Written and maintained by CASRAI Editorial Board
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General information about hospital and surgical-center supply practice, not medical advice and not a substitute for a facility’s own policies or the instructions for use of any product.
A case cart, in the surgical setting, is a cart of the instruments and supplies gathered for one planned procedure and staged for the operating room. This guide covers the hospital and surgery-center meaning, not camera-equipment carts. The practical point for anyone building or auditing a case cart checklist: the contents are not fixed by a standard. They come from the facility’s surgeon preference card for that procedure. No published source sets universal item quantities, so the table below lists categories and where each one comes from rather than numbers.
Purpose and setting
Who needs this: perioperative nurses, surgical technologists, sterile processing staff and supply-chain staff who need to know what a case cart is meant to hold and what keeps it accurate. After reading, you should be able to explain what drives a case cart’s contents, where it sits relative to the room, and which storage conditions apply to the sterile items on it.
AORN describes the preference card as a guide for the surgical case. A card typically lists the surgeon and the procedure, its format varies by facility (paper or built into the electronic record), and some cards list each instrument on a tray (AORN, “Why Do I Need Preference Cards?”). A case cart is the physical result of that card. The AORN pages cited here describe the cards and carts but do not formally define “case cart”.
Case cart checklist by category
Quantity guidance for every row is the same: take it from the current preference card, because no cited source sets standard counts.
| Category | Quantity guidance | Why it is on the cart | Notes |
|---|---|---|---|
| Instrument trays and sets | Per preference card | The card may list each instrument on a tray. | Listing detail varies by facility. |
| Core supplies for the procedure | Per preference card | AORN notes core supplies generally stay consistent across cases of a procedure. | Confirm against the card the day before. |
| Surgeon-variable items (for example suture type, drapes) | Per preference card | AORN notes details such as suture type or drapes may change from case to case. | A permanent change should be recorded on the card with the date. |
| “Needed” items | Per preference card | AORN’s organization tips place items that will be needed on a cart in the room. | The article uses cart placement as an example; each facility has its own process. |
| “Maybe” items | Per preference card | AORN describes items that might be needed as kept in the room, away from the sterile field, in covered containers so they can be returned to supply rooms if unopened; its example puts them on a cart right outside the room. | Keeps unopened items from being wasted. |
| Emergency items for the procedure | Per preference card | AORN describes a portable enclosed cart outside the room but readily available. | Procedure-specific emergencies only. |
| Non-supply preferences (for example a requested radio channel) | Not applicable | AORN notes a card can list items such as the radio channel a surgeon wants. | Not picked from stock. |
What varies by facility type
AORN states that preference card format varies by facility: some cards are attached to the supply and patient charges list, some are kept separate, and some are in the electronic medical record. The extent of detail also varies, since there is no limit to what a card may contain. Beyond that, the cited sources do not set different case cart rules for hospitals, surgery centers or other settings, so this guide does not either. For a supply-side view of one setting, see the ambulatory surgery center supply checklist.
Case cart vs par-level stock vs pre-assembled kits
A case cart is built per case from the card. Standing shelf stock is managed differently: see par level inventory and fill rate. Manufacturer-assembled packs are a third approach, compared in pre-assembled procedure kits vs build your own. Whether a case cart carries reusable or single-use instruments is covered in autoclavable vs single-use surgical instruments.
Storage, expiry and keeping the cart accurate
Sterile items on the cart
The CDC’s Guideline for Disinfection and Sterilization in Healthcare Facilities (Sterilizing Practices page) says a sterile product should remain sterile until some event causes it to become contaminated, which is the basis of event-related shelf life. For storage it states:
- Closed or covered cabinets are ideal, but open shelving may be used.
- Temperature may be as high as 75°F and relative humidity should not exceed 70%.
- Supplies should not be stored under sinks or other places where they can become wet.
- Sterile supplies should be stored far enough from the floor (the CDC gives 8 to 10 inches).
- Any package that has fallen or been dropped on the floor must be inspected for damage to the packaging.
The CDC page does not discuss case carts or cart transport; these are the general sterile-storage conditions for sterile supplies.
An out-of-date card produces an inaccurate cart
AORN says an outdated or incorrect preference card means extra time is needed to gather supplies during a case, and extra supplies may have needlessly been opened. A 2018 paper in Cureus (Huntley et al., “Updating the Surgical Preference List”, 10(7):e2997) reports that hardcopy lists are often substandard, poorly maintained or incomplete, out of date, and full of ambiguous or incorrect details. The authors argue for departmental rather than individual lists and describe updating electronic lists after case sign-out review within 24 hours; that is their own practice, not a standard. AORN’s organization tips add that reviewing the card the day before and confirming supplies are available is a useful step, and that a permanent change should be recorded on the card with the date and the requested change.
Standards or rules that apply
This guide cites the CDC guideline and the AORN and journal articles listed under Sources. Professional standards for perioperative practice and sterile processing also exist; a facility should consult them directly for its own policy. No specific rule on covered versus open carts is stated here because none of the cited sources states one.
FAQ
What is a case cart system?
It is the facility’s way of assembling, staging and delivering the instruments and supplies for each scheduled procedure, driven by that procedure’s preference card. The cited sources do not prescribe one system design.
What decides what goes on a case cart?
The preference card for the surgeon and procedure. Core supplies generally stay consistent, while items such as suture type or drapes may change.
Where do case carts sit relative to the operating room?
AORN’s example places needed items on a cart in the room and “maybe” items on a cart right outside, with emergency items in a portable enclosed cart outside the room but readily available.
Can unopened items go back to stock?
AORN describes holding items in covered containers so they can be returned to supply rooms if they are not opened. Return rules are set by each facility.
Sources
Links checked 2026-11-01.
- AORN, Why Do I Need Preference Cards?
- AORN, Four Tips for Organization During Complex Surgical Cases
- CDC, Sterilizing Practices, Guideline for Disinfection and Sterilization in Healthcare Facilities
- Huntley et al., Updating the Surgical Preference List, Cureus 10(7):e2997, 2018
