An evaluation of immediate-use steam sterilization practices in adult knee and hip arthroplasty procedures

Zuckerman, Scott L.; Parikh, Ravi; Moore, David C.; Talbot, Thomas R.

doi:10.1016/j.ajic.2011.11.006

Cited by 2 publications

(2 citation statements)

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“…Despite this evidence, hospitals continue to reduce the use of IUSS because of outdated recommendations, citing that the convenience of IUSS may lead to improper use and “using immediate use steam sterilization (IUSS) in surgical procedures leads to higher infection rates.” 4,6,21 Although SSIs have been linked to improperly sterilized implants and instruments, they remain a multifactorial entity arising from intrinsic and extrinsic factors 20 . Adhering to outdated guidelines lacking scientific evidence can result in severe financial consequences.…”

Section: Discussionmentioning

confidence: 99%

“…With 1.85% of surgical patients annually expected to develop an SSI, the added costs estimated to be >$20,000 per admission, and hospital stays extended to a mean of 9.7 days, SSIs have become a quality improvement focus 19,20 . Since the Centers for Medicare and Medicaid Services (CMS) included SSIs as a preventable condition in 2008 and announced in 2011 that reasonably preventable conditions would no longer be reimbursed, hospitals have begun initiatives to reduce or eliminate IUSS 21 .…”

Section: Discussionmentioning

confidence: 99%

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The Association of Immediate-Use Steam Sterilization with the Incidence of Orthopaedic Surgical Site Infections

Tantillo

Stapleton

Frane

et al. 2022

Journal of Bone and Joint Surgery

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Background:Immediate-use steam sterilization (IUSS), formerly termed “flash” sterilization, has been historically used to sterilize surgical instruments in emergency situations. Strict guidelines deter its use, as IUSS has been theorized to increase the risk of surgical site infections (SSIs), leading to increased health-care costs and poor patient outcomes. We sought to examine the association between the use of IUSS and the rate of orthopaedic SSIs.Methods:The cases of 70,600 patients who underwent orthopaedic surgery—total knee or hip arthroplasty, laminectomy, or spinal fusion—from January 2014 to December 2020, were retrospectively reviewed for IUSS use. Of this group, 3,526 patients had had IUSS used during surgery. A propensity score-matched (PSM) analysis was conducted to account for known predictors of SSIs and included a total of 7,052 patients. The risk difference (RD), relative risk (RR), odds ratio (OR), and McNemar test compared the SSI risk for patients whose procedure had included the use of IUSS and those whose procedure had not included IUSS.Results:After propensity score matching, 111 (1.57%) of the 7,052 matched patients developed an SSI. Of the 111 patients, 61 (54.95%) were in the IUSS group and 50 (45.05%) were in the non-IUSS group. The estimated probability for developing an SSI was 1.42% for the patients in the non-IUSS group versus 1.73% for the patients in the IUSS group (RR = 0.82 [95% confidence interval (CI)]: 0.57 to 1.19], RD = –0.3% [95% CI: –0.9% to 0.27%]).There was no evidence that the proportion of SSI was greater in the IUSS group (McNemar test, p > 0.29).Conclusions:SSI rates were not significantly different between IUSS and non-IUSS patients undergoing orthopaedic surgery. Future prospective studies are warranted to further explore the utility of IUSS during orthopaedic procedures.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Association of Immediate-Use Steam Sterilization with the Incidence of Orthopaedic Surgical Site Infections

Tantillo

Stapleton

Frane

et al. 2022

Journal of Bone and Joint Surgery

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Inventory management of reusable surgical supplies

Diamant

Milner

Quereshy

et al. 2017

Health Care Manag Sci

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We investigate the inventory management practices for reusable surgical instruments that must be sterilized between uses. We study a hospital that outsources their sterilization services and model the inventory process as a discrete-time Markov chain. We present two base-stock inventory models, one that considers stockout-based substitution and one that does not. We derive the optimal base-stock level for the number of reusable instruments to hold in inventory, the expected service level, and investigate the implied cost of a stockout. We apply our theoretical results to a dataset collected from a surgical unit at a large tertiary care hospital specializing in colorectal operations. We demonstrate how to implement our model when determining base-stock levels for future capacity expansion and when considering alternative stockout protocols. Our analysis suggests that the hospital can reduce the number of reusable instrument sets held in inventory if on-site sterilization techniques (e.g., flash sterilization) are employed. Our results will guide future procurement decisions for surgical units based on costs and desired service levels.

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An evaluation of immediate-use steam sterilization practices in adult knee and hip arthroplasty procedures

Cited by 2 publications

References 9 publications

The Association of Immediate-Use Steam Sterilization with the Incidence of Orthopaedic Surgical Site Infections

The Association of Immediate-Use Steam Sterilization with the Incidence of Orthopaedic Surgical Site Infections

Inventory management of reusable surgical supplies

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