CMS Backs Sterilization Terminology Change

Posted September 3, 2014

Acknowledging the infection control community’s concern over the use of the term “flash” as part of the decontamination and sterilization processes, the Centers for Medicare & Medicaid Services (CMS) has told its state survey agency directors to abandon it in favor of immediate-use steam sterilization (IUSS).

In an Aug. 29, memo, CMS notes that organizations with expertise in infection control—including AAMI, the Association of periOperative Registered Nurses, and the International Association of Healthcare Central Service Materiel Management—have advocated against the term “flash,” as it does not properly communicate the time and number of steps it takes to ensure proper sterilization.

For years, organizations used “flash” to describe sterilization cycles for instruments and devices that were not packaged in preparation for sterilization; were subject to minimal drying time; and were used immediately. However, CMS recorded unsafe practices and adverse events in healthcare facilities, including surgical site infections, when the term “flash” sterilization was used.

The new memo cites a 2011 position paper from AAMI and six other organizations that endorsed the use of IUSS over “flash” sterilization. The organizations argued that the use of “flash” had led to some abuses, and that “immediate use” would add some clarity. The paper defined immediate use as “the shortest possible time between a sterilized item’s removal from the sterilizer and its aseptic transfer to the field.” The paper also emphasized that an instrument has to undergo proper decontamination and cleaning before IUSS.

Despite backing the terminology change, the agency emphasizes that the use of IUSS should not be considered a substitute for maintain a sufficient inventory of instruments. It also lists instances in which IUSS is not acceptable, including for implantable devices, unless there is no other option available, and for the post-procedure decontamination of instruments used on patients who may have Creutzfeldt-Jakob disease or other prion-associated diseases.

The memo also lists questions surveyors should ask to determine if IUSS is being used incorrectly. “If there is evidence to establish that the answer to any of the following questions is ‘no’ or the provider or supplier is using IUSS in a manner that places its patients at risk for infection,” a citation may be warranted, CMS said.