orm_february-2024 - 12

STERILIZATION & INFECTION PREVENTION
BY SUSAN KLACIK
Managing immediate use steam sterilization
mmediate use steam sterilization
(IUSS, a standard steam sterilization
cycle with little to no dry time) is considered
safe for patient care when the
processes recommended in Association
for the Advancement of Medical Instrumentation
(AAMI) standards and AORN
guidelines are followed.
I
IUSS is a valuable option in an emergency.
Lack of instrumentation, lack
of time to process instrumentation, or
tight surgical schedules are never good
reasons to perform IUSS. It is vital to
ensure adequate instrument inventories
to meet the anticipated surgery schedule
and ensure there is enough time to
process instrumentation. When the procedure
is justified, an IUSS cycle needs
to be performed in accordance with the
instrument and sterilization container's
instructions for use (IFU). The preceding
processes of cleaning and rinsing
are critical and must be consistently
followed.
All preparation, packaging, and sterilization
steps must be performed in a
clean environment. Preparation steps
include vital presterilization cleaning
and rinsing of the instrumentation and
sterilization container-a rigid assembly
that includes the instrument basket, filters,
and other elements and is specifically
validated by the US Food and Drug
Administration (FDA) to protect against
contaminants.
IUSS cleaning process, record
keeping
Cleaning of instrumentation and the
sterilization container must be performed
by following all steps in the IFU,
followed by thorough rinsing to remove
all water and detergent residues and,
finally, drying with a non-linting cloth.
Lumened items should be dried with
instrument air. The items should then
be carefully inspected and prepared for
packaging.
Instrumentation should be
placed in the instrument basket, along
with a chemical indicator so steam can
contact all surfaces. Only FDA-cleared
12
OR Manager | February 2024
packaging for IUSS sterilization should
be used. The type of package and basket
to be used is a rigid sterilization
container specifically validated for IUSS;
this information can be found in the
container's IFU.
* the reason for performing IUSS.
The sterilization cycle selected will
be based on the instrument and rigid
sterilization container's IFU. The sterilization
cycle is started and monitored to
ensure all sterilization parameters are
met. Since there is little or no dry time
after sterilization, the container and instrumentation
may be wet and hot when
removed from the sterilizer chamber immediately
after the cycle. The container
will then be transported to the surgical
suite in a way that minimizes the risk of
instrument contamination and thermal
injury to patients or personnel.
Items processed by IUSS but not immediately
used should not be stored or
held for the next patient. Rather, they
should return to the sterile processing
department for terminal sterilization.
IUSS is safe
but only when
performed in the
right situations.
Instrumentation is then placed in
rigid sterilization containers to prevent
exposure to contaminants in the environment
and through handling by personnel
transporting the sterile devices
to the point of use. The container should
be labeled with the contents and sterilization
lot number and should indicate
that the container underwent an IUSS
cycle. This information should be recorded
in the sterilizer record log.
Record keeping for instrumentation
undergoing IUSS includes:
* the item(s) processed
* date and time the item was processed
* patient name or identifier
* type of cycle used
* monitored results
* name of the person who began the
sterilization cycle
* name of the person who unloaded
the sterilizer
Monitoring, mitigating risk of
infection
It bears repeating that IUSS should only
be performed on implantable devices
and for emergency situations when no
other option is available. Although IUSS
is a safe method to sterilize emergent
contaminated instruments, inappropriate
use may lead to an increased risk
for surgical site infection.
Implants are foreign bodies that increase
the risk of surgical site infections.
For this reason, additional precautions
should be followed, such as
running a biological indicator (BI) and
type 5 chemical
integrating indicator
with every load that contains an implant.
The results of the chemical integrating
indicator and BI should be
known and show as acceptable before
the implant is used.
Should an implant be used before
the BI results are known (and, later, the
BI shows to have a positive result), the
surgeon and infection preventionist(s)
should be notified as soon as possible.
Monitoring IUSS rates and processes
is essential for limiting the
procedure to appropriate emergency
situations. Such monitoring may reveal
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Table of Contents for the Digital Edition of orm_february-2024

orm_february-2024 - 1
orm_february-2024 - 2
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