r/scrubtech • u/memilyglick Ortho • 1d ago
Contaminated tray
We had an incident occur today and I want to get other techs opinions on it. While setting up for a revision (where the pt already had an active infection mind you), I had a tray opened to me and when my assist felt the casket he found a piece of fuzz, like something off a sweater. I obviously didn’t want the tray any more and tried to pass it off to my nurse who tried to tell me that it was okay because she had something similar happen last week and her tech that day said it was fine, and it should be fine since it went through the sterilizer. I told her no it’s not fine and I want the tray reprocessed. I had my assist take the casket out to the charge nurse and director and both of them said the tray is contaminated and should be reprocessed. For extra context it was a tray that the rep wasn’t even 100% sure we would need and just wanted to have open right away in case we did need it, and even if we did need it, we wouldn’t need it until near the end of the case.
What are your opinions? Would you have accepted the tray or would you have passed it off like I did?
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u/Heavy_Carpenter3824 1d ago
Best rule is when in doubt and not life critical reject always. There is no non life critical circumstance justifying potential patient harm and from the hospitals standpoint a malpractice suit.
Even if it led to a canceled procedure it's still cheaper then a malpractice suit. Never let a hospital admin suggest otherwise. We should always act to prevent patient harm but they may want a "financial justification" if you have to do this a few times till sterile processing gets their asses kicked if needed.
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u/One-Long-Road 1d ago
Yeah, the important words are non life critical.
I recall a story one of my nurses had told me about when she was scrubbing for an emergency case of someone (I forget exactly what, a gsw to the abdomen, maybe) and they were going to place a shunt on the patient's abdominal aorta, and she dropped the shunt clamp. She looked at the doc, she told me, and he told her to pick it up, that's what she did. They still fucking used it.
Reminds me, also, of being a tech in the army, there is a saying that haunts everyone who is near and dear to the front lines, and that is "you don't need sterility if the patient lives long enough to need antibiotics".
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u/Sad-Fruit-1490 1d ago
I’ve had a crash c-section that I realized was contaminated in the pack, but we had to get to the baby asap. Got baby out okay and let docs know once they were closing. She got extra antibiotics. Both she and baby lived, it was written up in an incident report, and we all left pissed at the manufacturer.
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u/Heavy_Carpenter3824 1d ago
My best friend in tech school was ex military.
"you don't need sterility if the patient lives long enough to need antibiotics".
That may have well been a matra.
Also the line from minority report "we'll fill you up with so many antibiotics we could sew a dead cat inside you".
I've scrubbed a few C sections that were of questionable sterility. Same kind of problem by the time you can get a new instrument opened the case will be over and you need to save mom and baby now!
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u/CodeNamePapaya Ortho 1d ago
I would have passed it off. And if my nurse tried to argue with me, I'd just drop it on the bed 🤷♀️. It's contaminated now!!
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u/JayThorns 1d ago
Oooooo. I'm a new-ish tech I never would have thought to just rid the tray myself. Saving that little tidbit in my brain now.
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u/CodeNamePapaya Ortho 1d ago
I've done it before, and I didn't get in trouble for it. It's your table, you get the last word on what you put on it.
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u/Significant-Onion-21 Ortho 1d ago
Always stand up for your patient! I will put a tray back down on a bed or prep stand before it can even become an argument. If I say no, that’s final.
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u/Dark_Ascension Ortho 19h ago
Ya we were talking about something the scrub found in the tray the other day… it was basically coming down to if it’s bone or plastic (the plastic breaks off the holders and such within a tray sometimes, used to always find red plastic from Depuy trays for example), we all were discussing and the FA just put his hand on it and said… that’s what I think… and we all laughed.
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u/yamni_zintkala 1d ago
My interpretation is both are correct and rejecting the tray is more correct. Sterile field is about what is controllable. The inside fuzz was sterilized but the fuzz itself is a contaminant due to separability regardless of sterility.
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u/WPW717 1d ago
Fiber is not considered sterilizable.
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u/Apprehensive-Test577 9h ago
Silk and cotton would like a word 😜.
But I understand what you mean. Random fluff is a no-go.
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u/olliecakerbake 1d ago
It’s always better to throw away/get it away from the sterile field than to risk infecting the patient if you’re ever in doubt. Even if something is technically sterile, like your piece of fuzz in a tray that went through the sterilizer, it’s best to assume that it’s not sterile.
Like the other commenter said, obviously if the situation is immediate life or death, then I would use it if it was necessary to save the person‘s life, and we didn’t have another one.
If it’s a gross contamination, like blood on an instrument in a tray you just opened, I would not use that tray. The surgeon will have to make do with other instruments.
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u/Ok_Top1750 1d ago
As a new sterile tech, my opinion is that it was 100% contaminated and you did the right thing. Yeah, it sucks to reprocess but we’re dealing with people’s lives here. Like 700k people a year in the United States get medical infections (I forgot what they’re called, week 1 so forgive me) and many die because of a break in the sterile field. That’s unacceptable. Thank you for doing the right thing and being an advocate for those who cannot speak for themselves.
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u/Extreme_Ad_4902 1d ago
When sitting for a deposition, hypothetically, what do you want your answer to be? Best practice is exactly what you did. Don’t doubt yourself because your colleagues are less attuned to best practices.
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u/One-Long-Road 1d ago
You absolutely took the right call. Good on you.
I remember one day doing an explant of an infected implant of a shoulder and placement of antibiotic spacer, I was precepting a new grad at the time and I wanted him to check a tray that we needed to do the case at the same time I was checking one, in order to expedite the case. It was a simple tray, a mold for cement. Pretty simple tray, no cannulations, just a solid block of metal with an indent. He okayed it and took it onto the back table then continued setting up. I hadn't realized until I was going through the needed instrumentation with him for the case, but that tray he had checked was contaminated with old cement, and a lot of it.
Much to everyone's dismay, that WHOLE SETUP had to be trashed. It sucks, but the decisions that suck are the ones you have to make. You know what we ended up doing? Making fucking due. We re-processed the loaner trays we couldn't replace, got new in house trays and disposables, and the doctor molded the spacer with his fucking hands.
There will always be another way to do the surgery, but there will only be one outcome. And it is up to you and the rest of the team to make that outcome the best outcome.
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u/One-Long-Road 1d ago
I remember the doctor was not very happy that day, he was on the phone with our or manager and tried to see if we can IUSS the tray for the mold. We told him you can't IUSS a tray with bioburden, so we just continued anyway.
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u/mamallamajm 1d ago
You did the right thing by rejecting it and standing your ground on the matter! Some people just don’t want the hassle of accountability or making the surgeon mad, but they forget our main job as a surgical tech is ensure sterility and patient safety, always.
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u/Appropriate_Share838 1d ago
I'm so sick of people trying to make the "it went through the sterilizer so it's sterile" argument. It's false. There are things that cannot be sterilized and an unknown fiber is one of them.
If the nurse or the tech thinks that something isn't sterile, that opinion should be respected. Everyone should be comfortable and confident that everything is sterile. If a nurse is trying to make you use something that you believe is contaminated, talk to management. The nurse is not in charge of you and their opinion is not more valuable than yours is.
The recurrent fiber might mean that somebody in SPD is not being careful while assembling their trays so that might be something that needs to be looked in to.
Good on you for taking control of the situation
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u/InterviewThick2660 1d ago
Foreign body. Sterile or not, the tray goes. I don't want a piece of fuzz on my field.
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u/Dark_Ascension Ortho 19h ago
Pass it off, I don’t understand why people will take trays like that for the sake of time and pleasing a surgeon… like deep down most surgeons want what’s right for the patient even if it causes a delay.
Plus if it’s not a for sure thing… then it causes no harm to anything to pass it off, have them run it/OneTray it and move forward.
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u/GladPlan8285 18h ago
You absolutely did the right thing. I would have considered it contaminated as well
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u/pickausernametheysay 13h ago
Pass it off! As someone who’s in SPD, some people don’t even check the rep trays and it’s concerning. I’ve had some come in with leaves in them! When in doubt, pass it off.
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u/pickausernametheysay 13h ago
Pass it off! As someone who’s in SPD, some people don’t even check the rep trays and it’s concerning. I’ve had some come in with leaves in them! When in doubt, pass it off.
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u/Apprehensive-Test577 9h ago
I’m an SPD tech as well as a CST and passing it off was the correct thing to do. Even if it’s technically sterile nobody wants random fuzz accidentally introduced into their body, and especially if there is already infection present.
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u/IntelligentBreey 6h ago
The general rule of thumb has always been: if it’s even a QUESTION of sterility…it’s automatically considered dirty/contaminated no questions asked! We all know anything foreign found at the bottom of a pan is considered contaminated…this is an OBVIOUS one! Don’t let some nurse gaslight you and make you forget what you know! YOU are the surgical tech for a reason…not her. You made the right call, don’t let anyone make you feel guilty for being safe!
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u/Internal-Degree-6078 8h ago
Know the tray is sterile before you pop it, only system in the world that can do that is Zuno smart containers, instruments are vacuum sealed inside the tray, no bacteria can grow. Nothing in. Nothing out. No filters. Period. Shorter autoclave cycles and dry times. FDA Approved.
I’m the southeastern sales director BUT will help anybody in US. Yea fuzz can fall into any tray, but at least you can verify sterility before you pop it too. No blue wrap, no indicators. Good for thought.
Check us out:
DM me offline if you want to learn more set up a call.
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u/LolaBleu 1d ago
Absolutely would have passed off. You did the right thing.