title: An evaluation of immediate-use steam sterilization practices in adult knee and hip arthroplasty procedures.
abstract: BACKGROUND
  Immediate-use steam sterilization (IUSS) is a safe method to sterilize emergently contaminated instruments, but inappropriate use may lead to an increased risk for surgical site infection. This study aimed to identify risk factors, rationale, and variability in procedural adherence in cases of IUSS.
  
  
  METHODS
  This retrospective, case-control study compared adult patients undergoing hip and knee arthroplasty in which IUSS was (n = 104) and was not (n = 81) performed.
  
  
  RESULTS
  Multivariate analysis revealed 4 predictive risk factors for IUSS: history of malignancy (odds ratio [OR], 3.2 [95% confidence interval (CI) 1.1-9.3]), obesity (OR, 2.3 [95% CI: 1.02-5.2]), procedure performed in operating room 13 (OR, 2.5 [95% CI: 1.2-5.4]), and Monday procedure (OR, 3.6 [95% CI: 1.4-9.1]). The only factor that protected against IUSS was performing the procedure in the morning (OR, 0.4 [95% CI: 0.2-0.96]). Only 9.5% of cases of IUSS involved an acceptable indication. Documented adherence to core practices was also variable.
  
  
  CONCLUSIONS
  Several patient- and case-specific factors can help predict the incidence of IUSS. Furthermore, practices should be hardwired to ensure IUSS is utilized for the correct indication. Documentation must be improved to allow institutions to accurately track IUSS.
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Zuckerman
authors.forename: Ravi
authors.initials: R
authors.lastname: Parikh
authors.forename: David C
authors.initials: DC
authors.lastname: Moore
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Talbot
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D006302:Health Services Research; D006621:Hip Joint / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013242:Sterilization / Q000379:methods*; D055815:Young Adult