CN IV Memorial Sloan Kettering Cancer Center New York, New York, United States
Description: Clinical Issue/Problem: Surgical Site Infection is a continuing risk for all our patients at Memorial Sloan Kettering Cancer Center. Understanding the vulnerability of our patient population of getting an infection is an aspect of care that we are committed to do every day especially in this time of Covid-19 pandemic. MSKCC performs 60-70 scheduled cases per day. The demand to increase case volume, multiple combined procedures, advancement of surgical approaches and turnover has challenged our surgical instrument usage. The Immediate-Use Steam Sterilization (IUSS) or “flash” sterilization played a role and had a place in our workflow for several years. It was a convenient way to support one-of-a kind instruments and gave instant gratification to the surgeon’s, nursing staff and CPD personnel. Getting accustomed to using IUSS was an issue of great concern. To make a change the OR-CPD task force came together every two weeks to review the process to look for a solution.
Description of the Team: The Surgeons, OR Nurse Leader, Staff Nurses, Central Processing Department, Materials Management, Surgical Staff Assistants, Infection Control, Clinical Nurse Specialist, NPDS. All reviewed the process in helping to reduce or eliminate the use of IUSS.
Preparation and Planning: Preparation involved identifying the instruments consistently processed through IUSS and determining the surgical specialty that uses it most. We solicited questions from the nursing staff to help us understand the reasons of utilizing IUSS. It also includes collaboration with surgery to review their trays with each service nurse leaders. Materials Management with the Infection Control Specialist and CNS has also assessed the procurement of ONE TRAY® containers.
Implementation: Staff education. Increased instrument inventory. Modified Instrument trays. Implemented advance time loaner tray drop off by vendors. Procured ONE TRAY® system. Daily communication from CPD for instrument conflicts. Continued quality assessment (QA) monitoring. Removed steam sterilizer on the platform.
Outcome: Zero utilization of IUSS from 2019 to present.
Implication for Perioperative Nursing: Fulfilling the needs of the surgical team and effectively giving the highest quality patient care are both important goals and significant objectives at MSKCC.
These efforts proved successful with zero utilization of IUSS from 2019 to the present. Increasing instrument inventory and modifying trays for each surgical specialty simplifies the process as shown by fewer calls, allowing nurses to focus on patient care while continually keeping infections at bay.