Infection prevention has been top of mind for healthcare providers for years. Yet, The Joint Commission recently reported that in 2017, 60 percent of ambulatory care facilities, 72 percent of hospitals and 62 percent of office-based surgery practices still were “not compliant” with its standard to “reduce the risk of infections associated with medical equipment, devices and supplies.”
Surprising? Maybe. Maybe not.
“When you think of the sheer number of opportunities for cleaning and performing low-level disinfection of medical equipment, devices, and supplies daily within a healthcare facility, you can imagine how challenging it is to ensure that correct processes are followed each and every time,” says Megan DiGiorgio, MSN, RN, CIC, FAPIC, clinical manager for GOJO Industries. “In addition, many different healthcare workers might clean or disinfect items, and they have various levels of training, depending on their role.
“Performing processes correctly all the time, every time, is critical to patient safety, and healthcare facilities are working towards meeting The Joint Commission Standard. But it’s not going to happen overnight. There must be a continuous focus on quality in order to see improvement.”
Sylvia Garcia-Houchins, MBA, RN, CIC, director of infection prevention and control for The Joint Commission, says there are plenty of reasons for the recent statistics:
- Instrumentation and equipment are more complex than ever before.
- Manufacturers’ instructions for cleaning and disinfection need to be improved.
- Cleaning and disinfecting surgical instruments is a tough, demanding job.
“Nobody goes to work to do a bad job,” she says. “We need to give people the resources to do a good one,” she says.
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Exacting work
“Today’s high-tech items can do things we never thought possible,” says Garcia-Houchins, pointing to ERCP scopes as just one example. “But with that comes incredible complexity. We’re not talking about cleaning and disinfecting scalpel blades and forceps.” On top of that, different types of equipment and instrumentation call for different processing techniques. Those in the OR and central sterile processing need to stay on top of all those requirements.
Medical device manufacturers don’t always make it easy.
“I have trouble reading the instructions for cleaning an endoscope from a leading manufacturer,” she says. In fact, she checked the readability stats of those instructions and found them to be at the 20th reading level. That’s the stuff that people with master’s degrees and PhDs read.
Then there are simply the demands of the job, which are high, says Garcia-Houchins.
“You’re asking people to take something with very high bacterial burden, and bring those levels down so the device can be disinfected. Cleaning is the key step.” Not everyone in the OR or central sterile uses the same technique or possesses the same skill levels. The workloads are demanding, and setting priorities in a busy OR can be difficult.
“You’re depending on people to do the greatest job possible, over and over again, and that’s challenging. The devil is in the details – reading every single line of instructions, making sure you dot all the ‘i’s and cross all the ‘t’s. Then think about all the different types of medical equipment and devices in use, each with its own cleaning and disinfection instructions.”
Challenging? Yes. Hopeless? No.
Solutions
“As with any problem that is complex, there isn’t a single solution,” says DiGiorgio.
“Education alone won’t solve the problem,” she says. “A multifaceted approach is needed, and support at all levels of the organization is critical to ensuring sustained improvement. The Joint Commission outlines the key elements of performance that healthcare facilities need to follow to demonstrate commitment to improvement, including training and competency, adequate staffing and supervision, process standardization and reinforcement, and ongoing quality management.”
Distributor reps should take the time to ask their customers about their challenges, and then determine how their products can help customers overcome them. “In my experience, too often reps lead with their solution,” she says “By taking the extra time to get to know the customer’s needs, you’ll establish a better relationship up front and going forward.”
Garcia-Houchins believes it is up to the leaders in the processing area to help their employees do the best job they can. Some examples:
- Make sure that lighting is adequate.
- Rotate duties in the processing area, so people don’t have to bend over for hours at a time.
- Give people a break. Who can wash dishes – let alone complicated medical devices – for eight hours straight?
- Improve the workspace. Is there adequate counter space? How about sink access? Warm water?
Garcia-Houchins suggests posting step-by-step processing instructions on wall charts. “Some people are visual, some are more auditory. Consider providing video or audio processing instructions.
“Processing is not a job you can do quickly. People need the time to do it carefully and consistently. And that goes back to the hiring process. There is a certain kind of person you will need to hire.” Hire them and give them the support they need to succeed, she says.