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© 2012 Beacon Converters, Inc.
Medical Device Packaging Tips, Learnings and Cautionary Tales OMTEC 2015 Chicago Alison Tyler Technical Director
Beacon Converters, Inc. June 2015
© 2012 Beacon Converters, Inc.
• Why is Medical Packaging so Important?
• Packaging Guidance and Compliance Standards
• Major decision points for selecting materials and packaging design
• Review of Recent FDA Recalls
Presentation Topics
© 2012 Beacon Converters, Inc.
• 490,000 Americans have died in 5 year period due to medical errors. These were all categorized as preventable deaths
1. 1. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer Health
2. System (Washington: National Academy Press 1999)
A Glimpse Inside Healthcare Environment (Where Medical Device Packaging is Used)
© 2012 Beacon Converters, Inc.
Survey of: 831 practicing physicians 1207 members of the public
© 2012 Beacon Converters, Inc.
291 Reported Medical Errors in their own care of family member care
35%
507 Reported Medical Errors in their own care of family member care
42%
Physicians
Public
© 2012 Beacon Converters, Inc.
Neither physicians nor the public named medical errors as one of the largest problems in health care today.
Malpractice Insurance
29%
Cost of Healthcare
27%
Insurance Companies and Health Plans
22%
Cost of Healthcare
38%
Cost of Prescription Drugs 31%
© 2012 Beacon Converters, Inc.
So how big a deal are they really?
Medical Errors were reported as a minimal problem...
Medical Errors 5%
Medical Errors 6%
© 2012 Beacon Converters, Inc.
Medical Reality • From 1994-1999 a study was done regarding how many
people DIED from preventable medical errors
• 490,000 Americans have died in this 5 year period due to medical errors. These were all categorized as preventable deaths
• 1. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer Health
• System (Washington: National Academy Press 1999)
© 2012 Beacon Converters, Inc.
So we were in Bad Shape in 1999…how are we today?
• Well, lets just say things aren’t pretty
Current data estimates that annually as many as ….
440,000 Americans die every single year from
preventable medical errors.
This now ranks medical errors as the 3rd
leading cause of death in the United States.
Highland Park Hospital
Highland Park Hospital
© 2012 Beacon Converters, Inc.
Greater Boston Area
© 2012 Beacon Converters, Inc.
West Virginia
© 2012 Beacon Converters, Inc.
So What Does this Have to Do with Packaging?
• This is the same environment that packages will be opened in, one that is riddled with errors
• You aren’t only going to sell your device in Boston.
• Your design must be easy to follow, must NOT contribute to any additional errors.
• You cannot depend on people working in this environment to police for package failures
• Lets get on to making great packages!
© 2012 Beacon Converters, Inc.
Packaging Guidance and Compliance Standards
1. AAMI/ISO- 11607 Packaging for terminally sterilized medical devices
• Part 1- materials, sterile barrier systems and packaging systems
• Part 2- Validation requirements for forming, sealing and assembly processes
2. AAMI TIR 22- Guidance for ANSI/AMMI/ISO-11607 Parts 1 & 2
Guidance Standards – Use Them!
(Don’t try to reinvent the wheel)
© 2012 Beacon Converters, Inc.
1. Protect the device from physical damage
2. Protect the device from undesirable environmental conditions
3. Allow device to be terminally sterilized
4. Allow that sterility to be maintained until the product is dispensed
5. Allow aseptic presentation
AAMI/ISO Standards 11607- Part 1
© 2012 Beacon Converters, Inc.
Design Inputs
• Product Attributes
• Protection Requirements
• Storage, Distribution and Handling Requirements
• Manufacturing Requirements
• Sterilization Requirements
• Customer Requirements
AAMI / ISO Standards TIR-22 (ISO 16775)
© 2012 Beacon Converters, Inc.
Annex Information • Regulatory references
• Test Method Validation
• Sterilization Considerations
• Design Inputs-Attributes & Requirements
• Investigating Failure
• Selection, Evaluation and Testing
• Generating a Validation Protocol
• Risk Analysis Tools
AAMI Standards TIR-22 (ISO 16775)
© 2012 Beacon Converters, Inc.
• Protect your device from physical damage
5 Major Points; Packaging Performance What does your package need to do?
1
• Puncture
• Abrasion
• Improper cushioning
• Crushing
• Insufficient shielding
Glue flap
Inside out / outside in puncture
© 2012 Beacon Converters, Inc.
Design Inputs Protection from Physical Damage
Predict Damage Possibilities with good inputs
– Size, Profile
– Weight
– Center of Gravity
– Fragile or rugged
– Sharp edges or points
– Surface Characteristics
– Small component pieces
– Bend Sensitive
© 2012 Beacon Converters, Inc.
Design Inputs Protection from Physical Damage
PMP News webinar archive: Reduce, Recycle, Recover: Redefine your sterile barrier system in a flexible footprint
• Multiple components of varying size and shape • Heavy, bulky handle • Fragile knob used to control the laser source • Large fluid reservoir • Bend-sensitive fiber optics and tubing
© 2012 Beacon Converters, Inc.
• Multiple components • Varied size/shape. • Sharp edged • Heavy (surgical steel). • Materials include steel
and molded polymer parts.
Orthopedic Drill and Pin Kit
Design Inputs Protection from Physical Damage
© 2012 Beacon Converters, Inc.
Protect the device from
undesirable environmental
conditions
Damaging Environmental Conditions
2
What conditions could harm or degrade your device and packaging
system?
Ultra Violet
Moisture
Carbon Dioxide
Temperature Extremes
Microbes
© 2012 Beacon Converters, Inc.
Water Vapor Oxygen
Material (g-mil / 100 in2-day) (cc-mil / 100 in2-day)
LDPE 1.2 510
LLDPE 0.8 280
HDPE 0.4 170
Ionomer 1.7 500
Cast PP 0.7 240
OPP 0.4 120
PET 1.2 2.3
BON 10 1.7
PVdC 0.1 0.1
PCTFE AlOx PET
0.015 0.1--0.005
9.8 0.2--0.006
MVTR: 100°F, 90% RH OTR: 73°F, 50%RH
Design Inputs Protection from Environment
© 2012 Beacon Converters, Inc.
024681012
0 100 200 300 400 500 600
LDPE
LLDPE
HDPE
Ionomer
Cast PP
OPP
PET
BON
PVdC
PCTFE
A60 AlOx PET
MVTR (g/100 sq.in/day)
OTR (cc/100 sq.in./day)
Mat
eri
als
(0.0
01
" ca
lipe
r)
Typical Vapor Barrier Levels
OTR
MVTR
Design Inputs Protection from Environment
© 2012 Beacon Converters, Inc.
PET HDPE
LDPE PP
Strength
Moisture Barrier
Oxygen Barrier
UV Barrier
Chemical Resistance
Seal Strength
Layers of Protection What do your flexible packaging materials do
• Active drug substance will degrade in light.
• Fluid loss affects drug dosage.
• Must be autoclaved to sterilize.
• Product visibility is required.
Protection from Environment
Overwrap Bag for IV products
• UV Light Barrier protects active drug substance.
• AlOx Moisture/Oxygen Barrier prevents loss of fluid/drug effectiveness.
• Heat resistant layers are durable in high heat process temperatures of autoclaving.
• Bag is translucent for product visibility
• Bag designed for tear open application
Overwrap Bag for IV products Protection from Environment
FDA
Tissue / Collagen Like Products Protection from Environment
• Increase in products requiring very high barrier • Sometimes liquid is part of product • Low profile • Moisture loss critical
A3460 A34 –Polyester/LDPE/Aluminum Foil/Seal layer A60- AlOx Polyester/Seal layer
© 2012 Beacon Converters, Inc.
• Allow device to be terminally sterilized
5 Major Points; Packaging Performance What does your package need to do?
3 • Porous or impermeable?
• Compatibility with process – steam, autoclave, VHP, EO, Gamma and electron beam
Guidance for
ANSI/AAMI/ISO 11607 Sterilization
Considerations Compatibility of materials subject to sterilization
© 2012 Beacon Converters, Inc.
Sterilization Steam & Autoclave
• Steam Sterilization requires porous package – Paper with good wet strength – In some cases Tyvek can be used if
temperature is less than about 121°C.
• HDPe, PP, PA are common film webs incorporated into high temperature moist applications
• Autoclave utilizes non-porous materials
© 2012 Beacon Converters, Inc.
Sterilization Ethylene Oxide
• Suitable for heat and humidity • Porosity must be sufficient to:
– allow gases to penetrate or exhaust all layers – reach the interior of the product – minimize the stress on materials and seals (don’t mask Tyvek®)
• How many layers will surround product?
• Primary and secondary packaging • Double or triple bagged • Kit building (all components must be considered) • Be Careful with labels
© 2012 Beacon Converters, Inc.
Sterilization Radiation- Gamma & E-beam
• Radiation
– Materials must maintain their properties for desired shelf life protection
– Package need not be breathable • Provide for outgassing
– Radiation can be damaging to packaging materials, paper and polypropylene in particular.
• Refer to TIR 17 or ask your supplier
• Flexible packaging uses thin caliper materials, more affected by sterilization dosages • If re-sterilizing, re-package for safety and durability
cumulative
© 2012 Beacon Converters, Inc.
Sterilization VHP- Plasma
• A hydrogen peroxide plasma is the primary sterilizing agent
– Non-cellulose porous packaging needed
– Process can be damaging to extrusion coated/laminated materials (adhesion to substrate is compromised)
– Typical package: PET/PE adhesive laminate sealed to Tyvek
© 2012 Beacon Converters, Inc.
Allow that sterility be maintained until the product is dispensed
5 Major Points; Packaging Performance What does your package need to do?
4
• Compromise of Sterility is event related • Sterility is not time related • A sterilized object will remain sterile until an
event compromises its sterility
© 2012 Beacon Converters, Inc.
Sterilization Compromising Sterile Barrier
• Package seal failures • Stressed in EO, improper seal strength specification
• Package material failures • Abrasion, puncture, tear, material under/over engineered
• Package damaged in manufacturing • Handling- manual or auto fills, damaged equipment
• Package damaged in distribution • Pressure changes and non-porous packages, UV over
exposure in storage
© 2012 Beacon Converters, Inc.
FDA Recalls Compromising Sterile Barrier
Customed Inc., Surgical Convenience Packs Damaged Packaging
On June 3rd, 2014 Customed, Inc. initiated a recall of sterile convenience surgical packs. The products have been found to have a potential defect due to adhesion. The defect could result in loss of product sterility and lead to infection . Reason for Recall: Surgical pack sterility may be compromised due to individual packs adhering to one another inside the shipping case. In some cases, the plastic packaging of one bag (along the printed words “SNAP
SMARTLY TO OPEN”) has adhered to the end seal of an adjacent pack.
When the bags are separated, the plastic film can tear and compromise the sterility of the contents.
© 2012 Beacon Converters, Inc.
FDA Recalls Compromising Sterile Barrier
Customed Inc., Surgical Convenience Packs Damaged Packaging
How much product was included in the recall? ALL product manufactured from 1/9/2009- 5/20/2014
459,146 units manufactured
3,562 manufacturing lots
Products were distributed within the domestic (Puerto Rico Commonwealth, Florida State, New York State, US Virgin Islands); and international market (Geographical Area Central America- Costa Rica & Panama; and South America-Colombia).
© 2012 Beacon Converters, Inc.
FDA Recalls Compromising Sterile Barrier
Class 2 Recall Medela Enteral Syringe, Acacia Piston Syringe March 11, 2015
1,959,187 units recalled
The firm is recalling sterile enteral feeding syringes due to determining that the sterility of the affected products may be compromised as a result of a potential breach in packaging.
© 2012 Beacon Converters, Inc.
FDA Recalls Packaging Process Controls
Class 2 Recall Ringloc Acetabular Shell Limited Hole Finned 52mm Feb 17, 2015 Mallory Head 4 Finned Acetabular Shell 50mm (Lot 364600) and Ringloc + Acetabular Shell Limited Hole Finned 52 mm (Lot 427840) following a mix up in packaging with the two FDA Determined Cause: PRODUCTION CONTROLS: Packaging Process Control
© 2012 Beacon Converters, Inc.
FDA Recalls Compromising Sterile Barrier
Class 2 Recall Pulsiocath PiCCO ProAQT Monitoring Kit Feb 17, 2015 Internal testing and investigation of the packaging revealed cracks and holes in primary packaging FDA Determined Cause: PRODUCTION CONTROLS: Packaging
© 2012 Beacon Converters, Inc.
FDA Recalls Compromising Sterile Barrier
Class 2 Recall Four Lead TUR Irrigation Set January 26, 2015 Manufacturer Reason for Recall Potential for failure of the pouch packaging seal at high altitudes. FDA Determined Cause: DESIGN: Packaging Design/Selection Quantity in Commerce 26,028 units – Baxter Healthcare
© 2012 Beacon Converters, Inc.
FDA Recalls Compromising Sterile Barrier
Class 2 Recall cryoICE cryoablation probe (CRYO2) December 30, 2014 19,190 units Cryogenic probe for cardiac ablation surgery, packaged individually in Tyvek pouches. Affected product may have compromised sterility due to packaging defects. It was determined that some mishandling of the product during the packaging process could inadvertently damage the sterile barrier. . FDA Determined Cause: Packaging Process Controls
© 2012 Beacon Converters, Inc.
FDA Recalls Compromising Sterile Barrier
Class 2 Recall Trauma Large Screws Manufacturer Reason for Recall: Firm is recalling sterile-packaged implants and instruments packaged in six different package configurations due to packaging design verification test failures. Specifically, multiple test samples from each of the six configurations failed simulated distribution and shipping testing when the devices either breached inner or outer package trays or seal integrity was lost. . FDA Determined Cause: Packaging Process Controls Zimmer
© 2012 Beacon Converters, Inc.
Shelf Life & Sterility Testing Sterile Barrier
Maintain Sterility Until Point of Use / Expiry
• Some supplies and or devices have expiration dates and degrade over time
• Make sure you understand your product and packaging expiry and data to support it.
© 2012 Beacon Converters, Inc.
• Test at worst case conditions • within the validated window of manufacture
• Worst case configuration of device- • most fitments, heaviest joint, most pieces
• Largest, smallest sterile barrier system • size and/or seal area
NOTE: Worst case is bad enough. Don’t test for conditions that don’t exist Do enough testing with enough units.
Shelf Life & Sterility Testing Sterile Barrier
© 2012 Beacon Converters, Inc.
Different Objectives Accelerated Aging & Environmental
Conditioning
• Accelerated Aging
– A protocol to determine the affects of time on
a package/product.
– Humidity not part of the model
• Environmental Challenge
– Goal to determine sensitivities
– Can be extreme
© 2012 Beacon Converters, Inc.
Accelerated Aging and Environmental Conditioning
Q~10~=2
Arrhenius equation = effect of increasing
temperature on homogenous 1st order reaction.
Accelerated aging – increase of 10
degrees Celsius doubles reaction rates.
Don’t get carried away!
© 2012 Beacon Converters, Inc.
© 2012 Beacon Converters, Inc.
• Tyvek is inherently clean peeling and low linting
• Coated Medical grade papers are designed to minimize particulate generation
• Clean peel minimizes the risk of introducing particulates into a clean environment.
Clean Peel Material Considerations
© 2012 Beacon Converters, Inc.
– Allows for sterile handling
– Peelable opening features allow for sterile presentation
– Outside of package is not sterile
– Must peel easily but demonstrate a good seal
Aseptic Presentation how long will it remain sterile?
• Allow aseptic presentation 5
© 2012 Beacon Converters, Inc.
Package development is an involved task.
Don’t forget your packaging supplier.
Packaging Design In Summary
© 2012 Beacon Converters, Inc.
5 Major Points; Packaging Performance What does your package need to do?
Questions?