Distribution Systems

Distribution is the final step in the sterile processing workflow — getting the right supplies to the right place at the right time while maintaining sterility.

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Types of Distribution Systems

1. Case Cart System

The most common system for surgical supply distribution:

• A cart is assembled for each specific surgical case based on the surgeon's preference card and procedure requirements
• Contains: sterile instrument trays, disposable supplies, sutures, drapes, gowns, gloves, and specialty items
• Prepared before the surgery date (often the evening before)
• Delivered to the OR suite and checked by the surgical team

Advantages:

• Customized for each procedure — reduces waste and forgotten items
• Efficient for OR workflow — everything needed is in one place
• Allows advance preparation and planning

Case Cart Quality Metrics:

2. Exchange Cart System

• Pre-stocked carts are maintained at a predetermined supply level
• A full cart replaces an empty/depleted cart on the nursing unit
• CS restocks the returned cart to the standard level
• Efficient for high-volume, standardized supply areas

3. PAR (Periodic Automatic Replenishment) Level System

• Each supply item has a set maximum quantity (PAR level) for each storage location
• Inventory is checked periodically and restocked to the PAR level
• The PAR level is determined by usage patterns and historical data
• Adjustments may be needed seasonally or when procedure volumes change

4. Requisition System

• Departments request specific items as needed by submitting a requisition
• Items are dispensed from central storage and delivered
• Less proactive than PAR or exchange cart systems
• Best for infrequently used or specialty items

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FIFO Rotation (First-In, First-Out)

FIFO ensures that the oldest sterilized items are used first:

• When restocking shelves, place newer items behind older items
• Check sterilization dates during restocking
• Ensures proper stock rotation and reduces waste from expired items
• Critical for facilities using time-related sterility expiration dates
• Even with event-related sterility, FIFO reduces the risk of packaging degradation over time

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Transport of Sterile Items

Requirements:

• Use covered or enclosed carts during transport
• Avoid transporting sterile items through soiled corridors or decontamination areas
• Protect packages from moisture, crushing, and puncture during transport
• Inspect packages at the point of receipt — reject any with compromised barriers
• Document transport (what was sent, where, when, who)

Elevator and Hallway Protocol:

• Sterile items get priority in clean elevators
• Never transport sterile and soiled items simultaneously in the same elevator or cart
• Cover sterile items if transported through public corridors
• Minimize transport time and handling

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Supply Chain Considerations

Consignment Inventory:

• Supplier-owned items stored at the facility
• Not charged until used on a patient
• Common for implants (orthopedic screws, plates, mesh)
• Facility must track and maintain proper storage conditions

Vendor-Managed (Stockless) Systems:

• Vendor manages the entire inventory, storage, and distribution
• Reduces facility storage space requirements
• Facility relies on vendor for timely delivery

Just-In-Time (JIT) Delivery:

• Supplies arrive shortly before they are needed
• Reduces on-hand inventory and storage costs
• Requires reliable supply chain — vulnerable to disruptions