A Guide to Choosing the Right Case Carts

It's often when you're considering the purchase of new case carts that you realize just how important they are. Case carts are essential to ensure the seamless flow of surgical instruments and medical supplies from the operating room to the Medical Device Reprocessing Department (MDRD). To help you make a decision about your next cart fleet, we've prepared the following.

Why Use a Case Cart?

Case carts are not complex pieces of medical technology;  however, they are essential to ensuring that necessary instruments are transported to the right place quickly and without aseptic breakdown. 

Not only do they prevent staff from having to improperly transport multiple sterile containers at once, but they also help prevent infections and optimize quality of care.

Designed to keep instruments and supplies clean and organized for surgical procedures, surgical case carts are a necessary investment for any hospital, clinic or private practice. 

How Do Surgical Case Carts Reduce the Risk of Infection?

Carts are extremely helpful in keeping surgical instruments and equipment sterile until they are needed for a procedure.

This is achieved by minimizing the handling of surgical instruments and supplies needed for the procedure that leave the reprocessing department and are taken directly to the operating room. 

The case cart system reduces the risk of procedure material being touched, handled or moved too often. This minimizes the dangers of contamination or damage to sterilized instruments or packaged supplies.

Which Is Better, Open Case Carts or Closed Case Carts?

While open carts are lighter, easier to push, and allow for quick viewing and access to contents, closed models with doors add a higher level of security.

With closed carts, surgical supplies and instruments prepared for a medical procedure can be secured and tracked. Even more important, however, is to maintain the sanitization of these medical devices during the entire journey from the MDRD to the operating room.

After procedures, carts with doors add an extra layer of protection against cross-infection. Keeping surgical instruments that have been used inside a case cart prevents the spread of contamination that could occur during transport to the reprocessing department. 

Whether you prefer to go with an open or closed model, make sure your cart doesn't have sharp edges that could potentially tear sterile wrap packages.

Who Can Help Determine Which Medical Case Cart Is Right?

Unless you're the only person in charge of purchasing for a new facility to be built, it's best to seek input from everyone whose day-to-day work involves case carts. 

Assemble a team that includes not only the management staff, but also the operating room nurses and reprocessing technicians. 

Make sure front-line staff are involved, as they are the ones who will ultimately use the carts. Without their input and approval, the introduction of new carts will not go smoothly.

Also, consult specialty medical equipment manufacturers who offer several models of carts. The experience they have gained over the years in meeting the varied needs of different customers can provide valuable insight into which solutions are best for the short and long term.

How to Select the Right Case Cart?

Maximizing the productivity of a workday requires careful organization and a smooth transition from one task to the next. Choosing the right case cart can be a key factor in how efficiently staff can complete their tasks. Here are some things to consider before choosing your next case carts.

Examine Your Workflow

To start, you need to familiarize yourself with your operating room processes. How many operations are typically performed simultaneously? How many procedures do you handle in a single day? Normally, you should have more than one cart per OR, or even three:

• one for the procedure being performed,

• a second for sterilization in the reprocessing area,

• and a third to prepare the material for the next procedure.

Anticipate the Type of Cases

How many major and minor procedures are typically scheduled each day? Knowing this information can help you choose the type of cart that will best optimize your workflow.

Evaluate the surgical instruments that need to be transported

Since small operations require fewer supplies and instruments, you can prepare a cart with the necessary items for multiple cases and keep it outside the operating room in order to be ready for upcoming procedures.

On the other hand, some surgeries may require long surgical instruments. Fortunately, carts are available up to 29 inches (737 mm) deep, which are perfect for large instruments sets. 

If you are purchasing carts for multiple types of cases, the best solution is to combine carts of different sizes. This way, you can select carts that are perfectly suited for the small and large surgical instruments you need to transport.

Measure your space

To ensure that your cart will go wherever it is needed, it is extremely important to measure all doorways, hallways, elevators and general floor space in your facility.

Also consider the parking space needed to park carts: how much space does your facility have to operate, disinfect and store carts between uses? 

It's best to make sure you have at least one large space to park all the carts, where they won't get in the way of traffic or be bumped into.

Determine the Size of Carts Needed

Cart size also plays a role in many ways.

When it comes to choosing the type of cart to use in a medical environment, the size and weight of the cart are two important factors to consider. 

Taller carts save floor space, as they are typically less wide and deep than shorter ones.

On the other hand, lower, wider carts offer an added benefit when their tops are used as a work surface for case preparation.

From an ergonomic standpoint, carts should always be a reasonable height for the medical staff who navigate with them. For example, a short person might not be able to see over a cart that is too tall.

However, taller carts have an undeniable advantage: when a heavy load needs to be retrieved, it is easier to do so from a higher shelf than from a lower shelf that requires squatting to lift it.

Identify the Most Useful Cart Features for Your Needs

Structure

Ideally, if you are using case carts, you will want to clean them in a cart washer, which is much more time efficient than disinfecting them manually. 

Therefore, you should look for carts that have a stainless steel structure and a reinforced floor with a drainage plan that will do well in automated washers.

Shelves

To make your staff's work as easy as possible, test all types of shelves: wire shelves, solid shelves, and perforated shelves.

• Which is easier to handle and clean?

• Are the shelves easy to remove and adjust in height?

• Are they deep enough to accommodate large instruments?

If you choose carts with sliding shelves, make sure they have a locking mechanism to prevent them from accidentally sliding out.

Casters

Ideally, an efficient cart should be easy to maneuver. The casters should roll effortlessly when the cart is pushed down a hallway, in an elevator or around a corner.  

Maximum load, diameter and material are important factors to consider when selecting casters. 

It is also important to know that the load of a cart is very often distributed over three wheels and not four, since floors are rarely perfectly level.

Ideally, casters with a high load capacity, such as 250 kg, should be chosen. This will make it easier to transport full carts.

Given the size and weight of case carts, the minimum casters size should be 125 mm to facilitate movement.

Another consideration is the rolling surface. For example, if the floor covering is ceramic, noise and vibration should be minimized by choosing a resilient soft rubber wheel.

Wheels made of firm materials such as polyamide or polypropylene will offer less resistance to starting and rolling, but will generate more vibration than elastic rubber or thermoplastic rubber wheels. 

Polyurethane wheels are a good compromise. Suitable for hygienically sensitive areas, polyurethane wheels absorb more noise and provide a high level of ride comfort when transporting heavy loads. 

For best performance, casters should be made of stainless steel and have a sealed ball bearing. For swivel casters, the swivel plate must be ball bearing and minimally equipped with a dust cover.

Fixed, swivel or directional lock?

Case carts are usually equipped with two swivel casters in combination with two fixed casters on the side opposite the push handles. The fixed casters provide optimal straight-line guidance when the cart is moved over longer distances. 

On the other hand, the use of four swivel casters allows for 360 degree swivelling and adapts to quick changes in direction or facilitates parallel parking. To facilitate long trips, one of the four swivel casters can be equipped with a directional lock on the push handles side of the cart. Once the directional lock is activated, the swivel caster assumes the same function as a fixed caster, providing better guidance of the cart.

When case carts are intended to be part of a convoy, the use of two fixed casters paired with two swivel casters is recommended.

For safe braking, ideally two casters should be equipped with total brakes (rolling and rotating) on the push handle side. This will also prevent cart movement when loading or unloading contents. However, when a cart has four swivel casters, one of which is directionally locked, the adjacent caster should be equipped with a total brake.

Whatever your final choice, the wheels and casters of your case carts will be subject to several constraints: meeting sanitary requirements, withstanding the high temperature of automated washers, resisting corrosion and supporting high loads. To find the best solutions, consult the experts.

Doors

If you opt for a closed case cart, it will have at least one door and maybe even two if it is a large model. If your cart has only one door, you must choose the door opening direction that best suits your workspace.

Cart doors should be designed to minimize the risk of contamination. Check if they are sealed with gaskets that help keep all materials inside sterile.

Also, for ease of loading, unloading and washing carts, check to see if the doors should open all the way (270 degrees) and stay in place. 

Also consider testing the quality of the door latch, as it is a critical component to prevent accidental opening of the doors during transport. 

Handles

The push handle is an important part of maneuvering a cart easily. ASSTSAS recommends a push handle height between 36 and 44 inches (from the ground).

In order to maintain a continuous workflow, it may be necessary to quickly remove carts from the cart washer, in which case, cool touch handles will be essential.

In conclusion, investing time and money in a new fleet of case carts can be an opportunity to reconsider their use, especially in terms of the features that will be most useful to you. Because carts are typically purchased for the long term, work with your OR staff and sterile processing department staff to make decisions about case carts. Input from both parties is essential to ensure a smooth flow of instruments and supplies.

If you are considering the purchase of a case cart in the near future, you can benefit from personalized and experienced technical assistance by contacting us.