IUSS Practice Change: Focus on Process

The longtime industry focus on reducing immediate-use steam sterilization rates has too often led teams to focus on when they use IUSS versus how they use it.

AORN’s latest sterilization guideline update will help teams put the focus back on sterilization process steps that ensure safe sterilization in any instance, including immediate use, according to Erin Kyle, DNP, RN, CNOR, NEA-BC, AORN perioperative practice specialist and co-author of the guideline update.

The guideline, which publishes electronically on Sept. 1, has been updated with new evidence and has been significantly reorganized for easier understanding and search capability.

Focus on the Sterilization Process

“Sterilization alone is not what protects our patients from infection, every step prior has to be done correctly for sterilization to be effective,” Kyle stresses.

She says the modern perioperative nurse may not have an active, hands-on role in sterilization and this division of responsibility can lead to a division of understanding between the two groups. “Perioperative nurses need a healthy knowledge and respect for the sterilization process and those who perform it.”

Ready to check your IUSS practices against the new guideline recommendations? Here’s a sneak peek at three recommendations from AORN’s latest guidance on sterilization that teams need to be focusing on when thinking about IUSS:

1. Process Matters— Saturated steam under pressure should be used to sterilize heat- and moisture-stable items unless otherwise indicated by the device manufacturer, according to Recommendation V in the updated guideline.

   “When necessary, IUSS may be a safe method for sterilization provided that every step is performed correctly according to the manufacturers’ instructions for use (IFU)—the crucial steps leading up to steam sterilization are often missed,” Kyle acknowledges.

   To help teams dial in these pre-sterilization steps, the guideline recommends following all of the same stringent cleaning and inspections steps as for terminal sterilization by referring to the Guideline for Instrument Cleaning.



2. Location Is Key—Sterilization should be performed in an area intended, designed, and equipped for sterilization processes, according to Recommendation II in the updated guideline.

   “The sterile processing area is where this expertise resides and that is where we recommend—whenever possible—that sterilization take place.”

   As an alternative, the guidance recommends that any sterilization activity, including IUSS, happen in a setting that is functionally equivalent to a sterile processing area with features that include:

• separate physical spaces and process for cleaning, decontamination, and sterilization;
• storage for cleaning supplies and personal protective equipment; and
• ready access to manufacturer IFUs for the device being sterilized, the sterilizer and any other equipment used.


3. Monitoring Is a Must—Sterilization processes should be evaluated and monitored in all areas of the facility where sterilization processes are performed, including IUSS, according to Recommendation X in the updated guideline.

All guidance for process monitoring is now consolidated in one recommendation, rather than spread throughout the guidance. This is to support consistent knowledge and application of sterilization physical, chemical, and biological indicators that should be used to monitor sterilization processes. “Sterilization process monitoring must be recognized and followed as a critical component of quality assurance,” Kyle stresses.

She says the guideline also makes clear that IUSS should only be performed when certain conditions are met. “We are still firmly behind idea that IUSS should never be used for convenience or to account for a lack of instrumentation.”

Resources

• Look for more information on sterilization in this month's Journal, Periop Briefing "Guideline for sterilization".

FREE RESOURCES FOR MEMBERS

Guideline Essentials: Improve IUSS safety in your facility with access to implementation tools for the guideline on sterilization. Available September 1, 2018.

• Gap Analysis Tools: Tools to assess areas in which your facility may not be compliant with the guidelines.
• Policy & Procedure Templates: Ready-to-use customizable templates for developing your facility’s policies and procedures
• Competency Verification Tools: Ready-to-use customizable templates for verifying competency to meet facility requirements

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