A prospective analysis of clinical detection of defective wrapping by operating room staff

•Sterile wrappers around surgical instrument trays are inspected visually for defects before use.•Defective wrappers are correctly identified with only 56.1% accuracy, 67.2% for defects 2-5 cm.•This study demonstrates a previously unassessed potential for operative site infection.•This study suggests a need for a new method to determine sterility of operative instruments. Surgical instrument trays are wrapped for sterilization, and these wraps are inspected by operating room personnel for defects before using the instruments. In this study, we intentionally damaged wraps, and these wraps were evaluated by operating room personnel. Examiners correctly identified a wrapper's sterile integrity with an overall 56.1% accuracy, with correct identification of 67.2% for defects between 2 and 5 cm. However, studies have shown bacterial contamination through defects as small as 1.1 mm. This study suggests that the current method for assessing sterility is inadequate.