But CS and OR personnel – and material managers — who assume a case cart is merely a simplistic, tray-toting box-on-wheels should take a closer look. As utilitarian as these stainless steel (or polymer) transporters may be, there are many design elements and characteristics that warrant a facility’s careful attention prior to committing to a purchase.

"Case carts are a major investment and should last a very long time," pointed out Stephanie Wolf, Blickman Inc., Lodi, NJ. "If you’re going to make that kind of investment, you should make sure it’s going to meet your needs."

Before actively shopping for new case carts, it’s important that personnel first weigh the product options against the design capabilities and limitations of their facility.

"The first question starts with the facility," said Dave Salus, market manager, healthcare division, InterMetro Industries Corp., Wilkes-Barre, PA. "How are they planning to use these carts? How are they going to manage them? What is their facility design? The answers to those questions will guide their decision on whether to buy open or closed case carts, and in what size configuration."

Sources pointed out that if a facility lacks designated hallways or elevators to allow direct access to and from CS and the OR, a closed cart may be the best choice. Not only will sterile instruments be able to be safely transported from CS to the OR, dirty instruments will be safely secured behind closed doors on their way back to the decontamination area.

"Most [CS departments] are in the basement with the OR several floors up, so it’s important that contents be protected," Salus continued, adding that facilities need to be adequately designed to accommodate open case carts. Aside from having designated corridors, hospitals that are eyeing open carts should also have two separate pathways (and even elevators) so clean and dirty carts can travel their own path, without risk of cross-contamination. Covers are, of course, a requirement for open case carts, as are solid bottom shelves to prevent dirt and debris from being kicked up onto contents by the casters.

Space must also be factored into the purchase decision. Aside from assessing the square footage capacity for storing the carts in-between use, facilities also need to consider corridor (and elevator) dimensions, as well as the available floor space in the OR and other departments where they’ll be used. This is especially essential for closed carts, which often have a larger footprint than their open counterparts.

"Make sure dimensions are exactly what you need to accommodate trays, elevators, corridors, washers, etc.," stressed John Marks, senior product manager, Medline Industries Inc., Mundelein, IL. "With carts, one size definitely doesn’t fit all, so if you have specific size requirements, don’t be afraid to contact the manufacturer directly and have them customize the carts to your needs."

Fortunately, chances are good there’s a cart in a manufacturer’s existing portfolio that will suit most facilities’ needs. That’s because today’s leading case cart vendors are offering carts in an array of sizes and configurations – from short and wide (which, in closed cart versions can also provide a sturdy table top for displaying instruments) to space-saving, high-profile carts that offer plenty of storage space in a small footprint.

For many facilities, a mix of open and closed case carts – in a variety of sizes – will best suit their needs.

Rose Seavey, RN, MBA, CNOR, ACSP, president/CEO of Seavey Healthcare Consulting Inc, and former Director of the Sterile Processing Department at The Children’s Hospital, Denver, described her ideal unit as small, yet flexible, "with the capability of hinging onto another cart, if necessary. Because storage is an issue, I also like vertical carts that can store a lot in little space." She went on to say that the case carts used at Children’s – a mix of both open wire and closed units – are quite ideal.

Whether a facility is in the market for new closed carts, open ones or both, there are some key construction and design features they simply can’t afford to overlook.

Durability is, of course, a must, which is why stainless steel models with sturdy bases remain a tried and true favorite.

Blickman CCC2 Multi-Purpose case cart (above) and CCC5 Ultra Space-Saver case cart (below)

User-friendly features push the limits

Staff having to routinely lift and transport heavy loads, should at least be able to count on their carts to provide enhanced ergonomic benefits.

Herman Miller case carts

Ensuring user safety begins with a correctly sized cart, stressed Hillebrand.

"Consider your typical employee and their ability to push a fully loaded cart and see over the top," he said. "You may want a small footprint so you pick a taller cart, but can your employees lift a 25 pound instrument container to the top shelf?"

From there, other ergonomic features can be considered. Aside from integrated, well- positioned handles for enhanced maneuverability and comfort, leading manufacturers are also incorporating removable shelf brackets and innovative shelving and drawer systems that can maximize flexibility, while also simplifying the loading and unloading of contents.

"In the past, people had to bend over and reach inside, which made it more difficult to load, unload and clean the carts and shelves. Today, there are roller shelves that provide half extension, so contents can be accessed with far less exertion," said Salus.

For added convenience and improved ease of use, customers can also find integrated shelf stops so shelves don’t fall out and dump contents onto the floor, pointed out Blickman’s Wolf.

Drawers that can be easily switched out to accommodate different size loads further increase flexibility, as does the use of subcontainers to keep drawer contents tidy, secure and readily accessible, added Everett.

Fixed shelving can have its benefits, too, however. In fact, Baskin said her favorite cart is an open wire one without moveable shelves. Preferring simplicity over flexibility, she explained "if they move then you have to worry about them breaking."

Even the most simple carts can be effectively organized – and at very little expense. Because many items need to be transported on case carts, Children’s Hospital relies on inexpensive totes that essentially serve as drawers. "We drilled holes in each corner of the tote so water could drain out easily in the washer," explained Seavey.

Metro closed case carts	Metro open case cart

To further enhance customization, customers have access to a wide range of accessories and add-on features. Rounded corners and rubber bumpers that protect both the cart’s frame and walls (and anyone who might find themselves on the receiving end of a moving cart) are available, as is shock absorbing technology and innovative sound-proofing features to prevent rattling and excessive noise during use. Tamper-evident seals and a variety of door and caster locks can also be added to many models, and if carts don’t come standard with preference card holders, they’re usually offered as an available option. On closed carts, optional drop-leaf shelving makes the most of available space by allowing staff to convert the top to a wider work surface without taking up more floor space.

"Again, it’s about providing the customer with as many different options as possible, so their carts are truly customized to their unique needs," said Marks.

Because facilities have a lot to consider, he said they should be diligent in how they evaluate case carts and equally conscientious in the way they care for them once the carts are in place.

"Different areas in the hospital will have their own specific needs, so be absolutely sure that you’re getting the right model before making the [financial commitment]," Marks continued, suggesting that, whenever possible, facilities should try out one cart before ordering an entire fleet – even if it means purchasing just one initially. "Case carts can last 20 to 30 years, so it’s not a decision that should be rushed."