3 6 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E M A Y 2 0 1 5
using terminal sterilization," says CMS in the position paper.
Even though it's tempting to do so, CMS warns against using IUSS to save
time or as a substitute for standard instrument reprocessing. "IUSS is designed
to manage unanticipated, urgent needs for instruments during an emergency,"
says CMS.
The CMS memo further stresses that for IUSS, you must complete the same
multistep process you use to prepare an instrument for terminal sterilization.
Also, the rigid container you use for IUSS must be validated by the manufactur-
er and cleared by the FDA for use in IUSS.
What your colleagues are doing
Flash as little as possible is the unwritten policy at Oroville (Calif.) Hospital,
says OR Manager Robyn North, BSN, RN, CNOR. Knowing that IUSS is not con-
sidered an appropriate substitute for maintaining a sufficient inventory of instru-
ments, Ms. North monitors which instruments are being flashed and purchases
more of those devices "so we don't have to flash as much." She also makes sure
she has 2 or 3 of each surgeons' favorite tool, be it a retractor, clamp or scissor,
so if one falls on the floor during a case, they can grab a replacement off the
shelf rather than flash the fallen one.
Jeanne Fanoni, RN, BSN, director of nursing at Cook Children's Pediatric
Surgery Center in Plano, Texas, says they haven't flashed in more than 2 years
and do everything in their power to avoid IUSS.
"I want every one of my patients' instruments to be decontaminated the same
way — to go through the washer-disinfector and then have the same steriliza-
tion," says Ms. Fanoni.
Her facility has specific criteria regarding when IUSS is allowed. For starters,
sterile processing must notify Ms. Fanoni. "There have to be no other instru-
ments," she says. "We have 2 of everything, at least. But when it's a one-of-a-kind
instrument that's dropped during the case and the surgeon has to have that and
there's no other substitute, [IUSS] is necessary."
