Reduction in immediate use steam sterilization associated with reduction in surgical site infections

Immediate use steam sterilization (IUSS) is a potential risk factor for surgical site infection (SSI). A quality improvement project to reduce IUSS was implemented at a single hospital after a regulatory survey noted excessive use.

Components of the project included 3 signatures for every cycle of IUSS; Ordering of additional trays; removal of ability of surgery personnel to perform IUSS; reduction in number of IUSS sterilizers from 8 to 1. The project was fully implemented in December 2019. No other changes were made that were anticipated to impact orthopedic SSI rates.

There was no IUSS use after November 2019. Prior to the project, there were 9 hip SSI (rate = 0.54 per 100 procedures) and 14 knee SSI (rate = 0.49). After the project, hip SSI decreased by 76% (2 SSI, rate = 0.13, P = <.05) and knee SSI decreased by 18% (7 SSI, rate = 0.41, P = .67).

A multidisciplinary quality improvement project was successful at drastically reducing the use of IUSS, and a correlating statistically significant decrease in hip SSI and clinically significant decrease in knee SSI was seen for 3 years after the project was completed.