Education Top Ten Sterilization Issues in an …

1 1070 May 2010 Trainingby Peggy Prinz Luebbert, MS, MT(ASCP), CIC, CHSPTop Ten Sterilization Issues in anAmbulatory Surgery CenterObjectives After completion of this self-study activity, thelearner will be able 10 key areas in cleaning and sterilizationthat a Centers for Medicare and MedicaidService (CMS) surveyor may evaluate during asite visit to an ambulatory surgical center (ASC). proper practices and documentationrequirements in these key three primary sources for professional guid-ance in cleaning and Sterilization practices Questions space is limited, patient care items may be stored inthe decontamination TrueB. area where surgical items are decontaminated shouldhave negative air pressure with room temperature between16-18 C (60-65 F).A. TrueB. sterile items received from a manufacturer can bestored indefinitely under event related sterility TrueB.

2 For Medicare and Medicaid Service ( CMS)requires that someone with infection prevention training[preferably a certified professional (CIC)] oversee thesterilization TrueB. items once opened in the operating area must becleaned, rinsed and sterilized with the same process asones actually used in the procedure. A. TrueB. qualification testing of a table-top sterilizer, a biolog-ical indicator ( BI) should be placed inside a processchallenge device (PCD) that is representative of the sametype of package or tray that is routinely TrueB. items secured in paper-plastic peel pouches shouldbe placed inside wrapped trays or containers for TrueB. you change lot numbers of the sterilized biological indi-cators (BIs) during the day then you need to run anotherpositive BI control with the same lot TrueB.

3 Package in a Sterilization load should be labeled withthe Sterilization date, the sterilizer number, and thenumber of items in the TrueB. allows the use of wrappers or containers for flashsterilization as long as all manufacturers instruction forthe devices are TrueB. FalseMany thanks to the team at 3M Health Carefor working with provide thefollowing accredited course. IAHCSMM hasawarded 1 contact point for completion of thiscontinuing Education lesson toward IAHCSMM recertification. The CBSPD has preapproved thisinservice for 1 contact hour for a period of five(5) years from the date of publication, and to beused only once in a recertification period. Thisinservice is 3M Health Care Provider approvedby the California Board of Registered Nurses,CEP 5770 for 1 contact hour.

4 This form is validup to five (5) years from the date of for submitting results are on page 92. and 3M Health Care will beworking collaboratively to provide continuingeducation courses in monthly editions 2010 many ambulatory Surgery Centers (ASCs) the Centers forMedicare and Medicaid Service (CMS) surveys will be the first time anyagency of any type has entered their facilities to inspect their environ-ment and practices. It can be overwhelming! I have had the opportunityto assist multiple ASCs in preparing for these inspections in a variety settings ( , orthopedic, eye, plastic surgery, general surgery). Ihave come across some common environment and process Issues that arenot up-to-date with current recommendations and guidelines. Theseissues may lead to citations when CMS walks in the door.

5 In this docu-ment, we will look at the Top Ten Sterilization Issues often observed inASCs. Please note that these concerns are not limited to just ASCs. Anyfacility that performs decontamination and Sterilization processes can beguilty of noncompliance in these areas. Also, note that there are otherconcerns both related to this scope of practice that we will not discusstoday. For example, one area where noncompliance is often seen is thatof safe injection practices. More information on these recommendationscan be found at the following Web site: Concerns With the Decontamination RoomMany ASCs (and hospitals) over time have not proportionatelyincreased space for physical processing of contaminated equipment astheir workloads increased. So today, these areas are frequently of poordesign and less than ideal.

6 I have also seen ASCs who have adapted inap-propriate spaces not meant for decontamination ( , hallways, closets,etc.) and are now unable to use proper workflow to move items progres-sively from being contaminated to being safe to to the guidelines and recommendations the decontamina-tion room should be a restricted area where only those working shouldenter. This area should contain only dirty contaminated items and theequipment necessary to decontaminate them. The Association for theAdvancement of Medical Instrumentation Comprehensive guide to steamsterilization and sterility assurance in health care facilities,ANSI/AAMI ST79:2006, A1:2008 and A2:2009, section states thatphysically the room should contain: Enough space to accommodate the activity that takes place there; Floors and work surfaces that are easy to clean and dry.

7 Carpetshould not be used in these work areas; Ceilings that are constructed to create a flush surface with recessed,enclosed pipes and fixtures. The ceilings should be constructed ofmaterials that are not of particulate- or fiber-shedding compositionsuch as seen in drop down ceiling with particleboard panels; Equipment in the room should be constructed to limit areas wheresoil and organisms could hide. Limit bulletin boards, art works, etc; Good general lighting and special lighting over work areas that mayinclude magnifiers with light for better visualization of fine anddelicate instruments should be present while cleaning; Eyewash stations should be available within 10 seconds travel should have the ability to flush a site for 15 minutes if needed; and Housekeeping cleaning supplies for this area should be separatefrom those used in clean prep or patient areas.

8 These areas should beEducation& Trainingcleaned daily as you would for all otherpatient care areas in the facility. A lowlevel disinfectant should be usedaccording to manufacturers copy of these instructions along withthe chemicals material safety data sheets( MSDS) should be easily should be comfortable with theinformation in both of these supplies that are used in the decon-tamination process should not be removed foruse in other areas of the facility. In theCenters for Disease Control s (CDCs) 2007 Guideline for Isolation Precautions: PreventingTransmission of Infectious Agents in Heatlh-care Settingssection II. J. and AAMI ST79,section it is noted that clean and dirtyequipment should be ,2 Considerthat the drawers, cupboards and open shelvesnear the decontamination work sink are allcontaminated by aerosolization of soiledcleaning liquids or by persons accessingitems from those areas.

9 If others must accessthe extra items and there is not a clean storagearea outside the decontamination room, aclose cupboard might be placed at the door tothe area, far away from the sink. It should belabeled clean storage to remind everyone notto touch it with soiled hands or gloves. Patient care items should never be storedin the decontamination area. The room orspace used for decontamination should not beused for clean processing unless absolutelynecessary. Even then, a facility is at risk ofbeing cited by CMS since it would be verydifficult to validate that staff are maintaining clean and dirty areas. If space is solimited that the decontamination room has tobe used for clean processing, the workflowshould move from dirty to clean and therecommendations noted above should beimplemented and enforced as much aspossible.

10 It is not acceptable to use an area fordecontamination, clean it and then use thesame space for cleaning as noted in AAMIST79 section First of all, we all knowthat in a day-to-day work environment staffwill not take the time to clean the area beforeplacing clean equipment on it and second ofall it would be difficult to document that thisis actually your 2010 Training Request the healthcare worker to describe the flow of itemsfrom the OR suite to the sterilizers. Ventilation, Temperature and HumidityProper air movement and moisture is key to limiting the risk ofmovement of microorganisms from dirty areas to clean. Many ASCsagain have adapted spaces not meant for decontamination and havea difficult time implementing and monitoring this air movement inorder to maintain proper ventilation and air ST79 in section states that air in a decontamina-tion room should be under negative pressure with at least 10 airexchanges per surveyor can quickly check this by holdingthe door into a room open about one inch and holding a tissue up tothe opening.