Standardization of Color Change Interpretation in Sterilization Chemical Indicators: A Multivariate Study Aligned with International Safety Colors

Standardization of Color Change Interpretation in Sterilization Chemical Indicators: A Multivariate Study Aligned with International Safety Colors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Standardization of Color Change Interpretation in Sterilization Chemical Indicators: A Multivariate Study Aligned with International Safety Colors Yao Shen, Shan Zhong, Zhuoya Yao, Jiaxin Liu, Haiqun Ban, Xianzhao Zheng, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6769692/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To address the clinical challenges caused by inconsistent color change criteria among sterilization chemical indicators, this study proposes a standardized interpretation system based on international safety colors (e.g., green for "pass") to enhance the accuracy and global harmonization of sterilization monitoring. Methods A multicenter cross-sectional analysis (2021–2023) evaluated color transitions of 211 chemical indicators across four sterilization methods: steam (n=78), hydrogen peroxide plasma (n=69), ethylene oxide (n=36), and formaldehyde (n=28). Data were analyzed against ISO 11140-1:2014 and GB/T 18282.1-2015 standards using SPSS 26.0 for compliance rate calculations and chi-square tests (α=0.05). Results Significant heterogeneity was observed:Steam sterilization: External labels/tape showed 100% compliance (yellow/green→black), while internal indicators varied (66.67% yellow→black; 100% purple→green). Hydrogen peroxide plasma: External labels/tape exhibited 41.18% compliance (red→yellow); internal indicators achieved 52.17%.Ethylene oxide: 45.00% of external labels transitioned multi-colors to green; internal indicators reached 53.33%.Formaldehyde: External labels demonstrated 33.33% compliance (red/brown→green), while internal indicators achieved 71.43%. Conclusion Manufacturer-specific color standards contribute to an 8.3% clinical misjudgment rate. Adopting universal safety colors (e.g., green for sterilization success) and enforcing regulatory harmonization could reduce errors and improve global healthcare safety. This study provides actionable insights for standardizing sterilization monitoring protocols. Health sciences/Medical research Health sciences/Risk factors Sterilization monitoring Chemical indicators Color standardization International safety colors Clinical safety Standardization 1. Introduction Effective sterilization monitoring is critical for healthcare safety, Sterilization chemical indicators are indispensable for verifying the efficacy of medical device reprocessing[ 1 ].However, current guidelines (ISO 11140-1, GB/T 18282.1–2015) lack quantitative parameters for color change interpretation[ 2 – 3 ]. Clinical studies report an 8.3% misjudgment rate due to inconsistent manufacturer standards[ 4 ], lthough ISO 11140-1:2014 and GB/T 18282.1–2015 outline general requirements for chemical indicators.Particularly with emerging sterilization technologies like hydrogen peroxide plasma[ 5 ], the absence of universal color criteria complicates clinical decision-making[ 6 – 10 ]. Aligning color change criteria with international safety colors (e.g., green for high visibility and consensus) offers a viable solution[ 11 ]. This multicenter study proposes a standardized framework based on international safety colors, aiming to reduce variability and align with global best practices. 2. Materials and Methods A cross-sectional investigation was conducted across(2021–2023). Data included:Sample types: Internal indicator cards, external labels/tapes, and process challenge devices (PCD).Sterilization methods: Steam (n = 78), hydrogen peroxide plasma (n = 69), ethylene oxide (n = 36), formaldehyde (n = 28).Inclusion criteria: Domestically produced indicators required valid disinfection licenses; imported products required FDA/CE certification.Pre- and post-sterilization colors were documented using standardized ISO 11140-1:2014 reference charts. Compliance rates were calculated as: Statistical Analysis SPSS 26.0 was utilized for descriptive statistics and chi-square tests (α = 0.05). 3. Results Key Findings by Sterilization Method.Chi-square tests confirmed significant differences in compliance rates across manufacturers (p < 0.05). 3.1Steam Sterilization External labels/tape achieved 100% compliance (yellow/green→black). Internal indicators showed 66.67% (yellow→black) and 100% (purple→green) compliance (Table 1 ). Table 1 Pressure steam sterilization indicato Type of indicator object Color before sterilization Color after sterilization Number of products coincidence (%) P Outer packaging label (indicator tape) yellow black 6 100% < 0.001 Outer packaging label (indicator tape) green black 5 100% < 0.001 Category 4 chemical indicator card yellow black 32 66.67 0.032 Category 4 chemical indicator card purple green 8 100% Category 6 chemical indicator card yellow black 2 66.67 0.045 3 .2Hydrogen peroxide sterilization External labels/tape exhibited 41.18% compliance (red→yellow); internal indicators reached 52.17% (Table 2 ). Table 2 Hydrogen peroxide sterilization indicato Type of indicator object Color before sterilization Color after sterilization Number of products coincidence (%) P Outer packaging label (indicator tape) red yellow 14 41.18 < 0.001 Category 1 chemical indicator card red yellow 7 50.00 0.032 Category 4 chemical indicator card red yellow 5 55.56 Batch monitoring indicators blue yellow 2 33.33 0.045 3.3Ethylene Oxide External labels/tape showed 45.00% compliance (multi-color→green); internal indicators achieved 53.33% (Table 3 ). Table 3 Ethylene Oxide indicato Type of indicator object Color before sterilization Color after sterilization Number of products coincidence (%) P Outer packaging label (indicator tape) brown, purple Red, blue.. ecru green 9 45.00 < 0.001 Category 4 chemical indicator card Red, pink blue 8 53.33 Batch monitoring indicators blue green 2 66.67 0.045 3.4Formaldehyde sterilization External labels/tape demonstrated 33.33% compliance (red/brown→green); internal indicators reached 71.43% (Table 4 ). Table 4 Formaldehyde sterilization indicato Type of indicator object Color before sterilization Color after sterilization Number of products coincidence (%) P Outer packaging label (indicator tape) Red、brown green 3 33.33 < 0.001 Category 4 chemical indicator card Purple, red, blue, brown, pink, reddish-brown green 10 71.43 Batch monitoring indicators Brown, reddish-brown green 2 40.00 0.045 4. Discussion The observed variability in manufacturer standards,heterogeneity in color transitions—such as opposing changes, (e.g., red→yellow vs. red→green,opposing color transitions for similar methods). For similar sterilization methods—increases the cognitive load on healthcare workers[ 12 ],highlights systemic risks. For instance,For instance, green—a high-visibility "pass" signal—is inconsistently adopted,(ISO 7010:2019)[ 11 ], leading to confusion.Training programs and visual guides (e.g., reference charts) are urgently needed to mitigate errors[ 13 ]. Adopting international safety colors (e.g., ISO 7010:2019) could resolve ambiguity. Green, recognized for rapid visual processing[ 9 ], should signify successful sterilization across all methods. Regulatory bodies must enforce unified criteria, mandating pre-sterilization color blocks for quality control[ 14 ]. While this study focused on four common sterilization methods, future research should evaluate emerging technologies 5. Conclusion This study underscores the critical need for harmonizing color change criteria in sterilization chemical indicators.Advocates for a global color standardization framework anchored in safety colors (e.g., green).By aligning with international safety colors and enforcing regulatory standards, healthcare facilities can reduce misinterpretations, and ultimately improve patient safety. reducing manufacturer heterogeneity and improving interpretability. Regulatory collaboration and technological integration are critical next steps[ 15 ].The samples collected in this study did not cover all the indicator products of relevant sterilization methods worldwide.The collected samples included chemical indicators used in four types of sterilization methods in hospitals. Declarations Acknowledgements Thanks to Researcher Zhang Yu from the Institute of Hospital Management of the National Health Commission for his guidance on the project.Thanks to Engineer Tian Youhao from Shandong Xinhua Medical instrument Co.,Ltd. for his technical support. Author contributions Tao Song, Mengjie Chang and Shan Zhong are responsible for collecting the forms. Jiaxin Liu and Jingjing Du is in charge of compiling, organizing, and analyzing the data. Zhuoya Yao is responsible for the project design. Yao Shen was responsible for topic selection and writing project documents.Corresponding authors Haiqun Ban and Xianzhao Zheng were responsible for there view and approval of the research plan,project guidance, and the writing and review of the paper.All authors contributed to the article and approved the submitted version. Funding This project originated from a self-selected topic and did not receive any financial support. Competing interests The authors declare no competing interests. Data availability The data is provided in the supplementary information file. Additional information Correspondence and requests for materials should be addressed Y.S References ANSI/AAMI. Comprehensive Guide to Steam Sterilization and Sterility Assurance in Healthcare Facilities. ST79: (2017). ISO 11140-1. 2014. Sterilization of Healthcare Products—Chemical Indicators—Part 1: General Requirements. GB/T 18282. 1–2015. Guidelines for Selection, Use, and Interpretation of Chemical Indicators for Sterilization. Hu, X. et al. Inconsistent color interpretation of chemical indicators in China. Am. J. Infect. Control . 49 (6), 732–737 (2021). Zhang, X. Analysis of low temperature sterilization monitoring results in operating room of a hospital in Nanchang from 2018 to 2020 [J]. South. China Prev. Med. 47 (6), 814–816 (2021). National standard of the People's Republic of China. Guidelines for the selection and use of chemical indicators for sterilization of medical care products and the determination of results: GB/18282.1–2015[S].2015. National standard of the People's Republic of China. Test method for chemical indicators of ethylene oxide sterilization GB/T33418-2016[S]. (2016). China Health Industry Standard. Evaluation requirements for medical low temperature steam formaldehyde sterilization indicators WS/T 651–2019[S]. (2019). Shandong Xinhua Medical Instruments Co. LTD. Enterprise standard. Chemical indicator card for hydrogen peroxide low temperature plasma sterilization.Q/0303SXH303-2019[S]. (2019). Lao Ken Medical Technology Co. LTD. Enterprise standard. Lao Ken brand LK/DZK type hydrogen peroxide low temperature plasma sterilization chemical indicator card. Q/71306987-6-9-2017[S]. (2018). Graphical symbols-Safety colours. and safety signs -Registered safety signs-Amendment 3 (ISO 7010:2019/AMD 3:2021 EN [S].2021. Gu Zhan, W. & Qin, W. Progress of chemical monitoring technology for pressure steam sterilization [J]. Chin. J. Disinfection . 40 (7), 542–545 (2023). McDonnell, G. et al. Colorimetric quantification of chemical indicator responses. J. Hosp. Infect. 104 (3), 287–294 (2020). Enhancements for SCI Submission. National standard of the People's Republic of China. Chemical indicators for medical and health care products Part 1: General rules GB18282.1-2015 [S].2015. Li, W. & Yunbiao, Y. Ban Haiqun. Introduction to national disinfection products and regulatory methods. China Laundry Prod. Ind. , (05):56–61. (2024). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6769692","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":475827960,"identity":"b4be05e5-cc88-4a17-8112-94ee23b25e66","order_by":0,"name":"Yao Shen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYDACCQhlJ8/efOBAQoWEHD+xWpINe44lPvhwxsJYsoFILYwNN3KUDWe2VSRuIKRFfnbzscc8NTbMjA05bNK88yQYNzAwP3x0A48WgzvH0o15jqXxsTOcPSbNu02C2ZyBzdg4B58WiRwzaR62w8yMjX1pIC1slg08bNL4tMjPyP8mzfPvMGPDYR4zad45EjwGBwhoYbgB8kIbUMsxHmPDmQ0SEgS1GNxIM5Oc25cGDGQ2YCAfkzCQbCbgF/kZyc8k3nyzsZOXfwyMypq6+n725oeP8ToMCJh4ULjMBJSDAOMPIhSNglEwCkbBCAYA+GZKXnnpsh4AAAAASUVORK5CYII=","orcid":"","institution":"Jiaozuo People's Hospital, Jiaozuo People's Hospital Affiliated to XinxiangMedical University，Jiaozuo","correspondingAuthor":true,"prefix":"","firstName":"Yao","middleName":"","lastName":"Shen","suffix":""},{"id":475827961,"identity":"6332948f-4d66-45b7-915f-c9485a6e7cac","order_by":1,"name":"Shan Zhong","email":"","orcid":"","institution":"Shinva Medical instrument CO., Ltd","correspondingAuthor":false,"prefix":"","firstName":"Shan","middleName":"","lastName":"Zhong","suffix":""},{"id":475827962,"identity":"873e8578-06e2-4bdd-9b57-d85b32c3806d","order_by":2,"name":"Zhuoya Yao","email":"","orcid":"","institution":"Henan Provincial People's Hospital, Zhengzhou University People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Zhuoya","middleName":"","lastName":"Yao","suffix":""},{"id":475827963,"identity":"0e9a204c-36ef-4937-852c-958eeaefef77","order_by":3,"name":"Jiaxin Liu","email":"","orcid":"","institution":"Jiaozuo People's Hospital, Jiaozuo People's Hospital Affiliated to XinxiangMedical University，Jiaozuo","correspondingAuthor":false,"prefix":"","firstName":"Jiaxin","middleName":"","lastName":"Liu","suffix":""},{"id":475827964,"identity":"bd8c227c-7fdf-40f6-8bec-7c589f44e70b","order_by":4,"name":"Haiqun Ban","email":"","orcid":"","institution":"Renji Hospital Affiliated to Shanghai Jiao Tong University","correspondingAuthor":false,"prefix":"","firstName":"Haiqun","middleName":"","lastName":"Ban","suffix":""},{"id":475827965,"identity":"fa916271-a344-4b3d-93c3-13488ecd44f5","order_by":5,"name":"Xianzhao Zheng","email":"","orcid":"","institution":"Jiaozuo People's Hospital, Jiaozuo People's Hospital Affiliated to XinxiangMedical University，Jiaozuo","correspondingAuthor":false,"prefix":"","firstName":"Xianzhao","middleName":"","lastName":"Zheng","suffix":""},{"id":475827966,"identity":"0a1a3a06-195f-46ca-b771-18becb6fac0e","order_by":6,"name":"Tao Song","email":"","orcid":"","institution":"Jiaozuo People's Hospital, Jiaozuo People's Hospital Affiliated to XinxiangMedical University，Jiaozuo","correspondingAuthor":false,"prefix":"","firstName":"Tao","middleName":"","lastName":"Song","suffix":""},{"id":475827967,"identity":"09c390d8-89dc-4961-aec5-46b4e6125bdc","order_by":7,"name":"Mengjie Chang","email":"","orcid":"","institution":"Jiaozuo People's Hospital, Jiaozuo People's Hospital Affiliated to XinxiangMedical University，Jiaozuo","correspondingAuthor":false,"prefix":"","firstName":"Mengjie","middleName":"","lastName":"Chang","suffix":""},{"id":475827968,"identity":"e30ea866-c951-4ac6-95ec-28facf94caa9","order_by":8,"name":"Jingjing Du","email":"","orcid":"","institution":"Jiaozuo People's Hospital, Jiaozuo People's Hospital Affiliated to XinxiangMedical University，Jiaozuo","correspondingAuthor":false,"prefix":"","firstName":"Jingjing","middleName":"","lastName":"Du","suffix":""}],"badges":[],"createdAt":"2025-05-28 15:53:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6769692/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6769692/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":86837898,"identity":"bfd587f3-44fe-465b-99e5-69459c7db880","added_by":"auto","created_at":"2025-07-16 07:31:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":661799,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6769692/v1/b953c5ed-6e7f-4402-b98a-08f6ad49e6cc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Standardization of Color Change Interpretation in Sterilization Chemical Indicators: A Multivariate Study Aligned with International Safety Colors","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eEffective sterilization monitoring is critical for healthcare safety, Sterilization chemical indicators are indispensable for verifying the efficacy of medical device reprocessing[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].However, current guidelines (ISO 11140-1, GB/T 18282.1\u0026ndash;2015) lack quantitative parameters for color change interpretation[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Clinical studies report an 8.3% misjudgment rate due to inconsistent manufacturer standards[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], lthough ISO 11140-1:2014 and GB/T 18282.1\u0026ndash;2015 outline general requirements for chemical indicators.Particularly with emerging sterilization technologies like hydrogen peroxide plasma[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], the absence of universal color criteria complicates clinical decision-making[\u003cspan additionalcitationids=\"CR7 CR8 CR9\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Aligning color change criteria with international safety colors (e.g., green for high visibility and consensus) offers a viable solution[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This multicenter study proposes a standardized framework based on international safety colors, aiming to reduce variability and align with global best practices.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003eA cross-sectional investigation was conducted across(2021\u0026ndash;2023). Data included:Sample types: Internal indicator cards, external labels/tapes, and process challenge devices (PCD).Sterilization methods: Steam (n\u0026thinsp;=\u0026thinsp;78), hydrogen peroxide plasma (n\u0026thinsp;=\u0026thinsp;69), ethylene oxide (n\u0026thinsp;=\u0026thinsp;36), formaldehyde (n\u0026thinsp;=\u0026thinsp;28).Inclusion criteria: Domestically produced indicators required valid disinfection licenses; imported products required FDA/CE certification.Pre- and post-sterilization colors were documented using standardized ISO 11140-1:2014 reference charts. Compliance rates were calculated as:\u003c/p\u003e \u003cp\u003e\u003cimg 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©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\" width=\"571\" height=\"73\"\u003e\u003c/p\u003e \u003cp\u003eStatistical Analysis SPSS 26.0 was utilized for descriptive statistics and chi-square tests (α\u0026thinsp;=\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eKey Findings by Sterilization Method.Chi-square tests confirmed significant differences in compliance rates across manufacturers (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e3.1Steam Sterilization\u003c/h2\u003e \u003cp\u003eExternal labels/tape achieved 100% compliance (yellow/green\u0026rarr;black). Internal indicators showed 66.67% (yellow\u0026rarr;black) and 100% (purple\u0026rarr;green) compliance (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePressure steam sterilization indicato\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of indicator object\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColor before sterilization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eColor after sterilization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber of products\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecoincidence (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOuter packaging label (indicator tape)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyellow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eblack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOuter packaging label (indicator tape)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003egreen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eblack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory 4 chemical indicator card\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyellow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eblack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory 4 chemical indicator card\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epurple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003egreen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory 6 chemical indicator card\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eyellow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eblack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3\u003cb\u003e.2Hydrogen peroxide sterilization\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eExternal labels/tape exhibited 41.18% compliance (red\u0026rarr;yellow); internal indicators reached 52.17% (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHydrogen peroxide sterilization indicato\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of indicator object\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColor before sterilization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eColor after sterilization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber of products\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecoincidence (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOuter packaging label (indicator tape)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eyellow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e41.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory 1 chemical indicator card\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eyellow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory 4 chemical indicator card\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ered\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eyellow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e55.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBatch monitoring indicators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eblue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eyellow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e33.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.3Ethylene Oxide\u003c/h2\u003e \u003cp\u003eExternal labels/tape showed 45.00% compliance (multi-color\u0026rarr;green); internal indicators achieved 53.33% (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEthylene Oxide indicato\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of indicator object\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColor before sterilization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eColor after sterilization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber of products\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecoincidence (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOuter packaging label (indicator tape)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ebrown, purple Red, blue.. ecru\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003egreen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e45.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory 4 chemical indicator card\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRed, pink\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eblue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e53.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBatch monitoring indicators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eblue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003egreen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e66.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.4Formaldehyde sterilization\u003c/h2\u003e \u003cp\u003eExternal labels/tape demonstrated 33.33% compliance (red/brown\u0026rarr;green); internal indicators reached 71.43% (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFormaldehyde sterilization indicato\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of indicator object\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eColor before sterilization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eColor after sterilization\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber of products\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ecoincidence (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOuter packaging label (indicator tape)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRed、brown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003egreen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e33.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory 4 chemical indicator card\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePurple, red, blue, brown, pink, reddish-brown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003egreen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e71.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBatch monitoring indicators\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBrown, reddish-brown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003egreen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e40.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe observed variability in manufacturer standards,heterogeneity in color transitions\u0026mdash;such as opposing changes, (e.g., red\u0026rarr;yellow vs. red\u0026rarr;green,opposing color transitions for similar methods). For similar sterilization methods\u0026mdash;increases the cognitive load on healthcare workers[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e],highlights systemic risks. For instance,For instance, green\u0026mdash;a high-visibility \"pass\" signal\u0026mdash;is inconsistently adopted,(ISO 7010:2019)[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], leading to confusion.Training programs and visual guides (e.g., reference charts) are urgently needed to mitigate errors[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdopting international safety colors (e.g., ISO 7010:2019) could resolve ambiguity. Green, recognized for rapid visual processing[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], should signify successful sterilization across all methods. Regulatory bodies must enforce unified criteria, mandating pre-sterilization color blocks for quality control[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhile this study focused on four common sterilization methods, future research should evaluate emerging technologies\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis study underscores the critical need for harmonizing color change criteria in sterilization chemical indicators.Advocates for a global color standardization framework anchored in safety colors (e.g., green).By aligning with international safety colors and enforcing regulatory standards, healthcare facilities can reduce misinterpretations, and ultimately improve patient safety. reducing manufacturer heterogeneity and improving interpretability. Regulatory collaboration and technological integration are critical next steps[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].The samples collected in this study did not cover all the indicator products of relevant sterilization methods worldwide.The collected samples included chemical indicators used in four types of sterilization methods in hospitals.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks to Researcher Zhang Yu from the Institute of Hospital Management of the National Health Commission for his guidance on the project.Thanks to Engineer Tian Youhao from Shandong Xinhua Medical instrument Co.,Ltd. for his technical support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTao Song, Mengjie Chang and Shan Zhong are responsible for collecting the forms. Jiaxin Liu and Jingjing Du is in charge of compiling, organizing, and analyzing the data. Zhuoya Yao is responsible for the project design. Yao Shen was responsible for topic selection and writing project documents.Corresponding authors Haiqun Ban and Xianzhao Zheng were responsible for there view and approval of the research plan,project guidance, and the writing and review of the paper.All authors contributed to the article and approved the submitted version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project originated from a self-selected topic and did not receive any financial support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data is provided in the supplementary information file.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence and requests for materials should be addressed Y.S\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eANSI/AAMI. Comprehensive Guide to Steam Sterilization and Sterility Assurance in Healthcare Facilities. ST79: (2017).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eISO 11140-1. 2014. Sterilization of Healthcare Products\u0026mdash;Chemical Indicators\u0026mdash;Part 1: General Requirements.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGB/T 18282. 1\u0026ndash;2015. Guidelines for Selection, Use, and Interpretation of Chemical Indicators for Sterilization.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu, X. et al. Inconsistent color interpretation of chemical indicators in China. \u003cem\u003eAm. J. Infect. Control\u003c/em\u003e. \u003cb\u003e49\u003c/b\u003e (6), 732\u0026ndash;737 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang, X. Analysis of low temperature sterilization monitoring results in operating room of a hospital in Nanchang from 2018 to 2020 [J]. \u003cem\u003eSouth. China Prev. Med.\u003c/em\u003e \u003cb\u003e47\u003c/b\u003e (6), 814\u0026ndash;816 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational standard of the People's Republic of China. Guidelines for the selection and use of chemical indicators for sterilization of medical care products and the determination of results: GB/18282.1\u0026ndash;2015[S].2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational standard of the People's Republic of China. Test method for chemical indicators of ethylene oxide sterilization GB/T33418-2016[S]. (2016).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChina Health Industry Standard. Evaluation requirements for medical low temperature steam formaldehyde sterilization indicators WS/T 651\u0026ndash;2019[S]. (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShandong Xinhua Medical Instruments Co. LTD. Enterprise standard. Chemical indicator card for hydrogen peroxide low temperature plasma sterilization.Q/0303SXH303-2019[S]. (2019).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLao Ken Medical Technology Co. LTD. Enterprise standard. Lao Ken brand LK/DZK type hydrogen peroxide low temperature plasma sterilization chemical indicator card. Q/71306987-6-9-2017[S]. (2018).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGraphical symbols-Safety colours. and safety signs -Registered safety signs-Amendment 3 (ISO 7010:2019/AMD 3:2021 EN [S].2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu Zhan, W. \u0026amp; Qin, W. Progress of chemical monitoring technology for pressure steam sterilization [J]. \u003cem\u003eChin. J. Disinfection\u003c/em\u003e. \u003cb\u003e40\u003c/b\u003e (7), 542\u0026ndash;545 (2023).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcDonnell, G. et al. Colorimetric quantification of chemical indicator responses. \u003cem\u003eJ. Hosp. Infect.\u003c/em\u003e \u003cb\u003e104\u003c/b\u003e (3), 287\u0026ndash;294 (2020). Enhancements for SCI Submission.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNational standard of the People's Republic of China. Chemical indicators for medical and health care products Part 1: General rules GB18282.1-2015 [S].2015.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi, W. \u0026amp; Yunbiao, Y. Ban Haiqun. Introduction to national disinfection products and regulatory methods. \u003cem\u003eChina Laundry Prod. Ind.\u003c/em\u003e, (05):56\u0026ndash;61. (2024).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Sterilization monitoring, Chemical indicators, Color standardization, International safety colors, Clinical safety, Standardization","lastPublishedDoi":"10.21203/rs.3.rs-6769692/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6769692/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo address the clinical challenges caused by inconsistent color change criteria among sterilization chemical indicators, this study proposes a standardized interpretation system based on international safety colors (e.g., green for \"pass\") to enhance the accuracy and global harmonization of sterilization monitoring.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA multicenter cross-sectional analysis (2021–2023) evaluated color transitions of 211 chemical indicators across four sterilization methods: steam (n=78), hydrogen peroxide plasma (n=69), ethylene oxide (n=36), and formaldehyde (n=28). Data were analyzed against ISO 11140-1:2014 and GB/T 18282.1-2015 standards using SPSS 26.0 for compliance rate calculations and chi-square tests (α=0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e Significant heterogeneity was observed:Steam sterilization: External labels/tape showed 100% compliance (yellow/green→black), while internal indicators varied (66.67% yellow→black; 100% purple→green).\u003c/p\u003e\n\u003cp\u003eHydrogen peroxide plasma: External labels/tape exhibited 41.18% compliance (red→yellow); internal indicators achieved 52.17%.Ethylene oxide: 45.00% of external labels transitioned multi-colors to green; internal indicators reached 53.33%.Formaldehyde: External labels demonstrated 33.33% compliance (red/brown→green), while internal indicators achieved 71.43%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eManufacturer-specific color standards contribute to an 8.3% clinical misjudgment rate. Adopting universal safety colors (e.g., green for sterilization success) and enforcing regulatory harmonization could reduce errors and improve global healthcare safety. This study provides actionable insights for standardizing sterilization monitoring protocols.\u003c/p\u003e","manuscriptTitle":"Standardization of Color Change Interpretation in Sterilization Chemical Indicators: A Multivariate Study Aligned with International Safety Colors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-26 12:39:01","doi":"10.21203/rs.3.rs-6769692/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"33895e7e-2ac7-4b84-b747-5b2647a0bea2","owner":[],"postedDate":"June 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":50526441,"name":"Health sciences/Medical research"},{"id":50526442,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2025-07-16T07:23:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-26 12:39:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6769692","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6769692","identity":"rs-6769692","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}