Infection control is a compliance issue
The Joint Commission and the Accreditation Association for Ambulatory Health Care (AAAHC) report that compliance with infection control standards is an ongoing problem.
In the first half of 2010, 23% of ambulatory organizations accredited by The Joint Commission were out of compliance with IC.01.03.01: The organization identifies risks for acquiring and transmitting infections. Additionally, 22% of ambulatory organizations were out of compliance with IC.02.02.01: The organization reduces the risk of infections associated with medical equipment, devices, and supplies.
AAAHC reports similar compliance issues. "I receive lots of calls from accredited organizations or organizations interested in being accredited who want to discuss their high level disinfection or sterilization procedures," says Marsha Wallander, RN, assistant director of accreditation services at AAAHC. "One of the issues in that topic is always the adequate and appropriate precleaning of devices."
Providers can't simply throw devices in an autoclave, Wallander says. "If an item isn't precleaned appropriately before it goes into its final disinfection or sterilization process, whatever bio film has been left behind because of poor or inadequate precleaning is very likely to become caked or baked or cemented in place," she says.
The precleaning of equipment is one of the most important steps in making sure equipment is safe to use on patient, Wallander says.
Note manufacturers' recommendations, she says. If using high level disinfection for example, are you diluting the disinfectant appropriately? "Some chemicals are used straight out of the bottle," she says. "Some are diluted one part to 10 parts." Wallander compares the process to following the instructions on a box of cake mix. "You can end up with cake, but if you use too much milk, you'll have a different outcome," Wallander says.
Another related issue for accredited organizations is how to start monitoring surgical site infections, Wallander says.
"Part of surveillance and infection control is monitoring the types of procedures you're doing, the types of equipment that you have on hand, and also your high demand or most performed procedures," she says.
Surveillance has to be tied into risk management and into quality improvement, "and this can sometimes be a complex issue for our organizations," Wallander says.
Environmental is a problem area
Another area that accredited organization struggle with is environmental, Wallander says.
"The busier you are, the faster you are turning around the room," she says. Many organizations now have rather a complex cleaning program, Wallander says. For example, the nurses might be charged with cleaning some of the semi-critical or critical pieces of equipment, and a surgical tech or housekeeping employee might be charged with cleaning other items in the OR. A cleaning service might come in at night.
"It's interesting to note that when you have so many people involved in this sort of complex cleaning that must be done, sometimes one group of people think someone else is cleaning that [item], so no one cleans that," Wallander says.
It's critically important that the administration know who is responsible for cleaning what, with what products, and when, she says. "Sometimes it's done by people who are either employees or contracts individuals who receive training according to the telephone," Wallander says. Like the child's game of telephone, where a sentence is passed around a circle and becomes distorted, training instructions can be miscommunicated, she says.
There need to be written guidelines, she says. This point is brought home by an incident she heard about a housekeeping person who read the label of a cleaning supply that said to use one ounce of the cleanser. "But she thought if 1 ounce was good, 2 ounces would be better," Wallander says. "It's not necessarily so.
When products aren't diluted appropriately, it can leave behind a sticky residue that adheres to germs and infective sources, she says. Also, the reverse is true, Wallander says. "If there's not enough product, you might not be working with a product that has an appropriate kill rate."
The Joint Commission and the Accreditation Association for Ambulatory Health Care (AAAHC) report that compliance with infection control standards is an ongoing problem.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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