Question #18: 

Does Case Medical have inserts, including instrument baskets to fit in Genesis containers?  Will our brackets fit these inserts as well?

Answer:  Yes, Case Medical has instrument baskets that fit our DIN size containers and other sizes that fit the Genesis container.  Our inserts, including our brackets, posts and

I-Cases fit all Case products. 

Question #19: 

We offer aluminum trays and baskets.  Doesn’t one need to use stainless steel instrument baskets with stainless steel surgical instruments?  Don’t different metals react with one another?

Answer:    If a tray system is properly anodized, there is no reaction with other materials.  Case Medical has had material compatibility testing of its component parts which include anodized aluminum, passivated stainless steel and FDA food grade silicone materials.  Furthermore, aluminum is a better material for sterilization. Aluminum instrument baskets have better thermo-conductivity than those of stainless steel or plastic. 

Question #20:

            If there is moisture in the container is it sterile?

Answer:  If there is moisture in a container that has been stored then it is not considered sterile.  For rapid sterilization, such as flash or express, there is always moisture, because of the rapid cycle and abbreviated dry time.  Use immediately.  The contents are considered sterile at point of use.  Case Medical has tested the contents of its sealed container, which was rapidly sterilized after 24 hours.   An independent laboratory validated the contents for sterility.  We do not endorse any wet loads as sterile after the 24 hour period.

Question #21:

How can we avoid wet packs?

Answer:  Don’t overload contents.  Use metal trays, especially aluminum, because of high thermo-conductivity.  Plastic trays do not come up to temperature easily and have a tendency to be wet.  Check your autoclave for proper function, specifically the steam trap and drain.  Last but not least, move up exposure to an 8-minute exposure time with a 20-minute dry time.  Crack autoclave door and leave in place for 15 minutes to cool.

      Questions #22 through #34

Background:  Recently Nancy Chobin and Sue Ellen Erickson raised a number of queries about ortho/neuro instrument trays in an article entitled “Rigid Containers Could Pose Risks” published in HPN, Jan. 2002.  The FDA is classifying all sterilization trays as Class II devices.  Our customers have raised a number of questions based on these events.  The following are their concerns and our answers to these queries:

Question #22:

Lack of information regarding manufacturer's validation of sterilization parameters for loaner instrument sets (organizing cases).

Answer:  It is the responsibility of the ortho/neuro companies to provide this data.  Olympus^® and Stryker^® orthopedic and Stryker endo have performed such studies on various Case products.    In addition, Case Medical has independently validated its tray systems in independent labs since 1995.  Case Medical has been manufacturing organizing cases and trays for the orthopedic industry for 17 years.  When Allan and I purchased the company in 1992, we immediately hired a QC/QA manager, established GMP, formalized the engineering review process, standardized our line and became FDA registered.  This was not the norm for sheet metal houses manufacturing custom procedure trays.  It was understood that the ortho/neuro companies would perform the validation on these sets.  Nonetheless, as we continued in our development of our tray systems, including the MediTray system and our SteriTite sealed container, we validated our line of products with up to 22 lbs. of instruments, including blades and lumens. 

Question #23:

Problems with drying organizing set cases, especially when plastic is used.

Answer:  As a company, Case Medical decided not to develop plastic custom trays despite the fact that the OEM customers were pursuing the market.  We developed a small line of standardized plastic trays, if required by our customers.  We used the best autoclavable material, Radel^®.   To combat the problem of moisture, we made our limited line of plastic trays highly perforated and included a metal insert tray to facilitate drying.  In general, we do not recommend plastic trays for sterilization as plastic has a very low thermo-conductivity coefficient of 2.4 as compared to aluminum with a much higher thermo-conductivity coefficient of 90.   Metal especially, aluminum, is much more effective for sterilization and results in dryer loads.

Question #24:

       Problems with breakage of plastic trays with the potential for employee injury, case contamination and damage to the pack-aging materials.

Answer:  Case Medical does not endorse the use of plastic trays for the above reasons.

Question #25:

If I am currently using a rigid container system that has been on the market for a while, how do I know that this system has been tested for all the devices we place inside them? For example, power equipment, endoscopic equipment, arthroscopy shavers, etc.

Answer:  You need to ask the manufacturer for a copy of the validation study in particular the summary statement of safety and effectiveness and the FDA 510k.  

Question #26:

How do we know if the sterilant is able to get inside lumens if devices with lumens are included on the set?

Answer:  Again, it is imperative to ask the container manufacturer or the company providing the set for the validation study.  Case Medical has provided this information to its customers.  Further we have validated kill of spores on surfaces, inside of inoculated lumens of 2-3mm in diameter and 40mm in length and most recently under occlusion in steam, EO and gas plasma (STERRAD Sterilization).

Question #27:

If the manufacturer of organizing case has not validated the case for effective sterilization parameters, does the risk now fall entirely with the healthcare facility sterilizing these cases?

Answer:  We believe that the responsibility falls jointly on the manufacturer or provider of the instrument case as well as the healthcare facility.

Question #28:

Why weren't healthcare facilities warned about the possible limitations of these containers?

Answer:  It is important for all of us healthcare providers, manufacturers and vendors to work together to develop standards and channels of information to communicate these concerns.  Many sterilization case manufacturers were grand fathered and not subject to the rigorous standards Case Medical had to prove to obtain 510k.  Other vendors have provided custom trays without validation and received bids based on low cost or marketing preference.

Question #29:

      Does your rigid container system have a 510(k) from the FDA as a Class II device?

Answer:  Yes, Case Medical has 510k for its SterTiteÒ rigid container system and MediTray products for steam, pre-vacuum and gravity displacement, as well as gas plasma sterilization.  In fact, we have the only sealed container system in the world approved for all current methods of sterilization including flash with FDA 510k.       

Question #30:

Did your company perform sterilization validation studies as required by the FDA? Would you provide a report detailing these studies?

Answer:  Yes, Case Medical has performed the studies as required by FDA for Class 2 medical devices.  Our SteriTite sealed container and MediTray inserts were utilized in these studies, as was our SteriTite container with FlashTite valve plate(s).  Recently, FDA cleared our MediTray products containerized and wrapped for all methods of sterilization.

Question #31:

Did your validation studies include specialty items such as power equipment, endoscopic equipment, orthopedic shavers, etc?

Answer:  Our products have been validated using endoscopic equipment and power equipment.

Question #32:

Did you perform validation studies for devices with lumens?

Answer:  Yes, Our Summary Statement of Safety and Effectiveness with 510k data is available upon request.  Case Medical performed validation studies for devices with lumens in steam, gas plasma and EO.  Metal and porous lumens were cleared for steam and gas.  (Metal lumens in STERRAD Sterilization as recommended by the manufacturer)

Question #33:

Did your company perform sterilization validation studies for your organizing case?

Answer:  Yes, Case Medical performed validation studies in its organizing inserts and instrument baskets.   In a recent study, ASP tested our sealed container versus our wrapped tray and found them to be substantially equivalent in incremental testing.

Question #34:

Did your company validate the decontamination processes for your organizing case with full contents?

Answer:  Yes, Case Medical validated the decontamination processes for our organizing cases.  We found that neutral pH detergents, including our NpHD^™ and our multi-tiered enzymatic products, PentaPrep^™ and PentaZyme^™, are effective and safe for surgical instruments and our sealed container system.  A thorough rinsing and drying of the container system is required.  We have not validated the decontamination process with full contents.  It is our understanding and recommendation that all parts be disassembled for decontamination.    

 Question #35:

How is the SteriTite container with disposable filter normally used for terminal sterilization capable of flash?

Answer: We designed an optional attachment to the existing SteriTiteÒ container, which we cleared with FDA.  FlashTiteÒ is a filter-less valve plate, which attaches to the locating pin in cover and base in place of the filter retention plates and disposable filters.   The valve accelerates the exposure time in steam sterilization to AORN standards for flash.

     Question #36:

How is it that the SteriTite container with FlashTite valve plate is sealed and does not require manual venting of steam?

Answer:  The SteriTite container with FlashTite valve goes into the autoclave sealed and comes out sealed.  Unlike other filter-less pressure sensitive systems, FlashTite utilizes a thermostatic valve, which opens and closes within the autoclave.  It opens at 180° F during the pre-conditioning cycle and remains open through out the sterilization process.  It mechanically vents the steam before removal from the autoclave.  To facilitate a dry outcome, we recommend a two-minute dry time during which the steam is expressed from the container and the valve closes.

Question #37:

      Can I use the solid bottom SteriTite container with FlashTite valve(s) in our pre-vacuum autoclave?

Answer:  Most pre-vacuum autoclaves have “gravity” flash cycles.  The perforated bottom model is universal.  If there is a chance that your flash setting is gravity, we recommend that you use the perforated bottom model.  Only use the solid bottom model if your sterilizer manufacturer has confirmed that the pre-vacuum cycle has been programmed and you observe three or more pulses in the print out.

Question #38:

      Why is Case Medical adding on products for instrument processing?

Answer:  At Case Medical, we believe in integrated solutions to the problems facing the sterile processing department and the OR.   The care and handling of surgical instruments, containers and medical devices must be coordinated to ensure effective results and positive patient outcome.  The products we offer are in response to our customers’ requests and input.

65 Railroad Avenue - Ridgefield, NJ 07657
888-227-CASE - Fax:201-313-9090
www.casemed.com