Improper sterilization and inadequate high-level disinfection (HLD) of medical
equipment can have devastating
effects on patients. Nevertheless,
substandard sterilization and
disinfection are relatively
common findings in on-site
surveys at health care institutions
seeking accreditation from The
Joint Commission. This problem
strikes at the core of surgery,
and a surgeon’s leadership on
this issue can play a large role
in enhancing an organization’s
processes for sterilization
and HLD of equipment.
In on-site surveys conducted
in 2016, The Joint Commission
reported at least one instance of
noncompliance with Infection
Prevention and Control (IC)
Standard IC.02.02.01, Element
of Performance (EP) 2. The
rates of noncompliance in
the following health care
settings were as follows:*
•Hospitals: 51 percent
•Critical access hospitals: 58
percent
•Ambulatory care: 43 percent
•Office-based surgery: 53 percent
Responding to increased
noncompliance
IC Standard IC.02.02.01, EP 2
states, “The practice implements
infection prevention and
control activities when doing
the following: Performing
intermediate and high-level
disinfection and sterilization
of medical equipment, devices,
and supplies. It is important to
note that sterilization is used
for items such as implants and
surgical instruments. High-level disinfection may also
be used if sterilization is not
possible, as is the case with
flexible endoscopes.”*
The Joint Commission has
been focusing ongoing efforts
on educating surveyors on the
challenges of sterilization and
HLD of equipment, which
has resulted in a keen eye on
surveying the areas where this
equipment is stored and used. As
a result, The Joint Commission
surveyors are now better able
to identify the problem and can
provide on-site education to
staff so they can better address
HLD and sterilization issues.
To further help organizations
with compliance and to raise
awareness of this critical
patient safety issue, in May,
The Joint Commission
published Quick Safety, Issue 33:
“Improperly sterilized or HLD
equipment—a growing problem.”
This report asserts that the most
vulnerable locations for lapses in
sterilization or HLD of equipment
are ambulatory care sites, including
office-based surgery facilities, and
decentralized locations in hospitals.†
Causes and effects
Many factors contribute to
noncompliance. The Joint
Commission’s Office of Quality and
Patient Safety listed some of those
reasons, such as the following:†
•Lack of knowledge or training in
proper sterilization techniques,
lack of HLD equipment, or
lack of access to evidence-based
guidelines
•No oversight by leadership
•Low priority assigned to
sterilization or HLD of equipment
• Lack of a culture of safety that
supports the reporting of safety risks
The consequences of failed
processes include the following:
•Patients placed at risk for
contamination
•Potential outbreaks of infections
•Potential loss of Joint Commission
accreditation
•Potential loss of Centers for
Medicare & Medicaid Services
(CMS) deeming status
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A LOOK AT THE JOINT COMMISSION
Improper sterilization and high-level disinfection
of equipment challenges organizations
by Carlos A. Pellegrini, MD, FACS, FRCSI(Hon), FRCS(Hon), FRCSEd(Hon)
* The Joint Commission on Accreditation of
Healthcare Organizations. Comprehensive
Accreditation Manual for Hospitals. Infection
Prevention and Control chapter. Oakbrook
Terrace, IL. 2017 update. (Manual and
corresponding updates are subscription-based.)
† The Joint Commission. Improperly sterilized
or HLD equipment—A growing problem.
Quick Safety, Issue 33. May 22, 2017. Available
at: bit.ly/2sBAqFp. Accessed July 6, 2017.
