Immediate-use sterilization should not be convenient-use practice

by Kara Nadeau Della Vecchia

In recent years the healthcare industry has turned a critical eye toward immediate-use steam sterilization (IUSS) – formerly known as flash sterilization – because its use in inappropriate clinical situations can increase the risk of healthcare-associated infections (HAIs). But the use of IUSS is still prevalent among healthcare facilities, with many using this sterilization practice out of convenience rather than out of necessity as it was intended. If continued use of IUSS is the reality, then how do facilities ensure it is being used appropriately and safely?

Multi-Society IUSS position statement:
The IUSS position statement published by AAMI and endorsed by numerous healthcare industry organizations (AAMI, AAAHC, AORN, APIC, ASC Quality Collaboration, IAHCSMM) defines IUSS as:

“The shortest possible time between a sterilized item’s removal from the sterilizer and its aseptic transfer to the sterile field. Immediacy implies that a sterilized item is used during the procedure for which it was sterilized and in a manner that minimizes its exposure to air and other environmental contaminants. A sterilized item intended for immediate-use is not stored for future use, nor held from one case to another.”

AAMI’s ST79 Landmark Recommended Practice for Hospital Steam Sterilization states that IUSS can be performed when deemed appropriate and when all of the following conditions are met:

  • The device manufacturer’s written instructions on cycle times, exposure times, temperature and dry times are followed.
  • Items are disassembled and thoroughly cleaned with detergent and water to remove soil, blood, body fats, and other substances
  • Lumens are brushed and flushed under the water with cleaning solution and rinsed thoroughly.
  • Items are placed in a closed sterilization container or tray, validated for immediate-use sterilization, in a manner that allows steam contact and aseptic transfer to the operating room.

In regards to when IUSS is appropriate to use, the American Association of periOperative Registered Nurses (AORN) states:

  • IUSS should be kept to a minimum and should be used only in selected clinical situations and in a controlled manner.
  • Immediate-use steam sterilization should be used only when there is insufficient time to process by the preferred wrapped or container method intended for terminal sterilization.
  • Regarding implants, there is an exception that IUSS can be used in defined emergencies when no other option is available.

The multi-society IUSS position statement notes that IUSS should NOT be performed on the following devices:

  • Implants, except in a documented emergency situation when no other option is available
  • Post-procedure decontamination of instruments used on patients who may have Creutzfeldt-Jakob disease (CJD) or similar disorders
  • Devices or loads that have not been validated with the specific cycle employed
  • Devices that are sold sterile and intended for single-use only

Immediate-Use Steam Sterilization Position Statement
http://www.aami.org/publications/standards/ST79_Immediate_Use_Statement.pdf

ST79: AAMI’s Landmark Recommended Practice for Hospital Steam Sterilization, http://www.aami.org/publications/standards/st79.html

Recommended Practices for Sterilization in the Perioperative Practice Setting, American Association of periOperative Registered Nurses (AORN), http://www.aorn.org