Surgical instrument spotting is a visible sign of an invisible problem: suboptimal water quality during instrument reprocessing. In many hospitals, spotting is dismissed as an aesthetic issue—but under AAMI ST108:2023, it’s now a red flag for compliance and patient safety. Spotting is typically caused by residual minerals, organic matter, or endotoxins left behind during the final rinse phase of cleaning and sterilization. Hard water, fluctuating pH, or high total organic carbon (TOC) levels can lead to these deposits, even when detergents and mechanical cleaning are properly executed.
For sterile processing departments (SPDs), spotted instruments are more than cosmetic—they suggest that biofilm or soil may remain, increasing the risk of surgical site infections (SSIs). According to ST108, final rinse water should meet “critical water” standards—low in endotoxins, minerals, and organic load—to ensure no residue is left on instruments entering the operating room.
This is where Facilities and Engineering teams play a pivotal role. Water quality is not solely an SPD issue—it’s a hospital infrastructure issue. Facilities directors can help by:
- Testing and documenting water quality at all reprocessing points of use
- Ensuring RO or deionized systems meet ST108 standards for conductivity, TOC, and endotoxins
- Collaborating with SPD leadership on ongoing maintenance and monitoring protocols
- Providing responsive support when changes in water quality are detected
When facilities and sterile processing teams align, spotting decreases—and so does the risk of infection. AAMI ST108 gives us the framework. It’s time to treat water quality as a shared responsibility in surgical instrument safety.