During the past few weeks, I have been getting many questions about stains on surgical towels. I felt this might be a good topic for this week's digest issue. It reminds me about an article done in Outpatient Surgery when they reported in their October 2011 Issue that, "... damage occurred when the hospital's staff used OR towels cleaned by the linen service in sterilizing stainless steel surgical instruments and titanium implants. The towels were wrapped around the devices, which were then put through a steam autoclave. At the end of the process, the OR towels had crumbled and some of the medical instruments they were wrapped in were discolored and had to be discarded..." An expert stated in court documents that "...traces of an acid that a linen service used to clean operating room towels have discolored and damaged surgical instruments." The point is that surgical towels are meant for wiping hands and their intended use is not for lining surgical trays. If you are using a surgical towel, make sure it is not causing other issues.
My experience has shown that most staining and spotting problems (regardless if on an instrument or tray liner) are more geographical in nature, due to such factors as water pH, boiler compounds in water lines, detergent residue and certain chemicals that are incompatible with the stainless steel on instruments or even surgical trays. Another factor that is overlooked is that the inner chamber of a sterilizer has not been cleaned in some time, and the walls are just disgusting. Any stain/color needs to be investigated but some experts have stated that, out of all of the concerns, one must look at the water and steam quality. It is generally found to be the main source of these stains/colors after a thorough investigation. It is the reaction during the steam process that makes these stains/colors appear because they were not there before being sterilized. Having a white tray liner just brings the issue to the forefront sooner than a colored towel. In a way, having them show up is a good sign because you should consider it an early warning sign to check things out.
In closing, AAMI ST 79 has a an excellent ANNEX on Steam Quality (ANNEX M). If you do not have a copy of ST 79, I would suggest purchasing one for your department.
In any case, if you see a stain, regardless if on a tray liner or instrument, check it out. I hope this information helps in starting your journey on investigating staining on your liner or towels.