A Tray With a Pale Indicator

In practice

Morgan, a surgical technologist, is setting up for a shoulder repair. The circulating nurse checks the outside of the instrument set: the wrap is intact, dry and untorn, the external tape shows the right color, and the label matches the case. Morgan opens the inner wrap with sterile technique and, before lifting anything, looks for the internal indicator. It is there, but its color change is incomplete: the strip is pale where it should be dark. Morgan compares it with the reference printed on the strip and is still not sure. Morgan says aloud that the internal indicator on this set has not fully changed, and that the set cannot be used. The circulating nurse agrees. The set is covered and moved away from the sterile field so that nothing from it is used by mistake. The circulator calls the processing department, which sends a replacement set processed in a different load and starts checking the records for the first set's load: the sterilizer printout, the other indicators from that cycle, and the biological indicator result. The patient is still in the preoperative area, so the case starts twelve minutes late. Later that day, the processing department reports that the tray had been loaded on its side and steam had not reached its center properly, and it reviews loading with its staff.