During time-out for a total knee, the scrub discovers that the incorrect implant is on the back table. The correct implant is available but unsterile. The surgeon would like to continue with the case. What is the best course of action?

• A. Notify the surgeon that the correct implant may be sterilized via the immediate-use steam sterilization method if biological and class V indicators are placed in the load
• B. Notify the surgeon that the correct implant may be sterilized via the ethylene oxide method if the aeration period is aborted
• C. Notify the surgeon that a root cause analysis will be initiated
• D. Cancel and reschedule the procedure

Answer: (A)

When an essential implant is available but not sterile and the case needs to proceed, the quickest and safest option is to sterilize it for immediate use with a flash (immediate-use) steam sterilization cycle. This method is meant for urgent situations where a sterilized item is required right away, allowing the surgeon to continue without a long delay. To ensure the process is reliable, the load should include a biological indicator and a Class V (multi-parameter) chemical indicator to verify that the cycle achieved sterility and that the process variables were met. If the indicators show a valid cycle, the implant can be used immediately for that patient, and proper documentation should accompany the use.

Ethylene oxide is not appropriate here because its cycles are lengthy and require aeration—doing this would cause an unacceptable delay to the procedure. Canceling or rescheduling would unnecessarily disrupt the case, and while a root cause analysis is important for preventing recurrence, it does not address the immediate need to maintain the patient’s surgical course.

So the best course is to proceed with immediate-use steam sterilization, with appropriate indicators to confirm sterility, and then use the implant for this case.