Boxes and Shipping Containers

What is The Joint Commission's position on managing cardboard or corrugated boxes and shipping containers ?

Any examples included in this response are for illustrative purposes only.

Fire Safety:  Cardboard in storage quantities (recommend consultation with your Fire Marshal) should be placed in hazardous areas protected per LS.02.01.30 and cannot obstruct the means of egress in accordance with standard LS.02.01.20. Containers that are contaminated should be removed based upon the cleanliness requirements of the storage area. Many suppliers have paper or cardboard distribution boxes that are designed for use in laboratory, pharmacy, patient care areas or sterile storage areas. 

Infection Prevention and Control: The organization should conduct a risk assessment in accordance with standard IC.01.03.01 to determine the appropriateness of having the container type used in a particular area. This could include where to load or unload supplies, criteria for content break-down areas, and what level of packaging to keep within the area in question. The risk assessment could also address the use of boxes that came out of the shipping container where box labeling is essential to proper use (for example, expiration dates, contents, ingredients, directions for use, etc.). 

When conducting the risk assessment, the organization should involve infection control personnel as well as the primary occupant of the area being evaluated. A course of action should be determined, a policy generated, staff trained and the process implemented. The organization is expected to assess whether the desired affect was achieved, and adjust accordingly.  Use of evidence-based guidelines may support and guide generated policy and procedures specific to this topic.

Here is an example for consideration from AAMI ST:79
5.2.1 General Considerations
• Clean or sterile items to be transported to central processing and storage areas within the facility should be removed from their external shipping containers before they enter the storage areas of the department. Any instructions for use accompanying the items should be kept with the items.

Rationale: External shipping containers have been exposed to unknown and potentially high microbial contamination. Also, shipping cartons, especially those made of a corrugated material, serve as generators of and reservoirs for dust.
Also, The Joint Commission standard LD.04.01.01 expects the organization to comply with other controlling authority(s) (for example, local or state health departments). Governmental entities (like the CDC or FDA), trade organizations, and other evidence-based guidelines are good assessment criteria resources for areas such a laboratory, pharmacy, sterile processing, food service, etc. The survey process will check to make sure there is a policy in place, and whether the policy is effective through policy review and tracer activities.
Last updated on December 30, 2019
Manual: Ambulatory
Chapter: Infection Prevention and Control IC

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