Which items must be sterilized with an accompanying biological indicator (BI)?

The appropriate selection in this question is the titanium screws, as they are deemed high-risk items due to the critical nature of their use in surgical procedures and the need for assurance of sterility. Biological indicators (BIs) are utilized in sterilization processes as a key part of sterility assurance. They provide a direct measure of the effectiveness of the sterilization process by indicating whether the conditions needed to kill resistant microorganisms have been achieved.

In the case of titanium screws, which are often used in orthopedic surgeries, ensuring these items are sterile is vital to prevent surgical site infections (SSIs). The presence of a BI during the sterilization cycle is crucial, as it confirms that the sterilization parameters were met, thus ensuring patient safety.

Other items listed, while they may also require sterilization, are routinely evaluated through standard sterility assurance protocols that may not necessarily include biological indicators for every sterilization cycle. BIs are generally reserved for complex loads or especially high-risk items where contamination could have serious consequences.