© Copyright, The Joint Commission The employees and/or speakers for this presentation have...

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The employees and/or speakers for this presentation have disclosed that they do not have any financial arrangements or affiliations with corporate organizations that either provide educational grants to this program or may be referenced in this activity.

Furthermore, each of the previously named speakers has also attested that their discussions will not include any unapproved or off-label use of products.

Disclosure Statement

The Down and Dirty of Sterilization

OR Today – Surgical Services Conference

August 31, 2015

Lisa Waldowski MS,APRN,CIC

Infection Control Specialist

The Joint Commission

At the conclusion of this presentation, the participant will be able to:– Relate Infection Prevention and Control

Standards and IC-related NPSG’s to challenging areas in the field of Infection Prevention and Control – NPSG’s– Medical Equipment, Devices, and Supplies

Learning Objectives

Hand HygieneSSI’s

IC related NPSG’s Goal 7 – Healthcare-associated infections

(HAI’s)

Center Infection Focus Areas

ConfidentialSeparate from Accreditation

Guided Robust Process ImprovementMeasure current stateAnalyze causesSelect targeted solutionsSustain and spread improvements

MOVING TOWARDS RELIABILITY

Robust Process Improvement® leads to dramatic results

Center Projects Results(%)

Hand hygiene 71Colorectal SSIs 32

Milbank Q 2013;91:459-90

RELIABILITY

Jt Comm Journal on Qual Pat Safety 2015;41(1):4-12 and 13-25

IC.02.02.01 The organization reduces the risk of infections associated with medical equipment, devices, and suppliesEP2 Performing intermediate and high-

level disinfection and sterilization of medical equipment, devices, and supplies

EP4 Storing medical equipment,devices, and supplies

Related Standards

Overarching Risks in ReprocessingMedical Equipment, Devices, and Supplies

Not adhering to manufacturer’s

instructions for use (IFUs)

Not following recommended practices

or evidence-based guidelines

Lack of documented staff competency

Lack of competent, trained managerial/supervisory oversight

IC involvement

Standards that support Sterilization

Human Resources – Staff competency and training– Infection Control Practitioner (ICP)– Managerial/Supervisory oversight

Leadership – Centralized versus de-centralized

locations conducting sterilization– to include off site locations

– Knowledge, support, and accountability

Environment of Care– Ventilation/pressure relationships

Infection Prevention and Control– Risk assessment, IC Plan– Quality monitoring process and

documentation – sterilization– Use of evidence-based guidelines

Monitoring Program:– Compliance to protocols– Assess if current P&P’s are effective– Document competency and training– Provide feedback to improve performance

How do you report reprocessing breaches/lapses? What actions do you take?

To Do List:

Case Study - Sterilization

No pre-cleaning at point-of-use

Leaving hinged items in the closed position

No documentation of sterilizer preventative maintenance/cleaning

One BI documented for the year 2015

Double peel packs; inner peel pack folded over/wet

Premature releasing of IUSS

No competency, training of frontline staff on file

Manager of OR has oversight with no competency/training

What do you do or say?

A. Do or say nothing.B. Opportunity to re-educate and train

staff on sterilization

processes.C. Reprocess all

instruments involved in these

breaches.D. Both B and C.

Efficient Workflow – Lean Process

Encompass reprocessing with related systems– Concentrate improvement effort on workflow

Eliminate variability (waste)

Reduce error

Standardize Work Practices

Determine process/best practice – Standardize to it

Involve frontline staff

Develop P&P

Train/Re-educate

Follow-up to assure sustainability and provide feedback

From OR to SPD and back again

Process efficiency

Questions to consider:– How often is a case delayed due to contaminated

equipment, devices, or supplies?

– What is the cost of a delayed case due to

contaminated equipment, devices, or supplies?

Articles

Wubben, I., Van Manen, J.G., Van Den Akker, B. J.,

Vaartjes, S.R., VanHarten, W. H. (2010).

Equipment- related incidents in the operating room:

an analysis of occurrence, underlying causes and

consequences for the clinical process. Quality &

Safety in Health Care, 19, 1-7.

doi:10.1136/qshc.2009.037515

Key Points

OR RN’s reported equipment related incidents over a 4 week duration

57.7 % response rate (911/1580)Equipment related incidents = 15.9%Non-sterile equipment = 5.4%Findings/Conclusions

– Under-reporting– Extra work, delays, added time per event

Articles

Wong, J., Khu, K.J., Kaderali, Z., &Bernstein, M.

(2010). Delays in the operating room: signs of an

imperfect system. Canadian Journal of Surgery, 53

(3), 189-195.

Key Points

1531 elective surgical cases (2000-2009) Delays (33.6%) = most common error type

occurring 51.4% of all cases had at least 1 delayContamination (ranked #3) = 24.4%Conclusions

– Human error and system deficiencies related to delays – most commonly equipment related

Measure Process Performance

Identify a process issue

What is real versus perception?

Measure facts

Obtain a baseline

Measure what you value

Trust Report Improve

High Reliability and Infection Prevention and Control

Adapted from AHRQ; Castle, Wagner, Ferguson & Handler (2011); Reason (2000)

Safety Culture

– Empowered to report errors

– Visible effective leadership

– Respectful treatment of staff

– Collaboration across departments

– Sense of teamwork

– Training and education

– Effective communication

Castle, Wagner, Ferguson & Handler (2011)

For Consideration …..

Internal/System resources

What can/is immediately corrected

Leadership response

Infection Control involvement

Patient risk, look-back, notification

Resources Sterilization:

- AAMI ST79:2010 & A1 & A2 & A3

Comprehensive guide to steam sterilization and sterility assurance in health care facilities

- AAMI Sterilization Part 1: Sterilization in Health Care Facilities, 2014.2 Edition

AORN 2015 Guidelines for Perioperative Practice

– Guideline for Sterilization

– Guideline for Cleaning and Care of Surgical Instruments

Resources

2008 CDC Guideline for Disinfection and Sterilization in Healthcare Facilities.

Resources

Email:

lwaldowski@jointcommission.org

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