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Immediate Use Steam Sterilization (IUSS) in UW Health Operating Rooms (2.31)

Immediate Use Steam Sterilization (IUSS) in UW Health Operating Rooms (2.31) - Policies, Clinical, UWHC Clinical, Department Specific, Surgical Services, Clinical

2.31

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

FEBRUARY 1992
ORIGINAL
 REVISION

SEPTEMBER 2017
PAGE 1
OF 5
POLICY #

2.31
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE

Immediate Use Steam Sterilization (IUSS) in UW Health
Operating Rooms


I. PURPOSE

A. To provide a method of sterilization of items needed for immediate use. For example:
1. Instruments that have become contaminated and are needed urgently for ongoing procedures.
2. Immediate use steam sterilization (IUSS) of implantable items that are not sterile and are needed
for an immediate surgical procedure.
3. Unanticipated need of instruments that are clean but not sterile.

II. POLICY

A. The preferred method of sterilization for all instrumentation and implants is to be sterilized by the
Central Services (CS) Reprocessing Department.
B. Use of IUSS should be kept to a minimum.
C. In the event that sterilization of an unsterile implantable item is necessary, the four minute pre-vac
cycle should be used. The Sterile Reprocessing Technician then would transfer item (s) needed for
sterilization to Reprocessing Dept. and put the instrumentation needed for IUSS through a proper
cleaning process. He or she will perform the sterilization using an Aesculap pan and will include a
biological indicator.
1. If an implant is used prior to the biological monitor result, the “Exception Form for Premature
Release of Implantable Items” must be filled out and signed by the Faculty/Attending surgeon.
D. If a complete set of instruments is needed in less than one hour's time, IUSS may be done using the
four minute pre-vac cycle. The nurse will contact Sterile Reprocessing. He or she will perform the
sterilization using an Aesculap pan. Whenever possible, look for a duplicate instrumentation set.
E. Items other than routine metal instruments may require exposure times of different lengths and
should be sterilized using the manufacturer's recommendations.
F. A physical Class V chemical integrator is placed in the pan for each sterilization load (and another in
the lip of the IUSS pan). A biological indicator is placed in any set containing implantable items.
G. The autoclave operator reads the autoclave printout paper to verify that the proper time and
temperature parameters have been reached during sterilization. (Refer to related documents IUSS
autoclave CSC/AFCH/TAC posted chart.) The Autoclave Log (Refer to related documents IUSS
autoclave log is completed with the date, sterilizer number, load number, operating room location,
service, patient medical record number or patient label, item undergoing IUSS, reason for the IUSS,
minimum temperature, autoclave cycle, integrator check, and person placing item in/removing item
from the Autoclave (i.e. first initial and last name).




UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

FEBRUARY 1992
ORIGINAL
 REVISION

SEPTEMBER 2017
PAGE 2
OF 5
POLICY #

2.31
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE

Immediate Use Steam Sterilization (IUSS) in UW Health
Operating Rooms



III. PROCEDURE FOR INSTRUMENTATION PANS OR SINGLE INSTRUMENTS

A. Clean the item with detergent to remove blood and secretions.
1. The reliability of sterilization is affected by bioburden or other materials which effect the penetration
of the steam.
2. Items to be sterilized for immediate use should be subjected to the same decontamination processes as
instruments that are decontaminated in the CS Reprocessing Department.
3. Items must be disassembled and thoroughly cleaned with detergent and water to remove soil, blood,
body fats, and other substances.
4. Instrument cleaner must be used to clean instruments prior to IUSS. Rinse this
chemical off completely prior to sterilization and pat dry.
5. Lumens must be brushed and flushed under water with a cleaning solution and rinsed thoroughly.
Brushes or pipe cleaners can be obtained from CS Reprocessing Department or take item to CS for
cleaning.
B. Place the item in a covered IUSS pan according to manufacturer’s directions. Begin entry on the
Autoclave Log.
1. To achieve sterility, saturated steam must come into direct contact with all surfaces of all items.
Air removal, steam penetration and drainage of condensation are enhanced by proper positioning
of items.
2. Instruments and devices with concave surfaces should be positioned with the open side down.
3. All hinged instruments should be opened without engaging the ratchet, and should be placed on
racks or stringers as needed.
4. Items with removable parts should be disassembled.
5. Heavy items should be placed in such a way that they will not damage more delicate items.
C. Select appropriate time and temperature settings (refer to related documents IUSS CSC/IUSS
AFCH/IUSS TAC):
1. The recommended minimum exposure time and temperature for nonporous loads, such as those
containing routine metal instruments only, is seven minutes at or above 270°F, 135°C.
a. Metal instruments require surface sterilization only. The addition of porous items requires a
longer exposure time to ensure adequate steam penetration.
2. One minute exhaust is recommended. This is included in the pre-programmed cycles.
a. The exhaust cycle pulls the steam from the chamber, avoiding steam released on the operator

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

FEBRUARY 1992
ORIGINAL
 REVISION

SEPTEMBER 2017
PAGE 3
OF 5
POLICY #

2.31
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE

Immediate Use Steam Sterilization (IUSS) in UW Health
Operating Rooms


when opening the door.
3. When nonporous (metal) and porous (non-metal) items are sterilized together or the number of
instruments cannot be opened and spread on the bottom of the pan, the minimum exposure time
should be ten minutes at or above 270°F, 135°C, with one minute exhaust.
4. Reprocessing of specialty instruments and devices may require different exposure times and
temperatures. Reference UW Health Clinical Policy #4.1.7 Cleaning, Disinfection and
Sterilization of Patient Care Devices and Equipment. Contact the CS Reprocessing Department
for assistance to sterilize these items.
a. The devices or instruments are sterilized following manufacturer's instruction in accordance
with hospital Policy and Procedure.
D. Place a Class V chemical integrator with the load.
1. Performance of Class V chemical integrators correlates to the performance of biological
indicators, and the result of the Class V chemical integrator is known immediately.
E. At the completion of the cycle, inspect the autoclave paper print out, confirming the correct time and
Temperature parameters have been reached. Complete the Autoclave Log. Related documents IUSS
UH/AFCH/TAC.
F. Inspect the integrators, ensuring that the dark bar has entered the ACCEPT zone or the color change
is consistent with the printing on the integrator prior to items being placed on the sterile field.
1. If the integrator is not acceptable, the load must be re-run. The operator will indicate that the load
has been re-run on the log. The Sterile Processing Technician will notify appropriate service
personnel if needed.
G. Shutdown steps for sterilizer (the IUSS item is no longer needed):
1. Press ABORT front panel button. Wait approximately thirty seconds. The autoclave will then
automatically discontinue the cycle, allowing access to the unsterilized items.

IV. PROCEDURE FOR IUSS OF IMPLANTABLE DEVICES USING A CLOSED IUSS
CONTAINER SYSTEM

A. All implantable items that undergo IUSS must be monitored using a biological indicator. The
biological indicator gives a result in three hours.
B. The CS Reprocessing Department will be notified when any implantable item needs to undergo
IUSS. OR Staff will call IUSS line at 608-440-6625.
C. An Aesculap container will be used for IUSS of the implantable item. The Sterile Processing
Technician will place the implantable item(s) in the container along with a Class V chemical
integrator and a biological indicator. An additional Class V chemical integrator will be attached to
the outside of the container. The container will then be sterilized in an autoclave close to the
Operating Room requesting the implantable item(s), using a four minute pre-vac cycle.

UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

FEBRUARY 1992
ORIGINAL
 REVISION

SEPTEMBER 2017
PAGE 4
OF 5
POLICY #

2.31
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE

Immediate Use Steam Sterilization (IUSS) in UW Health
Operating Rooms


D. The Sterile Processing Technician will fill out the appropriate section of the “Exception Form for
Premature Release of Implantable Items” (related documents IUSS UH/ IUSS AFCH/ IUSS TAC)
for each use of the closed IUSS container.
E. Following sterilization, the container will be taken into the Operating Room. The container will then
be opened and the biological indicator will be removed using sterile technique. The Aesculap pan
containing the IUSS implant will be left open in the Operating Room and protected from
contamination. The contents are not introduced to the sterile field until the biological indicator gives
a result or the surgeon deems it necessary to use the item before the result is available.
1. If the Class V chemical integrator in the container is not acceptable, the implantable item(s) must
be re-sterilized using the above procedure along with a new biological indicator.
F. The Sterile Processing Technician will notify the Operating Room in question immediately after the
result is available. The staff surgeon in the Operating Room will be notified of the test result.
G. Whenever the implantable item is placed on the sterile field and/or implanted by the staff surgeon
before the result of the biological indicator is known, the Sterile Processing Technician will
return the exception form to the Operating Room where the “Operating Room Report” will be filled
out and signed by the Faculty/Attending surgeon.
1. The “Operating Room Report” does not need to be filled out if the implantable item was not
placed on the sterile field prior to knowing the result of the biological indicator.
H. Whenever the implantable item is placed on the sterile field and/or implanted by the staff surgeon
and the result of the biological indicator is positive, the Faculty/Attending surgeon will be
immediately notified and a Patient Safety Net Report will be completed by the RN in the room.
I. If the result of the biological indicator becomes available after the case is complete, the Sterile
Processing Technician will immediately notify the Operating Room Charge Nurse of any positive
result. The Operating Room Charge Nurse will immediately notify the Faculty/Attending surgeon of
the positive result and refer to steps within Policy # 4.22 UW Health Event Reporting.
J. All completed exception forms will be kept on file in the CS Reprocessing Department for future
review.

V. REFERENCES

A. AORN Guidelines for Perioperative Practice
B. ANSI/AAMI ST79






UNIVERSITY OF WISCONSIN

POLICY & PROCEDURE

EFFECTIVE DATE

FEBRUARY 1992
ORIGINAL
 REVISION

SEPTEMBER 2017
PAGE 5
OF 5
POLICY #

2.31
ADMINISTRATIVE MANUAL
NURSING MANUAL
OTHER Surgical Services
TITLE

Immediate Use Steam Sterilization (IUSS) in UW Health
Operating Rooms





REVIEWED BY
Katarzyna Pogorzelski, Manager, Sterile Processing- TAC 6/2017
Michelle Schmitz, Infection Control, 6/2017
Ashley J. Rusch, Nursing Education Coordinator, 5/2017
Michelle Daveler, Reprocessing Manager, 6/2017
Nasia Safdar, MD, 6/2017

SIGNED BY

Anne Mork, MHCDS, MS, RN
Director, Surgical Services