245 - Changing the Culture Around Immediate Use Steam Sterilization (IUSS)
Clinical Issue: Over the last decade there has been increased attention to reducing the risk to patients of hospital acquired infections. Immediate Use Steam Sterilization (IUSS) may put patients at risk for these infections. It also disrupts through-put in the OR, distracts the circulating nurse from caring for the patient and increases the risk of errors in instrument reprocessing and sterilization. With the introduction of the Multi-Specialty Statement on Immediate Use Steam Sterilization and The Joint Commission’s National Patient Safety Goal to reduce hospital acquired infections, a team at Beth Israel Deaconess Medical Center in Boston, MA began process improvement work to reduce the use of IUSS in the Operating Rooms. We self-identified as a high outlier in the frequency of occurrences and dependency to handling instruments using IUSS. We soon realized in order to make the impact we needed it would require changing our culture. In addition, we soon realized that the tool kit we developed could also be utilized as a predictive vehicle in the on-boarding of new surgeons and in managing the growth of service lines. This poster outlines our impact over six years. Team members included Perioperative Leadership, OR & CPD Staff, our Systems Engineer and the Administrative Director of Operations for the Department of Surgery. Planning and
Assessment: In January of 2013 we begin our preparation and planning by reviewing our frequency rate. We had run over 2100 IUSS loads in support of our 40 ORs in seven autoclaves. The Ophthalmology Service became our “burning platform” for change with the greatest opportunity for improvement. Implementation: Our pilot team enabled us to create processes that not only provided us reductions in the incidence of IUSS but also created a robust mechanism to implement best practices in the OR as well as CPD. The resulting tool kit has allowed us to focus on multiple service lines. Outcome: Initially in our pilot service line we were able to reduce the frequency of IUSS by over 60% in less than two years. Our improvement has continued and we have experienced a culture change but we are not done yet. As of August 30, 2019 we have reduced the use of IUSS overall by 93%. In fact we have removed 50% of the autoclaves in the OR suite. Implications for Perioperative Nursing: Changing the culture has had major implications. Circulating nurses are able to spend more time at the bedside with patient; we have a standardized mechanism to track IUSS to the individual patient, daily huddles offer real time review of occurrences and we are well on our way to achieving our goal to virtually eliminate IUSS.
Co-Authors: Nancy Dwyer Doraiswami, Elena Canacari, Ross Simon