Does ‘Flash Sterilization’ Affect Surgery Infection Risk?

Against the backdrop of Medicare opting not to pay for what they determine is preventable, a team of researchers from New York has delved into the relationship between immediate-use steam sterilization (“flash” sterilization) and surgical site infections.

Their work, “The Association of Immediate-Use Steam Sterilization with the Incidence of Orthopaedic Surgical Site Infections,” appears in the March 29, 2022, edition of The Journal of Bone and Joint Surgery.

Tyler J. Tantillo, D.O., with the Department of Orthopaedic Surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Huntington Hospital in New York, explained the genesis of this study to OTW, “We decided to perform this study now as healthcare reform to improve patient outcomes and reduce costs has been a recent focus within our hospital system.”

“With Medicare and Medicaid limiting reimbursements for conditions deemed preventable, such as surgical site infections, hospitals have enacted policies to decrease practices associated with increased infection risk. Immediate-use steam sterilization, formerly flash sterilization, is one such practice. It has been heavily scrutinized for increasing surgical site infections. Due to the lack of high-quality evidence, we decided to examine the association between immediate-use steam sterilization in orthopaedic cases and the incidence of surgical site infections (SSI).”

The research team collected data from nearly 71,000 patients from 10 hospitals in northeastern U.S. They then conducted a retrospective cohort study on that data and found an overall 1.57% infection rate. They also cited reasons for employing immediate-use steam sterilization as holes in the wrap and/or filter of the instrument tray, followed by instrument reuse and dropping.

“Based on our propensity score-matched study, we showed that there is no statistically increased risk of developing an SSI if immediate-use steam sterilization is used during an orthopaedic procedure,” explained Dr. Tantillo to OTW.

“Our findings challenge previous studies reporting a theoretical increased risk of SSI with immediate-use steam sterilization, formerly flash sterilization. Based on our study, we believe that it is safe to perform immediate-use steam sterilization during an orthopaedic procedure. While we acknowledge that this study may not change policy immediately, we hope to generate a discussion and encourage further studies in this area to improve patient outcomes and maintain quality.”