Issues & Legislative Committee Reports

June 11, 2009

JCAHO / GPO Oversight Committee

Steam Sterilization - Update on The Joint Commission's Position
The Joint Commission has been in discussion with multiple professional and trade organizations in regards to the common and proper use of sterilization using steam. Recently, some decisions have been made which will have an impact on the interpretation of standards as well as the survey process.

In reviewing this method of sterilization, several issues have emerged including:

• The terminology used to describe the sterilization process. Flash sterilization is the most common term used to describe certain types of steam sterilization that do not utilize a full (also known as terminal) cycle. Originally, this term meant sterilizing unwrapped instruments using steam for 3 minutes, at 270 F. at 27 to 28 lbs of pressure. Over the last several decades, a number of improvements have been made to this process, such as longer exposure of the instruments to steam, the use of special trays and packs to hold and protect the instruments, and the routine use of biological indicators.
• Indication-related issues that involve the selection of the sterilization cycle or method. Previously, the selection of a sterilization cycle or method was a primary focus during a survey. Now surveyors will be looking more closely into all aspects of the sterilization method or cycle (see the next bulleted item regarding process-related issues). Examples of findings would be a high percentage of steam sterilization using less than a full sterilization cycle, as well as exclusive use of this process for certain types of instruments.
• Process-related issues involving the way that a given sterilization method is executed. Examples of findings would be failure to adequately clean the instruments before sterilization, lack of chemical indicators, and transporting uncovered instruments back to the operating room after they have been sterilized.
• Based on discussions with experts in the field, professional organizations, and government organizations, The Joint Commission has decided to refocus its survey efforts on all of the critical processes included in sterilization. If a complete and effective process of sterilization is used, it will be considered an effective sterilization method. Therefore, surveyors will review the critical steps of disinfection and sterilization to determine if the process is appropriate.

Surveyors will, among other activities: Observe instruments from the time they leave one operating room to when they are returned to the next; ask healthcare workers to provide the manufacturers' instructions for instrument sterilization, and to describe and demonstrate how instruments are being cleaned and decontaminated according to those written instructions; observe the cleaning of instruments. Rinsing is rarely enough to properly remove soil from instruments; meticulous cleaning is needed; verify that staff members are wearing appropriate personal protective equipment; Observe the sterilization process. The surveyor will ask for the manufacturer's instructions for the following items: the sterilizer, wrapping or packing, and the instruments; Review sterilization logs. Surveyors will ask about parametric, chemical, and biological indicators; Observe the return of instruments to the sterile field and verify that they are being protected from recontamination. Visit here for more information.

Source: HPN Daily Update – June 26, 2009/AHRMM eNews June 30, 2009

Quality / Medication Errors / Safety Issues

Safety

“CHG Sponge helps prevent catheter-associated infections”
Materials Management in Healthcare,  May 2009, pg. 4

A $6 medicated sponge can reduce dramatically the catheter associated infection rate for high-risk intensive care patients, a new study demonstrates. The randomized, controlled study was conducted at four hospitals in France. It included 1525 patients with central venous or arterial catheters during ICU stays of up to 10 days. It tested the effect of a sponge containing the antimicrobial agent chlorhexidine gluconate (CHG) on the rate of bloodstream infections. It released CHG over time and prevents regrowth of microbes during catheter use. The product is called BIopatch. The study was published in the March 24 “Journal of the American Medical Association”. This study round the Biopatch use reduced the rate of clinical sepsis by 61% and the rate of catheter-related infection by 75%. It also allowed for longer times between dressing changes. According to the CDC, 80,000 ICU patients in the US develop bloodstream infections from catheter annually, adding up to $56,000 to the cost of their treatment.  However, current CDC guidelines which date from 2000, do not recommend Biopatch use and that has made materials managers reluctant to contract for it.

Medication Errors

“Medication errors in critical care: Risk Factors and prevention”

Source: Canadian Medical Association Journal

Medication errors account for 78% of serious medical errors in the intensive care unit (ICU) but there are strategies that can help reduce errors and improve patient safety. Strategies to prevent medication errors including eliminating extended physician work schedules, computerizing orders and intravenous devices, having pharmacists participate in the ICU, reconciling medications upon admission to or discharge from the ICU, and maintaining detailed, up-to-date medication lists. Click here  for the full article.

Supply Chain Standards – GS1/HSCSC

The Standards Stat! video made its debut last month. The six-minute video is a general overview of why standards are necessary and features speakers from various parts of the supply chain and the government. It was designed to be appropriate for a broad audience – CEOs and CFOs of companies and hospitals, Materials Managers, Directors, basically anyone working in the healthcare supply chain or in a position to influence the standards movement. It can be viewed on AHRMM’s standards microsite, http://www.ahrmm.org/ahrmm_app/ext/standards/.