By Julie Vandenbark, MLS, BSN, RN
In surgical care, sterilization is nonnegotiable. Every instrument that enters the operating room must be free from contamination to protect patients from infections. Among the methods available, immediate use steam sterilization (IUSS) – once referred to as “flash sterilization”– is intended only for urgent situations when no sterile replacement is available. Overreliance of IUSS may have serious implications for patient safety, compliance and hospital quality performance.
Faster Process = Increased Vulnerability
IUSS is a rapid steam sterilization cycle designed for instruments that must be turned over quickly when no sterile replacement is available. Unlike standard sterilization, IUSS bypasses protective packaging and complete drying, which means instruments are highly vulnerable to recontamination once they leave the sterilizer.
This raises concerns with increased risk of surgical site infections. Because instruments are not wrapped and often transported while still drying, sterility can be compromised during the handling process. Professional organizations stress that IUSS should not be used on a routine basis. Its use should be limited to emergencies where patient harm could occur if surgery is delayed.
Accrediting Organization Expectations
Frequent use of IUSS is a red flag. ACHC Standards are aligned with CMS and require that instrumentation, supplies and equipment are sufficient in quantity so that movement in and out of the area is minimized during cases.
As stated in the 2025 edition of Accreditation Requirements for Acute Care Hospitals, “IUSS is reserved for immediate use or emergency needs, such as when a needed instrument has been contaminated and there is no sterile replacement available.” The same requirement is in the 2023 edition of Accreditation Requirements for Ambulatory Surgery Centers. “IUSS is not a substitute for an adequate supply of instruments and should only be used in rare circumstance.”
The facility’s policies and procedures must adopt criteria in accordance with infection control and IUSS guidelines. Elements include:
- Adherence to manufacturer’s instructions for sterilization.
- Identification of devices or instruments that are not compatible with IUSS.
- Physical monitoring for each IUSS cycle.
- Indications for use of chemical indicators.
- Indications for the use of biological indicators.
- The sterilization procedure.
- The use of labels.
- The frequency of testing.
During an ACHC accreditation survey, policies are evaluated and IUSS rates reviewed. The surveyor verifies that employee files contain documentation of staff training and competencies to ensure compliance with manufacturer instructions for use regarding IUSS with respect to each instrument, sterilizer, container and the cleaning supplies used.
Opportunities for Analysis
Frequent use of IUSS is rarely just a sterile processing issue. It usually signals deeper operational challenges such as inadequate instrument inventory, poor coordination of case scheduling, inefficient loaner tray management, or gaps in communication between the OR and sterile processing.
For these reasons, IUSS should be tracked as a quality indicator. A spike in IUSS can point to a need to evaluate supplies, workflows or turnaround processes.
Best Practices
Surgical environments can demonstrate compliance and a commitment to patient safety by:
- Maintaining adequate inventory of commonly used instruments.
- Tracking and trending IUSS cycles and reporting data to quality and infection control committees.
- Prohibiting use of IUSS for implants.
- Educating staff in both the operating room and sterile processing on alternatives and best practices.
- Auditing scheduling and workflow processes to address recurring causes of IUSS.
IUSS is not designed for routine use. When applied sparingly and with proper documentation, it is a valuable tool for cases of urgent need. By maintaining adequate instrument inventories, tracking IUSS as a quality measure, and using it only in emergencies, your organization is protecting patients and strengthening trust in your surgical service.
– Julie Vandenbark, MLS, BSN, RN, is an ACHC Senior Standards Interpretation Specialist for acute care and critical access hospitals. Before joining ACHC, she served as Director of Corporate Integrity for a health care system in Ohio and has many years of accreditation program management and coordination experience. Some lucky organizations may meet Julie as an ACHC Surveyor, an aspect of her current role that keeps her keenly aware of on-the-ground challenges.
