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6 Ways to Slow Down on Immediate Use Steam Sterilization

Publish Date: 8/8/2012

Thomas Jefferson University Hospital is a 957- bed acute care system in urban Philadelphia, housing 58 OR suites. In January 2010, a perioperative working group identified the overuse of immediate use steam sterilization as a potential threat to patient safety.

Although there is no national benchmark against which to measure, TJUH perioperative leaders knew that their flash rate was too high. (The rate equals the number of loads flash sterilized over the total number of cases.)

“We had evolved into an operating room environment where flashing had become the norm,” said OR Nurse Educator Eleanor A. Kelly, MS RN CNOR.

AORN’s Recommended Practices for Sterilization in the Perioperative Practice Setting states that the use of immediate-use steam sterilization should be “kept to a minimum.”

(It) should only be used in selected clinical situations and in a controlled manner. (It) may be associated with increased risk of infection to patients because of pressure on personnel to eliminate one or more steps in the cleaning and sterilization process. 

Through extraordinary diligence, ongoing process improvement and advocate passion, a working group of nurses lowered and maintained the system’s rate to 3.2 percent in 18 months. Here are some of recommended action steps for nurse leaders concerned about overuse:

  1. Measure the problem: When the project started, “we had inconsistent, incomplete or missing data, which led to great variation,” said Kelly. The solution was to develop and adhere to a standard measurement rate and log book plus find individual site owners to ensure records were kept. “I made it my personal business, every morning, to review the flash records,” Nurse Manager Diane Wolk, MSN RN CNOR, said. “I would go through the autoclave tapes, and if nurses didn’t record it, I would track each one of them down and make sure the process was correct.”
  2. Investigate the problem: The team identified 17 different reasons why a nurse might use immediate use steam sterilization. Those reasons went on the log, and answers pointed to root causes.
  3. Enforce rules with vendors: TJUH’s just-in-time delivery system contributed to the problem. Despite a policy of 24-hour prior-to-case drop off, vendors would arrive two to three hours before a case and drop off instruments and trays. “We notified all of our vendors that past a certain date, we would no longer accept drop offs same day of surgery,” Kelly said. “The message was, ‘if you want to do business with us, you have to follow our rules.’ It made a huge difference.”
  4. Communicate with sterile processing: TJUH asked for sterile processing’s input on causes and solutions. Today, the OR team and sterile processing huddle to talk through next day’s cases; look for conflicts between cases; and ensure the facility has enough trays.
  5. Buy more instruments: Whenever nurses hoard instruments, the flash rate goes up. TJUH’s team reviewed which instruments were most frequently flash sterilized and recommended that the facility invest $200,000 in augmenting supplies.
  6. Institute a “No Flash Day”: For one randomly selected day, the system sought to “eliminate the use of flash sterilization from our institution,” Kelly said.

    Vendors, sterile processing department personnel, technicians, physicians and nurses were alerted. Countdown sheets were posted in all coffee break rooms and “Stop - Do Not Flash” signs at all autoclaves. Nurses talked up the goal for weeks at staff committee meetings. The result was just one instance of immediate sterilization that day. “It was an ‘aha’ moment,” Wolk said. “Management realized: if we can get it right in one day, we can do it every day.”


For more information about reducing immediate steam sterilization, attend the AORN eCongress education session on “Solve the Puzzle: How to Attain Best Practice for Quality and Safety Using Lean Six Sigma.” Learn more or go here to register.

Recommended Practices for Perioperative Health Care Information Management can be found in Perioperative Standards and Recommended Practices, 2012 Edition. You can now order the 2012 edition here.

Multi-society statement on immediate-use steam sterilization (formerly flash sterilization) 


Guidelines for Perioperative Practice


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