8.4 Case Cart Systems, Requisition & Distribution Methods

Case Cart Systems, Surgical Requisition & Distribution

The Case Cart System represents the primary operational link between the Sterile Processing Department (SPD) and the Operating Room (OR). It is a centralized logistics model designed to assemble, stage, and deliver all necessary instrumentation, sterile sets, single-use disposables, and specialized equipment for specific surgical procedures. By consolidating supply assembly within SPD, case cart systems enhance OR turnaround efficiency, standardize instrument setups, reduce clinical supply hoarding, and ensure strict infection control compliance during transportation.

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Open vs. Closed Case Carts

The choice of case cart design is dictated by facility architecture, transport routes, and environmental containment requirements.

Closed Case Carts

• Construction: Enclosed stainless steel cabinets fitted with continuous rubber door gaskets, heavy-duty latches, and internal height-adjustable shelves.
• Transport Requirement: Closed case carts are mandatory whenever sterile surgical supplies are transported through non-restricted or semi-restricted hospital corridors (e.g., public hallways, general elevators). The gasketed doors shield sterile packages from ambient dust, humidity shifts, physical impact, and air currents.
• Decontamination Containment: Post-procedure, closed case carts act as biohazard containment vessels. Used, contaminated surgical instruments can be placed back inside the closed cart and safely transported back to the Decontamination area without exposing patients or staff to bloodborne pathogens or biohazardous aerosols.

Open Case Carts

• Construction: Open wire-frame or stainless steel shelving carts without solid side walls or doors.
• Transport Mandate: If open case carts are transported outside of restricted surgical suites, they MUST be covered with clean, protective plastic or fitted fabric covers. The cover must remain securely tied or zipped until the cart arrives inside the restricted OR environment.
• Advantages & Limits: Open carts are lighter, less expensive, and allow easy visual identification of contents, but offer significantly less physical and biohazard protection.

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Operating Room Preference Cards & Pick Lists

The assembly of a surgical case cart is governed by the Surgeon Preference Card (also referred to as a Pick List).

Preference Card Content

A preference card is a master profile maintained in the facility's surgical management software (e.g., Epic, Cerner) tailored to a specific surgeon and surgical procedure (e.g., Dr. Smith – Total Knee Arthroplasty). It details:

1. Primary Instrument Trays: Major bone set, total knee instrument set, specialized power tools.
2. Sterile Single-Use Disposables: Specific drape packs, suction tubing, skin prep solutions, blade sizes.
3. Sutures and Implants: Specific suture codes, needle types, mesh, or trial implant sizes.
4. Equipment and Positioners: Tourniquet cuffs, side braces, camera light cables, patient positioning gel pads.
5. Surgeon Preferences: Preferred glove size, gown size, headlamp preference, and specific room setup instructions.

The Picking & Verification Process

• Execution: SPD case cart technicians retrieve the printed or digital preference card, navigate sterile storage using a logical picking route, pull required items, and place them carefully into the designated case cart.
• Quality Verification: A second technician or lead executes a audit against the preference card to verify that all lot numbers, sterilizer load stickers, and item counts match exactly before locking or tagging the cart.
• Maintenance: Preference cards must be updated continuously by OR nurse liaisons to reflect changes in surgeon technique or standardized products, preventing supply clutter and costly OR delays.

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Supply Distribution Methods Across Healthcare Facilities

Healthcare organizations employ multiple supply distribution modalities to deliver sterile goods to clinical care areas.

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Automated Dispensing Cabinets (ADCs)

In modern healthcare facilities, point-of-use inventory in specialty units is managed via Automated Dispensing Cabinets (such as Pyxis, Omnicell, or SupplyStation).

• Mechanism: Computerized storage cabinets equipped with electronically locked drawers or doors. Access requires user login via password, ID badge scan, or biometric fingerprint.
• Patient Charge Capture: When a clinician removes an item, they select the specific patient's medical record number. The system logs the item consumption, bills the patient account, and deducts the item from inventory.
• Automated Reordering: When internal bin levels reach a pre-programmed threshold, the system automatically transmits a pick request to SPD or an order to the vendor.

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Case Cart Processing & Decontamination Cycle

The lifecycle of a case cart forms a closed loop between clean assembly and decontamination areas.

1. Post-Surgical Return Transport

Immediately following surgery, contaminated instruments, reusable basins, and motor handpieces are loaded back into the case cart inside the OR. Soiled items must be sprayed with an enzymatic pretreatment foam to prevent bio-soil drying. The cart is closed, tagged with a red biohazard label, and transported to Decontamination via dedicated dirty elevators or enclosed corridors.

2. Automated Cart Washer Sanitization

Empty case carts must be thoroughly cleaned and disinfected before returning to clean assembly areas:

• Automated Cart Washers: Large drive-through processing chambers designed specifically for carts and rigid containers.
• Cleaning Cycle: Executes a high-pressure washing cycle using heavy-duty alkaline detergent, followed by a hot water thermal disinfection rinse (water temperature ≥ 180°F to 195°F / 82°C to 90°C).
• Drying Phase: High-velocity forced hot air dries the cart completely to prevent rust and moisture transfer.
• Manual Alternative: Carts incompatible with automated washers must be manually scrubbed using EPA-registered hospital disinfectant detergent, rinsed, and dried thoroughly before crossing the threshold into clean storage.