basis to compensate for an insufficient instrument inventory or to
keep up with fast turnovers. There are concerns that shortcuts are
inevitable: not taking instruments completely apart, poor placement of
instruments so that steam can't penetrate all parts and not validating
that parameters have been met.
Nursing groups and accreditors want us to use IUSS as little as possi-
ble — only in emergency situations, when there is insufficient time to
sterilize an item by the preferred packaging method of wrap or con-
tainer — with a goal of total abstinence. Our surgical, infection control
and central sterile teams have spent the past few years working
toward that same goal of zero. We're not there yet, but our monthly
IUSS rate has dipped considerably: from an average of 6 times per
month in 2014, to 2.5 in 2015 to 1.25 in 2016 — including a few IUSS-
free months. What's more, we've addressed some of our toughest
reprocessing challenges along the way. Here's how we did it.
1. Changing the culture. Kicking the IUSS habit starts with
changing how we think about it, not as a convenience or to compen-
sate for insufficient instrument inventory, but as a last resort. We
began by educating OR and central sterile staff about the risks associ-
ated with IUSS, but we realized that wasn't enough; we also had to
change the culture and make people realize IUSS was to be used only
in an emergency, such as an instrument falling on the floor when the
surgeon absolutely needs it to continue the surgery.
We now require OR staff to get "approval" from a designated leader
before using IUSS. This gives us an opportunity to make sure there
isn't another set with an available instrument rather than going direct-
ly to IUSS. It also serves as a reminder of how seriously we consider
each use of IUSS. Everybody has since bought into the culture, includ-
ing the surgeons. In certain cases, forgoing IUSS might mean having
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