ACS Bulletin - August 2017

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.)