Targeting Zero—preventing Surgical Site Infections by Reducing Immediate Use Steam Sterilization (IUSS) of Surgical Instruments

Background This hospital went through a reorganization, at which time the IUSS (Immediately Use Steam Sterilization) rates were currently 25.95%, with an average of 200 cycles being ran each month. The SPD leadership made the decision, in partnership with Infection Prevention and hospital leadership, that the IUSS rates were a priority for the facility to prevent Surgical Site Infections (SSIs) and increase patient safety. The hospital defined the target of 2%, which the health system later followed as the system-wide target. Methods The facility made a “hard stop” date where IUSS cycles were no longer going to be allowed without OR (Operating Room) and SPD (Sterile Processing Department) leadership approval. Before the start date, education was given to surgeons, clinical teams, and SPD to ensure process understanding and risk of infection due to IUSS. The facility also recognized workflow as a large part of why instruments were being sent through IUSS, due to a backup in the department. Many items were purchased to increase workflow, such as a new washer, sonic, adding a pass-through window, a low-temperature sterilizer and replacing 3 sterilizers with newer models. The facility also purchased more instruments to create additional trays to accommodate the surgical volume. The Sterile Processing Department also underwent LEAN Kaizen events in both the clean and dirty sides to improve workflow and efficiency to prevent further IUSS. Results The facility saw an immediate reduction of IUSS cycles being performed and were able to drop below the goal of 2% after the first month of using the new process. The rate has continued to be below 2% for more than 5 months. Conclusions Communication and partnership between the OR, Infection Prevention and SPD proved to be beneficial and will continue to move the facility forward in a shared decision-making model in the future as improvement continues.