1. Infection Prevention and Control Issues Related to Ambulatory Surgery Centers (ASC)
Kathleen Dunn-Cane, MS, RN-BC Field Representative, Ambulatory Care The Joint Commission

2. Learning Objectives At the conclusion of this presentation,
the participant will be able to:
1. Identify elements that contribute to Infection Control findings in ASC’s
2. Identify specific infection control elements that contribute to an Immediate Threat to Life (ITL) determination

3. Risk Assessment IC.01.03.01 Risk Event Probability of Occurrence
Likelihood of Infectious Transmission to Others
Severity of Infectious Outcome
Risk Level

4. Risks for Acquiring and Transmitting Infection
Organization-wide
Ambulatory Surgery Centers/Clinics
New programs
Whenever risks significantly change

5. Basic Steps Risk Assessment Plan Set Goals “Best” Evaluate Re-Evaluate
Strategies
Implement Strategies
Evaluate Re-Evaluate
(Document/Report)
Collect Data: Internal/External
Analyze
Prioritize
Explain Why?
Measurable Timeframe
Collect Surveillance Data
How will you achieve the goals?
11/7/13

6. Evaluating IC Plans
IC evaluates annually and whenever risks significantly change
Includes review of the following:
Prioritized risks
Goals
Implemented plan activities
Communicated at least annually (ie. Patient Safety Committee)

7. Infection Prevention and Control Plan
Risk assessment
- Risk events
- IC Program goal(s)
- Strategies to meet goals
- End of year evaluation
- Status (Met or Not Met)

8. IC related NPSG’s Goal 7 – Healthcare-associated infections
Hand Hygiene-
CDC or WHO Guidelines
Set Goals for improving compliance
Assess compliance with established guidelines through a comprehensive program monitoring compliance and providing feedback
Improve compliance based on goals

9. IC related NPSG’s Goal 7 – Healthcare-associated infections
Surgical Site Infections (SSI)
Educate staff/patients on prevention
Implement policies/procedures on reducing risk of SSI
Conduct periodic assessments using evidence-based guidelines
Monitor compliance
Evaluate the effectiveness of prevention efforts

10. IC Considerations during Emergency Management
Emergency Management Scenario: EBOLA or Pandemic influenza
Surge of infectious patients
Additional Resources: Pandemic/Public Health
Ebola Preparedness Resources
   

11. Risk Reduction
IC The organization reduces the risk of infections associated with medical equipment, devices, and supplies
EP 2 Performing intermediate and high-level disinfection and sterilization of medical equipment, devices, and supplies

12. Risks in Reprocessing Medical 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 12

13. Reprocessing Process for Sterilization
Point of Use/Removal of gross soil
Transport to Processing Area
Preparation for Cleaning/Cleaning
Inspect/Package
Sterilization
Storage
Manual
Auto-
mated 13

14. Spaulding Classification System
Classification of devices, processes, and germicidal products
Device Classification
Device (examples)
Spaulding process classification
EPA product classification
Critical (enters sterile tissue or vascular system)
Implants, scalpels, needles, other surgical instruments, etc.
Sterilization – sporicidal chemical; prolonged contact
Sterilant/disinfectant
Semicritical (touches mucous membranes [except dental])
Flexible endoscopes, laryngoscopes, endotracheal tubes, and other similar instruments
High-level disinfection – sporicidal chemical; short contact
Noncritical (touches intact skin)
Thermometers, hydrotherapy tanks
Intermediate-level disinfection
Hospital disinfectant with label claim for tuberculocidal activity
Stethoscopes, tabletops, bedpans, etc.
Low-level disinfection
Hospital disinfectant without label claim for tuberculocidal activity
Modified from Favero MS, Bond WW. Chemical disinfection of medical and
surgical materials. In: Block SS. Ed. Disinfection, sterilization and
preservation. 4th ed. Philadelphia: Lea & Febiger 1991:627 14

15. Reprocessing Process for High-level Disinfection (HLD)
Point of use/Removal of gross soil
Transport to processing area
Clean
HLD
Rinse
Dry
Store 15

16. Quality Monitoring of Sterilization
Mechanical/Physical Indicators
• Displays, printouts
• Indicates if equipment working
properly
•Not indicator of sterility 16

17. Quality Monitoring of Sterilization
Chemical Indicators
•Change color with timed exposure to
heat, steam
•Used to show items have gone
through sterilization process
•Not indicator of sterility 17

18. Quality Monitoring of Sterilization
Biological Indicators
- Demonstrates bacterial spores on test
strips or in vials/containers have all
been killed
- Indicator of sterility 18

19. Quality Monitoring of HLD
High-level disinfectants are prepared according to manufacturer’s instructions for use
Length of time
Temperature
Documentation/logs
Test strips – labeled, expiration date, follow instructions for use, correct test strip for solution 19

20. Equipment storage and IC Considerations
IC EP4 Storing of medical equipment, devices, and supplies
Sterile storage
Scope storage-
In a manner to prevent re-contamination after disinfection
policy on “hang time”, the maximum time scopes may be stored without being reprocessed

21. To Do List: 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 investigate reprocessing breaches/lapses? What actions do you take?

22. Immediate Threat to Health or Safety (ITL) Related to IC
Situations identified on site
Have or potentially may have serious
adverse effects on the health or safety
of patients

23. ITL’s Identified while on survey
Standards Interpretation Group (SIG) survey report review
Office of Quality Management (OQM) submitted complaint
Identified during Abatement Survey

24. Frequent Noncompliant IC Standards
IC The organization identifies
risks for acquiring and transmitting
infections
IC The organization reduces
the risk of infections associated with
medical equipment, devices, and
supplies

25. ITL’s Potential risk of infection to patients
associated with medical equipment,
devices, and supplies
Infection control breaches identified in
the cleaning, disinfection, and
sterilization process of endoscopes,
surgical instruments and devices
Lack of knowledge, adherence, or
availability to evidence-based guidelines
pertaining to high-level disinfection (HLD)or
sterilization
– HLD product use and following
manufacturer’s instructions for use not
demonstrated
– Documentation ( maintaining logs) on HLD
and sterilization to allow for traceability back
to the patient, a recall event, and for quality
monitoring purposes not performed
– Incorrect use of biological indicators (BI’s) and controls; use of expired BI products

26. ITL’s Lack of knowledge, adherence, or
availability of evidence-based guidelines
pertaining to high-level disinfection
(HLD)or sterilization
Improper HLD product use- not following manufacturer’s instructions

27. ITL’s No documentation (logs) on HLD
and sterilization to allow for traceability
back to the patient, a recall event, and
for quality monitoring purposes not
performed
Incorrect use of biological indicators
(BI’s) and controls; use of expired BI
products

28. ITL’s Lack of orientation, training, and
competency of staff involved in the
processing or handling of medical
equipment, devices and supplies
Lack of a qualified professional who
has training in infection prevention and
control and has responsibility for
infection prevention and control within
the ambulatory center

29. Resources
2008 CDC Guideline for Disinfection and Sterilization in Healthcare Facilities.
ANSI/AAMI ST58:2013 Chemical Sterilization and high-level disinfection in healthcare facilities

30. Resources
ANSI/AAMI ST79:2010 & A1:2010 & A2:2011 & A3:2012 (Consolidated Text) Comprehensive guide to steam sterilization and sterility assurance in health care facilities

31. Resources
2013 AORN Recommended Practices for Perioperative Nursing – Sterilization and Disinfection
Disinfection – High-level
Flexible Endoscopes – Cleaning and Processing

32. Resources
2013 SGNA Guidelines for the Use of High Level Disinfectants & Sterilants for Reprocessing Flexible Gastrointestinal Endoscopes
2012 SGNA Standards of Infection Control in Reprocessing of Flexible Gastrointestinal Endoscopes