Poof! Reduction of Immediate Use Steam Sterilization via Education and Transparency

• Published in: American journal of infection control 2020-08, Vol.48 (8), p.S21-S21
• Main Authors: Gilman, Margaret, Brown, Joel M., Vinocur, Charles
• Format: Article
• Language: English
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2020.06.121

Immediate use steam sterilization (IUSS) is used in Operating Room (OR) environments when an instrument is needed for surgery about to occur or currently occurring and there is not sufficient time to perform sterilization in Sterile Processing (SPD). The IUSS process is less effective than standard sterilization processes, which may increase the risk of surgical site infection (SSI). There is no benchmark frequency of IUSS, but trending use by procedure, instrument, and reason is useful. We sought to identify the current IUSS baseline and identify improvement strategies. Baseline surveillance from 2016-2017 demonstrated an overall rate of 0.28% with a high of 0.9% in October 2017. Improvement strategies included the addition of IUSS rates at the Infection Prevention and Control Committee and the SSI Prevention Huddle, including run charts. The rationale for IUSS was defined for more targeted approaches to data collection. Based on data, targeted education of OR members included physicians and nurses to the appropriate use of IUSS instead of standard practices. SPD processes and expected turnaround time were discussed. The hospital policy on standard practices were reviewed with vendors. Inventory was assessed to insure proper par levels for surgical instruments. Finally, the surgeon must sign a document acknowledging the risks, that benefits outweigh those risks, and they wish to proceed when IUSS is required. IUSS rates dropped from 0.28% to 0.11% for 2018-October 2019 (p=0.0013). Between July 2018 and October 2019, IUSS was not used in 9 of 16 months, including four consecutive months in 2019. Additionally, there was a shift from “contaminated during procedure (30% to 19%),” towards “compromised packaging of unique item” and “vendor non-compliance,” which rose to 50% and 38%, respectively. Minimization of IUSS can be indicative of a highly reliable OR. With focused infrastructure and transparency, instances of IUSS can be minimized, even zero.