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Equipment disinfection compliance continues to plague many hospitals


January 1, 2013

Equipment disinfection compliance continues to plague many hospitals

IC.02.02.01 remains in the top ten Joint Commission citations, indicating that hospitals need to review their entire process

Proper disinfection of medical equipment and devices can be an intense and sometime elaborate process, but one that is crucial to patient safety.

According to statistics provided by Joint Commission Executive Briefings, the standard that governs this process (IC.02.02.01) ranks as the fifth most-cited Joint Commission standard among hospitals in 2012, with 39% of hospitals receiving citations. The statistic reveals that despite the increased focus on having thorough and specific procedures for cleaning various pieces of medical equipment, noncompliance with even one step of that process can cause regulatory pitfalls in addition to patient safety risks.

The elements of performance for IC.02.02.01 require that hospitals implement infection prevention activities when performing low-level disinfection, intermediate and high-level disinfection, sterilization, disposal and storage of medical equipment, and reprocessing of single-use devices. However, the devil is in the details, since facilities need to ensure they are specifically following manufacturer's instructions for various pieces of equipment, and that staff members are appropriately trained and complying with each step of the disinfection or sterilization process.

This particular standard is one that emphasizes the importance of each particular step in reprocessing patient care equipment, says Libby Chinnes, RN, BSN, CIC, infection prevention and control consultant and owner of IC Solutions, LLC, in Mount Pleasant, S.C.

"This is probably one area that is most fraught with inconsistencies," Chinnes says. "An employee may have been trained upon hire on sterilization and disinfection 10 or 15 years ago and never had any more training or oversight."

Given the relatively high rate of noncompliance and the intricate process that's required for instrument ­disinfection, healthcare facilities need to take a closer look at ­appropriately training and retraining staff members and ensuring there is a detailed and effective policy in place to prevent noncompliance.


Walk through the process

One way to both evaluate your equipment disinfection and sterilization process and prepare for a Joint Commission survey is by periodically tracking an instrument through all the steps of reprocessing.

Peggy Prinz Luebbert, MS, MT(ASCP), CIC, CHSP, owner and consultant for Healthcare Interventions, Inc., in Omaha, Neb., recently worked with a facility as it was going through a Joint Commission survey. The surveyor followed a piece of orthopedic equipment through the entire process to ensure compliance during each step.

"They followed that piece of equipment from clean storage to the OR and then back again," Luebbert says. "They wanted us to talk through how we would use it and how it was disinfected."

Specifically, the surveyor wanted to see the following:

  • How did staff members use the equipment in the OR?
  • How was it stored in the OR?
  • How was it brought back to the central services and sterile processing department?
  • Did central services and sterile processing perform manual or automatic cleaning? What agents were used in these processes?
  • How was the equipment sterilized?
  • What physical chemical and biological indicators were used and how were they monitored?
  • What process did the facility use if one of these indicators failed?


The cleaning portion of the process is particularly important and one that surveyors will be focusing on, Chinnes says. This is especially true with instruments like endoscopes due to their intricate design and delicate nature.

"Failure to perform meticulous cleaning may lead to disinfection and sterilization failures, which contribute to infections and outbreaks," she notes.


Check the manufacturer's instructions

Joint Commission surveyors will also want to see that the facility has access to manufacturer's instructions for each piece of equipment to ensure the recommended cleaning processes are being followed. Luebbert helped her facility contract with a company called One Source, which locates and stores all manufacturer's instructions specific to your facility in a personalized online inventory.

"Both CMS and Joint Commission surveyors asked about manufacturer's instructions on pieces of equipment," Luebbert says. "For example, with the laryngoscope blades they had questions about how we stored those, and they wanted to see if they were packaged after they were disinfected."

Regardless of whether you have the instructions organized in a binder or stored on a laptop, they need to be available to staff members. ­Contact equipment manufacturers to obtain posters of the reprocessing procedures for specific equipment, which can then be placed on the wall in the reprocessing area as a reminder for staff, Chinnes says.


Training staff members

Initial training and periodic retraining is crucial to the success of your disinfection and sterilization program.

Both human error and racing against the clock can cause disruptions in the process and noncompliance with proper procedures, Chinnes says. Over time, steps in the disinfection process may be forgotten or omitted simply because the person doing the job is overwhelmed, busy, or being pressured to speed up the process.

"Since we're human, sometimes we skip steps or don't wear the PPE," Chinnes says. "I've seen staff hold dirty scopes against their uniform to transport to the ­decontamination area. Every step of this process is important, but you need to do step one before step two and make sure it's followed each time to protect the patient and the healthcare worker."

Staff members should be trained to routinely monitor (and document) the disinfection and sterilization processes as well. For sterilization, a combination of mechanical, chemical, and biological indicators should be used per manufacturer's instructions, and results should be documented. For high-level disinfectants, routinely test the disinfectant through use of product-specific test strips to ensure minimal effective concentration of the active ingredient. Check the solution each day of use (or more frequently). If the solution fails or if its expiration has been reached, discard it and prepare a fresh solution.

For their own protection, staff members should also know what to do if there is a spill. Surveyors will often ask staff members what kind of high-level disinfectant they use and what risks are associated with that disinfectant. "Potential exposure to chemicals should be part of your department education at least upon hire and as needed," Luebbert says. "Lots of departments will place them on their annual competency if they have some high-risk chemicals that they are using."


Immediate-use sterilization

Immediate-use sterilization-or "flash sterilization" as it used to be called-is a particular area of focus for surveyors. This sterilization method should not be used due to insufficient inventory of instruments; it should only be used when there is not enough time to process an instrument using the preferred wrapped/container method per the Association of periOperative Registered Nurses.

"That's where a lot of facilities are getting dinged, from hospitals right down to surgery centers, in that they are flashing too many things," Chinnes says.

If immediate-use sterilization is occurring frequently in your facility, it may be a sign that you need to retrain staff members, reevaluate your inventory, or reschedule surgical cases to allow more time for the preferred sterilization method.

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