Do you read your packaging IFUs? . . . you should. Do you double peel pack? . . . you probably shouldn’t. Most surveyors will cite you for doing it if your peel pack doesn't support it.
When double packing using paper-plastic pouches, one must be mindful of the risks. Proper sizing and application of pouches must allow for air removal, steam penetration, and drying. Improperly sized double-pouching, folds within pouches, plastic facing paper, are all factors that may prevent the sterilant from reaching the surface of anything with which the plastic side is in physical contact.
Both AAMI and AORN state that if a hospital chooses to double peel pouch, they must be sure the manufacturer has validated their pouches for double pouching. Many pouches have not been validated for double pouching. Using light weight, poor quality pouches to obtain perceived savings could get you into trouble as well. Even with double pouching, AAMI and AORN recommend the use of tip protectors.
So why do it? Usually it’s because the scrub team asserts they need to be able to deliver an instrument to the field that would otherwise be hard to deliver or retrieve from a single pouch. Some ORs want certain items double pouched for sterile presentation. Others claim it is necessary to prevent tears and punctures.
We submit that using instrument protectors (such as sterilization cards) will do a better job of promoting sterilization, will protect the sterile barrier during transport and storage, and are easier to pass off to the sterile field.
By adding structure to the pack, you prevent movement of the instrument which protects the pouch seals, you prevent crushing and creasing when handling, you hold hinged instruments open, and you create an easier aseptic presentation.
With the value offered by instrument protectors/sterilization cards, everyone should be saying . . . MAKE MINE A SINGLE!