Publish Date: October 23, 2019
Immediate Use Steam Sterilization (IUSS) should be used for emergent situations and situations where patient care items cannot be packaged, sterilized and stored before use.
“IUSS can become routine for facilities with insufficient instrument inventory. When surveyors identify this, it often leads to further exploration of IUSS-related processes,” according to Lisa DiBlasi Moorehead, EdD, MSN, RN, CENP, associate nurse executive for The Joint Commission’s Department of Accreditation and Certification Operations and a former Joint Commission surveyor.
For these and other reasons, she says IUSS is among the most frequent issues that surveyors find during surveys.
What Surveyors are Looking For
Moorehead says the first thing a surveyor is looking for with IUSS is to see under what circumstances IUSS is being used, “If an instrument is dropped and there is no replacement, that would be an acceptable instance to use IUSS, as long as the manufacturer’s instructions for use of the instrument allow IUSS and the sterilizer has a compatible IUSS cycle.”
The perioperative nurse or tech responsible for IUSS should always defer to the device manufacturer’s instructions for use.
Moorehead shares three reminders to prevent IUSS misuse.
- Don’t use IUSS to balance low inventory.
She shares the example of a facility she visited as a surveyor where the organization had two eye trays but routinely scheduled eight cases on one day, requiring them to use IUSS for the last six concurrent cases. “This is a good example of the routine IUSS practices we see that are unsafe.”
Another example of IUSS used routinely is when organizations do not implement or enforce a policy about loaner trays and vendors routinely deliver the trays too close to the time of surgery to allow for required cleaning and sterilization and results in IUSS rather than with enough time to follow routine reprocessing requirements.
While there is no set formula for excessive IUSS, Moorehead shares an example of a facility with 600 uses of IUSS over a two-month period, which is too many.
- Don’t skip a step.
When items undergo IUSS, the expectation is that the organization will follow a rigorous process that is in compliance with current standards, including cleaning, disassembly and sterilization following the instrument manufacturer’s instructions. “When any of these steps are missed in IUSS, a surveyor will take note,” Moorehead says. “We see parameters for the IUSS sterilization cycle not being followed and we also see instruments being stored after IUSS, which is unsafe.”
- Don’t forget to document IUSS practices.
Organizations should be able to provide traditional load documentation such as time, temperature, pressure, load contents, and biological indicator. Case information such as surgeon and patient, and the reason for IUSS, such as dropped or soiled instrument also should be noted.
When IUSS practices and frequency are documented, frontline nurses, educators and leaders can best track the data to understand opportunities for improvement, Moorehead notes. “Surveyors will definitely be looking for documentation related to IUSS.”
What Frontline Nurses Can Do
“Speak up and talk with management and leaders about trends you are seeing in IUSS,” Moorehead stresses. “Leaders may not know a practice is occurring and it’s everyone’s responsibility to speak up and bring forward issues that could impact safety.”
One example she shares is letting leadership know if vendors are making a habit of not delivering instruments with enough time to process prior to the case.
Moorehead suggests frontline nurses prepare themselves for survey by speaking with leadership to understand how organizational policies for IUSS were developed. “State requirements vary and those are what we look at first, then we look at requirements outlined in the conditions of participation, followed by manufacturer instructions for use. If there is not clear direction, which there usually is, then we would ask which evidence-based guidelines the organization has considered in developing their policies,” she explains.
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