USE IT OR LOSE IT A sterilized item intended for immediate use is not stored for future use, nor held from one case to another.

Rule No. 1 when describing the various steam sterilization cycles used to process items not intended to be stored for later use: "Flash sterilization" is out. "Immediate-use steam sterilization" is in. The term "flash," which arose out of the unwrapped device's abbreviated time of exposure, has given way to "immediate use," which is the shortest possible time between a sterilized item's removal from the sterilizer and its aseptic transfer to the sterile field. Semantics aside, there's still much confusion about the proper way to sterilize an item during the procedure for which it is to be used. We hope this 10-question quiz clears things up for you and your staff.

1. Can we still call it "flash sterilization?"
No. "Flash sterilization" has been used to describe steam sterilization cycles where unwrapped medical instruments were subjected to an abbreviated steam exposure time and then used promptly after cycle completion without being stored. This is in contrast to traditional "terminal sterilization" cycles, where instruments are sterilized within containers, wrappers or primary packaging designed to maintain the instruments' sterility and let you store the devices for later use. "Flash sterilization" doesn't fully describe the various steam sterilization cycles needed to process some items, the longer exposure times, and the use of single wrappers or containers designed to allow for aseptic transfer of an item to the point of use. The term "immediate-use steam sterilization" (IUSS) more accurately reflects the current use of these processes. Immediacy implies that a sterilized item was sterilized in a manner that usually has no dry time and does not allow for storage.

2. Do I need to use a rigid container for IUSS?
Yes, you should use rigid containers that are specifically intended and labeled for IUSS. These containers help to decrease the potential for contamination of the item during transport to the sterile field. You may use other methods of packaging and wrapping — textiles, paper-plastic pouches and non-woven wrappers, for example — but only if the packaging is specifically intended and labeled for IUSS. Be sure to clean, inspect — for wear of gaskets and other critical components — and maintain the rigid containers you use according to the manufacturer's written instructions after each use. Be sure to immediately use the items sterilized in IUSS containers and don't store them for later use, not even for the next procedure.¹

3. Where can I find the time and temperature settings for IUSS?
You'll find the time and temperature settings for each item to be sterilized using IUSS in the manufacturer's written instructions for use. The instructions for use may or may not require a dry time and may require a cycle length or temperature different than the traditional times. Because of the variations, follow the manufacturers' written instructions for use and adjust the sterilizer settings for each item or group of items having identical requirements.¹

STERILIZER SIGNAGE
Want to Reduce Flashing?

ATTENTION-GRABBERS These signs on autoclaves have reduced the incidences of immediate-use steam sterilization at Memorial Hospital in Chattanooga, Tenn.

To discourage OR staff from using the flash autoclaves on the surgical floor above them, the sterile processing department at Memorial Hospital in Chattanooga, Tenn., got creative. It placed signs on the autoclaves that deliver a loud-and-clear message: Do not use! "We wanted to decrease flash autoclaving on the autoclaves that have the flash cycles on them," says Debbie Hollis, the sterile processing quality educator at Memorial Hospital in Chattanooga, Tenn. "Our reprocessing staff isn't always there to see what's in the autoclaves and many OR staffers don't want to come to the sterile processing department." Ms. Hollis argues that if the SPD staff are notified each time the OR needs an instrument turned over, they can offer alternative options, "resulting in fewer flashed instruments and all patients receiving instruments sterilized the proper way." So far, the signs seem to be doing their job. "The signs really got their attention and out of the habit of flashing," says Ms. Hollis. "We're at zero flashing."

— Dan O'Connor

4. The OR sterilizer is broken and I need to process an instrument by IUSS. Could I perform IUSS in an autoclave in the sterile processing area?
Yes, but only if the sterilizer is capable of achieving the required settings. The instruments should also be processed in a rigid container, intended for IUSS, which facilitates the safe transportation to the sterile field. The location for sterilization does not depend on the type of sterilization — IUSS vs. terminal. Rather, it depends on the sterilizer being able to meet the requirements for sterilization.^1,2

5. May I use IUSS for implants?
No. Immediate-use steam sterilization should not be used for implants, except in emergency situations when no other option is available. Follow the manufacturer's written instructions for use when determining which cycle to use. Place a biological indicator and a class 5 chemical integrating indicator in each load. Don't use the implant until the results of the biological indicator is known. If you happen to use an implant before the biological indicator results are known and the biological indicator is found to be positive, notify the surgeon and infection preventionist as soon as possible. If you don't immediately use the implant, resterilize it before use.¹

6. How do I document an IUSS cycle?
Documentation for each load of instruments processed using IUSS should include the items processed, patient identification, the type of cycle (gravity-displacement, dynamic-air-removal) including cycle parameters (temperature, duration of cycle), monitoring results, the date and time, operator information (person who initiated the cycle, person who retrieved the item from the sterilizer) and the reason for using IUSS. Record this documentation in a logbook or in another form that is equally retrievable. You should also document what you could have done to prevent the use of IUSS. Use this documentation as part of the quality monitoring system.¹

7. My vendor brought in 6 trays of instruments just before the case and wants us to sterilize them using IUSS cycles without decontamination. Is this correct?
This is incorrect. The loaner instruments should be decontaminated and prepared for terminal sterilization at the facility where they are to be used. The late arrival of the instruments should not be used as a reason for using IUSS. The facility and the vendor should have a process for requesting and delivering the instruments to the facility.¹

8. When can I use immediate-use steam sterilization?
Only when the device manufacturer's written instructions for use include instructions for IUSS. The instructions should include the requirements for cleaning, cycle type, exposure times, temperature settings and drying times if required. In addition to the device manufacturer's written instructions, you must follow the containment device manufacturer's written instructions for use. Only use a containment device that has been validated for IUSS and cleared by the FDA for this purpose. When performing IUSS, place the instruments in the device in a manner that lets steam contact all instrument surfaces. After the sterilization process is complete, take measures to prevent contamination during transfer to the sterile field. Immediately use the items that have been sterilized using IUSS; don't store them for later use or hold them from one procedure to another.¹

9. I was told to just quickly wash the scissors that were dropped on the floor, in the scrub sink. Is this the correct thing to do?
No. You should perform all instrument decontamination in an area intended, designed and equipped for decontamination activities and not in scrub sinks. Follow the same decontamination process used for terminal sterilization for items to be steam-sterilized for immediate use. Review the manufacturer's written instructions for decontamination before decontamination to determine the exact process that's safe to use. The manufacturer's written instructions for use may include details on which detergents to use and if the item may be immersed. Additional information on instrument decontamination can be found in AORN's "Recommended practices for cleaning and care of surgical instruments and powered equipment."^1-3

10. What type of monitoring devices should be used for the IUSS cycle?
The monitoring devices you'll use for IUSS include physical monitors, biological and chemical indicators. Use physical monitors, such as printouts, digital reading, graphs and gauges, to verify cycle parameters for each load. These monitors can indicate immediate sterilizer failure and record cycle parameters (time and temperature) for each cycle. Use biological and chemical indicators to monitor sterilizer efficacy and to assess whether conditions of sterilization have been achieved. Use a class 5 chemical integrating indicator or a class 6 indicator within each sterilization container or tray. The Class 6 indicators are cycle-specific; use them only in the specific cycles for which they are labeled. Biologic indicators may or may not be used, based upon the contents of the load.¹