Counting basics #8- indicators

Now that I’ve gone through the importance of counting ALL the things, let’s talk about the instruments themselves. You get a casket (yes that is what we call them) aka a small metal box containing your instrument set. On the outside is a sticker with the load information on it, and a sterility indicator that shows you if the tray has been run through the sterilizer or not. It usually is tape with stripes that turn black when exposed to steam.

This is the first indicator.

The tray is locked.

No this isn’t a dungeons and dragons tale. There are plastic locks that keep the tray closed during transport. And a tray is not able to be opened without popping the lock. If the locks are in place and still intact, the tray should be sterile inside.

Right? Right?

Eh, not necessarily.

The outside indicators are only signals that this tray has been through the sterilizer and been exposed to enough steam to change to black. And the locks allow the person opening the tray to be sure that the tray has not been opened or otherwise tampered with.

It is the inside indicator that shows whether the tray has been sterilized or not.

There can be several layers to trays. How else are you going to pack all the instruments into the metal container, and make it light enough to move, but have enough instruments to do the case?

Each layer should have a sterility indicator. These are usually strips that change color, again in the evidence of steam. However, these strips also indicate how long the strip was exposed to the steam. There is usually a line that is marked acceptable. The color may not be completely changed the entire way through the line, but if it has reached the acceptable line, sterility can be assumed.

As the tech is setting up their table will examine these strips to ascertain whether or not the tray has been sterilized. There should be two for each level of the tray, in opposite corners. And if there is a paper bag full of delicate instruments, there should be an indicator in there too.

No indicator?

Don’t use the tray. Because you don’t know if the tray contents are sterile or not.

The outside lock is broken, or missing?

Don’t use the tray. Because you don’t know if anyone has opened the tray and absentmindedly put it back on the shelf, instead of taking it to SPD for processing.

The indicator color change looks weird and does not reach the acceptable line?

Don’t use the tray. Because sterility of the instruments has not been met.

There are many, many different sterility indicators for this. It depends on what purchasing has bought, or the sterilizer company itself recommends.

I will try to attach the questionable sterility indicator from this past week. This tray was not used because the acceptable line was not reached, although the tray had been through the autoclave. There are steps to be taken after that: informing the SPD, informing the supervisor. But most importantly, get another tray. Sometimes a little outside of the box thinking is required, especially if it is end of day and the day has been busy. If all of tray A are not sterile or are in cases, and tray B is almost the same. Open tray B, you might have to add a few instruments but the case can go on.