Does Your Sterile Storage Stack Up for Safety?

By Tony Thurmond, CRCST, CIS, CHL, FHSPA

This article originally appeared in the May-June 2026 issue of Healthcare Hygiene magazine.

Proper storage of sterilized instruments is essential for patient safety, but it does not always get the attention it deserves. For starters, Sterile Processing departments (SPDs) may lack adequate sterile storage space, a problem exacerbated by the addition of new services and physicians who require specialized instruments.

To determine whether a facility’s sterile storage is adequate, it is essential to ask some key questions. Do you and your colleagues routinely struggle to locate instrument trays? Are they stored in a logical location or placed wherever there is an opening on a shelf (for example, do you often find bone-holding forceps in the eye instrument section)? Do you find unidentified instrument trays on shelves? Have you come across a tray that has not been used or sterilized in years? If so, it is necessary to address those problems so items are stored in the correct location and in an organized state that keeps them safe, uncompromised and ready for the next procedure.

Remember the Basics
Safe, sterile storage goes beyond just square footage and organization. Sterile Processing (SP) professionals must always remember and apply the basics of sterile storage and refer to standards, such as ANSI/AAMI ST79:2017(R)2022, Comprehensive guide to steam sterilization and sterility assurance in health care facilities, for guidance.

Sterile instruments and supplies must be stored in environmentally controlled conditions that minimize the risk of contamination. The areas must be kept clean and dry, with temperature and humidity monitored daily (at a minimum). The temperature may be as high as 75°F (24°C), and the relative humidity should be 70% or less. Additionally, there must be at least four air exchanges per hour in a positive airflow environment.

Shelving should meet specific requirements. Sterile items must be stored at least 8 to 10 inches from the floor, at least 18 inches below the ceiling or 18 inches from the bottom of the sprinkler head, and at least two inches from outside walls. Bottom shelves of storage units must be solid to protect them during environmental cleaning, and the shelving material should be metal or plastic to allow for thorough cleaning (wood or other porous materials must never be used). Shelving should be ergonomically designed for employee access, with adequate spacing between shelves and sufficient depth to prevent products from overhanging. Heavier trays should be placed on the middle shelves to make lifting safer. Shelves should also be clearly labeled, so items are easy to place, rotate and locate. To help ensure sterile items remain uncompromised, traffic to sterile storage areas should be limited to staff who work in the area or those granted permission to access it. Doors and windows should remain closed.

When organizing the sterile storage area, it is best to store specialty items (and those for surgical-based specialties) together. For example, Orthopedics can be extremely broad, so storing all power equipment together and arthroscopic items together makes it easier for technicians when pulling cases. Implant trays should be stored within the same vicinity and separated by vendor. Laparoscopic instruments should also be stored together, keeping cameras, endoscopes, and other laparoscopic equipment in close proximity when possible for easier case pulling. Doing so also allows the surgical team to find items more readily if they need to visit the SPD to pick up instruments or supplies. Note: Technician input should be solicited to ensure the sterile storage organization meets the team’s needs.
The sterile storage area should be cleaned routinely (each organization must establish and adhere to its cleaning policy). At my facility, each cleaning assignment is to be done every three to four weeks or as needed. This cleaning assignment is designed to address cleaning, stock rotation, and quality assurance checks. Staff members are required to check each tray, wrapped item or peel pack for package integrity. If holes are detected or a wrapper is compromised, it is removed from storage, opened, and taken to the decontamination area to restart the process. The same process happens if an item is missing the lot sticker or label. Once the item is released from the sterilization process, it should not be relabeled.

The cleaning assignment should include removing all items from the shelf and inspecting the packages for integrity and cleanliness. The outer indicator, whether a card in the container or the sterilization tape, must be identifiable. If there is any doubt, the package should be removed from service and taken to decontamination. The shelves should be wiped with an appropriate hospital-approved solution and allowed to dry properly before the items are returned. They should be placed in first-in, first-out (FIFO) order. The FIFO method—often overlooked and misunderstood—is a stock rotation system in which the oldest product is pulled first. The best FIFO method involves pulling from the right, meaning the newest item is stocked on the left, and older items are moved to the right. This method ensures that the oldest item is used first. Another practice that must be clearly understood is event-related sterility, which means items remain sterile until an event makes them unsterile.

Many factors can create an event, and the following must always be considered:

Product manufacturer recommendations – Most manufacturers of sterilization products state in their IFU that the integrity of the packaging was evaluated for a specific period and was not assessed beyond that period. For example, some wrappers and peel pouches are recommended only for a specific period.

The condition of the package – Remember, we often send trays or peel-pouch items to the OR that do not get used and then return to the sterile storage area.

Some questions to consider: How many people touched this product, and was it left in a safe place outside the sterile storage area? All items must be carefully inspected upon their return. If a package appears compromised or its integrity is in question, the item should be reprocessed.

The importance of proper care and handling of sterile instruments cannot be overstated. Proper attire is vital. Carrying items without a cover jacket is not acceptable. The same is true of holding sterile trays against the body or scrubs. How many times have you seen a teammate or OR staff member take a sterile tray and place it under their arms to carry it to another location? Trays should always be transported and stored upright, held with both hands away from the body to keep the items in place and prevent them from shifting. Transporting items by cart is easier and safer.

Proper management of sterile storage must be prioritized to ensure the patient receives the highest-quality, safest product for their procedure. It is every SP professional’s responsibility to ensure that sterilized items are properly stored to maintain sterility and that items are well organized, properly rotated, and easily retrievable.

Tony Thurmond, CRCST, CIS, CHL, FHSPA, is sterile processing manager at Dayton Children’s Hospital.