Once called “flash sterilization,” a term that took on a negative connotation, the practice of quickly sterilizing a surgical instrument and returning it to the sterile field now is called immediate-use steam sterilization (IUSS). Regardless of the name, it generally has been been discouraged if used as a substitute for lack of sufficient supplies or to save time for a non-emergency reason.

“IUSS should be limited to situations where the need is urgent for an instrument or we have an emergency situation,” said Zachary Juno, MBA, MHA, director of Operations and Perioperative Services, Emory University Hospital Midtown, in Atlanta.

Juno collaborated with Jill Holdsworth, MS, CIC, FAPIC, NREMT, CRCST, manager of infection prevention at the hospital, to prevent surgical site infections (SSIs) by reducing IUSS of surgical instruments. They gave a joint presentation on the project recently at the 2021 virtual conference of the Association for Professionals in Infection Control and Epidemiology (APIC).

There was no defined national benchmark for an appropriate level of IUSS, so Juno and Holdsworth set a target of no more than 2%.

“Our facility noticed that we needed a call to action around the time of January in 2018, when we had an IUSS rate of over 25% and 200 IUSS cycles per month,” Holdsworth said. “We understood that this was not an acceptable rate, and [we had] way too many IUSS cycles per month that were not for an urgent need. We had the goal of 2%, and we knew that we had a lot of work to do.”

A multidisciplinary approach team was formed that ensured all stakeholders were at the table, understood the problem, and had input in the process.

“The facility decided to use March 1, 2019, as a hard stop where IUSS would no longer be acceptable without the permission from OR (operating room) and sterile processing leadership,” Juno said. “Before this date, extensive education had to be performed for the OR team members, surgeons, and sterile processing department (SPD).”

The IUSS process was designated as an SPD tech responsibility to ensure proper training and competency, he said. Workflow challenges were identified as the main barrier in reprocessing, causing delays and the need to perform IUSS for instruments not processed in a timely manner. Changes implemented to improve the process were extensive, including installing a fourth washer, creating a pass-through window to eliminate traffic from contamination to clean, and adding a second ultrasonic machine.

“We replaced three older sterilizers with new versions, added a second low-temperature sterilizer, and purchased new instruments to create additional sets,” he said. “Data collection changed from manual to electronic in June of 2019.”

Surveillance of 10 surgical procedures showed a drop in SSI rates, Holdsworth said.

“Our overall IUSS rates were observed to go down pretty dramatically in the beginning, starting with that March 1 hard go-live date in 2019,” she said. “Ever since that go-live date, we have consistently kept our IUSS rates below 2%. Not only that, we have consistently, for the last year and a half, been below 1% and with many months of zero IUSS.”

When they occur, IUSS events are discussed to see if the problem is inventory, overscheduling, not enough instruments, or other issues, she adds.

“[We want to] involve the surgeons more. How we can make sure that they know when their instruments are going through an IUSS cycle?” she said. “We also review these in response to SSI investigations and include those as part of our review process. We want to make sure that we’re very transparent with this data.”