Chapter 13 Point of Use Processing

ANSI/AAMI ST79

States that IUSS can be performed when all of the following conditions are met: -Items are needed immediately. -Items are dissembled, thoroughly cleaned according to manufacturer's IFU, with approved detergents and water to remove soil, blood, body fats, and other substances. -Lumens brushed and flushed, and rinsed. -Device manufacturers written instructions on the sterilization cycle, exposure times, temperature settings, and dry times are followed. -Processed items are transported in a manner to prevent contamination.

Point of use Processing

That which occurs when a medical device is processed immediately before use, and/or close to the patient care area.

Terminal sterilization

The process by which surgical instruments and medical devices are sterilized in their final containers, allowing them to be stored until needed.

Immediate Use Steam Sterilization (IUSS)

The process designed for the cleaning, steam sterilization and delivery of patient care items for immediate use; formerly known as flash sterilization.

AAMI Minimum Recommended IUSS cycles

Type of Sterilizer - Load Configuration - Temp - Time For Nonporous items - routine metal instruments, no lumens For Porous items - rubber, plastic items, items with lumens Gravity displacement - Nonporous - 270F - 3 min Nonporous and porous- 270F - 10 minutes Prevacuum - Nonporous - 270F - 3 min Nonporous and porous - 270F - 4 min Steam-Flush Pressure-pulse - Nonporous or mixed nonporous/porous - 270F - 4 min

a chemical process

all low-temperature processes utilize what kind of process

sterilized

if items are not properly cleaned then they cannot be what?

transported before use

in other cases, the decision to process heat-sensitive items at point of use is to reduce the distance that unwrapped processed items must be what?

turnaround time

in some cases, the decision to process heat-sensitive items at point of use is made in an effort to reduce instrument what?

single use device

never use IUSS on this type of device

Nonporous items

routine metal instruments, no lumens

Porous items (AAMI Minimum Recommended IUSS cycles)

rubber, plastic items, items with lumens.

at least weekly

this is how many times at minimum the sterilizer must be tested with a biological test for each IUSS cycle

lack of instrumentation

this is not a valid excuse for using IUSS

Two types of steam cycles commonly used for IUSS

-Gravity displacement. -Dynamic air removal - includes the pre-vacuum and steam flush pressure pulse (SFPP) cycles.

CMS indicates that IUSS is not acceptable in the following circumstances:

-When sterilizing implants, except in documented emergency situations. -For post-procedure decontamination of instruments used on patients with possible Creutzfeldt-Jakob Disease (CJD) or other prion diseases. -When devices or loads have not been validated for the specific cycle used. -On single use devices.

Gravity displacement, Prevacuum

Nonporous - 270F - 3 min

prevacuum

Nonporous and porous - 270F - 4 min

gravity displacement

Nonporous and porous- 270F - 10 minutes

Steam-Flush Pressure-pulse

Nonporous or mixed nonporous/porous - 270F - 4 min