© 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
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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
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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
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Hand HygieneSSI’s
IC related NPSG’s Goal 7 – Healthcare-associated infections
(HAI’s)
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Center Infection Focus Areas
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ConfidentialSeparate from Accreditation
Guided Robust Process ImprovementMeasure current stateAnalyze causesSelect targeted solutionsSustain and spread improvements
MOVING TOWARDS RELIABILITY
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Robust Process Improvement® leads to dramatic results
Center Projects Results(%)
Hand hygiene 71Colorectal SSIs 32
Milbank Q 2013;91:459-90
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RELIABILITY
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Jt Comm Journal on Qual Pat Safety 2015;41(1):4-12 and 13-25
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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
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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
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Standards that support Sterilization
Human Resources – Staff competency and training– Infection Control Practitioner (ICP)– Managerial/Supervisory oversight
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Standards that support Sterilization
Leadership – Centralized versus de-centralized
locations conducting sterilization– to include off site locations
– Knowledge, support, and accountability
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Standards that support Sterilization
Environment of Care– Ventilation/pressure relationships
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Standards that support Sterilization
Infection Prevention and Control– Risk assessment, IC Plan– Quality monitoring process and
documentation – sterilization– Use of evidence-based guidelines
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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:
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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
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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.
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Efficient Workflow – Lean Process
Encompass reprocessing with related systems– Concentrate improvement effort on workflow
Eliminate variability (waste)
Reduce error
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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
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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?
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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
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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
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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.
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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
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Measure Process Performance
Identify a process issue
What is real versus perception?
Measure facts
Obtain a baseline
Measure what you value
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Trust Report Improve
High Reliability and Infection Prevention and Control
Adapted from AHRQ; Castle, Wagner, Ferguson & Handler (2011); Reason (2000)
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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)
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For Consideration …..
Internal/System resources
What can/is immediately corrected
Leadership response
Infection Control involvement
Patient risk, look-back, notification
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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
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AORN 2015 Guidelines for Perioperative Practice
– Guideline for Sterilization
– Guideline for Cleaning and Care of Surgical Instruments
Resources
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2008 CDC Guideline for Disinfection and Sterilization in Healthcare Facilities.
Resources
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