Measuring Immediate Use Steam Sterilization

“Taking steps for achievement in Quality and safety”

Nestor Hernandez,CRCSTSPD Manager

■ Define Immediate Use Steam Sterilization and its use■ Discuss the Association of Perioperative Registered

Nurses (AORN) and the Association for the Advancement of Medical Instrumentation’s (AAMI) recommended practices on IUSS

■ Identify Quality Control Measures and Documentation for IUSS

■ Create an Action Plan to Decrease IUSS Rates

Objectives: What Is IUSS?■ The shortest possible time between a sterilized item’s removal

from the sterilizer, and it’s aseptic transfer to the sterile field.■ The sterilized item is:

~ used during the procedure for which it was sterilized~ used in a manner that minimizes its exposure to air and

other environmental contaminants~ not stored for future use~ not held from one case to another

Why Is IUSS Being Used?

■ Research has shown 80% of the time in a study at one large hospital, IUSS was used for reasons other than its recommended purpose of “Intraoperative Contamination,” when instrument is dropped.

■ The most common reasons documented were:~ operating room turnover~ receipt of an unsterile instrument~ intraoperative contamination~ a one-of-a-kind instrument

When To Use IUSS■ AORN states IUSS “should be

used only when there is insufficient time to process by the preferred wrapped or containerized method intended for terminal sterilization.

■ IUSS should not be used as a substitute for insufficient instrument inventory.

■ AORN, AAMI and The Center for Disease Control and Prevention agree that IUSS should not be used to sterilize implants. When IUSS of implants is unavoidable, a Process Challenge Device (PCD) should be run with the load.

How To Minimize IUSS■ The Joint Commission’s National Patient Safety Goal 07.05.01,EP4, states…”As

part of the effort to reduce surgical site infection, conduct periodic risk assessments for surgical site infection in a time frame determined by the hospital” this could be interpreted to apply IUSS

■ Conduct a risk assessment to determine why the facility is using IUSS and how to eliminate all reasons except for intraoperative contamination.

■ Question????~ does AORN have a national benchmark to recommend how many IUSS

cycles are acceptable in a month?~ How does one calculate IUSS rates?

Answer: AORN recommends that IUSS be kept to a minimum and used only in selected clinical situation and in a controlled manner. AORN does not have a benchmark for IUSS cycles per month. Calculation of IUSS rates is often done by dividing the number of IUSS per month by the number of case. It may be easier and more meaningful for health care organization to benchmark against themselves to track improvement in IUSS rates because there is“not” currently a national benchmark.

Measuring/Tracking For Improvement■ Determining monthly IUSS allows a health care organization to identify trends. Knowing

the total IUSS monthly rate for the department; however, may not be as useful as taking a more detailed look at:

~ types of instruments that are IUSS….used or not~ the types of procedures for which instruments are IUSS~ specific surgeons whose procedures requires a higher number of IUSS~ the time and day that instruments are processed

Look at other trends that can be determined from the IUSS records to develop action plans to decrease IUSS rates.

Action Plan To Decrease IUSS Rates■ Build more efficient instrument sets: Inventory instrument sets and determine those

that are more frequently used. Streamlined instrument sets should be built to include frequently used instruments. Fewer instruments per set allows for faster overall processing. With streamlined sets, money isn’t wasted on rarely-used instruments.

■ Enforce revised vendor policy. Sets must be delivered 48hrs prior to scheduled case.■ Investigate the need to purchase more instruments.■ Re-educate staff, Sterile Processing Technicians, Vendors, Physicians and

Administration to align their practice with AORN/AAMI standards and recommended practices.

■ Institute an interdepartmental project “No IUSS Day.” Reward and recognize with a trophy by the hospital administrative team for achievement in Quality and Safety as it relates to the visibility wall.

■ Measure the problem. Do you have inconsistent, incomplete or missing data which led to great variation? Develop and adhere to a standard measurement rate and log book, plus find individual site owner to ensure records are kept. (SPD to take ownership of biological incubation and IUSS logs)

■ Communicate with Sterile Processing at OR huddles to talk through next day’s cases. Look for conflicts between cases and ensure the facility has enough trays. Borrow from other sites if necessary.

In Conclusion■ Network documentation may suggest IUSS is associated with several factors predicting its

usage. Furthermore, encourage leadership to strictly assess the rational for IUSS and documentation of core IUSS components. Only sound documentation will assist to monitor and improve “Quality.”

■ Teams should communicate and plan for the unexpected. No two days are alike in surgery, and the team in the operating room (OR) and SPD must communicate with each other to ensure the patient’s need are meet.

■ Over 40 million surgical procedures are performed in US hospitals each year, resulting in nearly 300,000 surgical site infection (SSI). Identifying perioperative practices that may increase patient’s risk for such morbidity is an important step in reducing SSI. One a practice which, if not performed correctly, has potential to increase risk of infection is…..IUSS.

■ The final and most important solution to avoid excessive use is through education. Physicians, nurses, surgical technologist and management should understand the correct processes and the associated risks involved with ……………Immediate Use Steam Sterilization. By initiating all of the outlines mention above,

LVHN was able to reduce IUSS to a 1% Rate.