Four infection control industry experts weigh in on a few of the best ways to ensure patient safety through improved infection control processes.
1. Make sure pre-owned equipment is in good condition. Making sure pre-owned equipment is in good condition before using it is imperative in preventing infection at your ASC, said Ray Midlam, product manager, certified pre-owned equipment for Olympus America. Be sure to find out if the model is still supported by the original equipment manufacturer, otherwise you may end up with a product with no access to replacement parts. "Certified" or "CPO" labels are no guarantee. Those are unregulated terms with no standards to support them. Ask the supplier what, in fact, their "certified" label means and how the product was repaired.
For example, if the equipment is an endoscope, did it undergo a rigorous refurbishment process with all parts inspected? Were the insertion tube and other worn or damaged parts replaced with OEM parts? If not, buyers beware: A scope that has been altered with third-party parts — even those purporting to be reverse engineered or "OEM-like" — is no longer FDA 510(k) compliant, which means it is no longer validated for reprocessing. Therefore, unless you are purchasing the pre-owned scope from the OEM, make sure to ask the seller for reprocessing validation for any of its modified parts. Also check with your facility's infection control department for any specific instructions relative to modified medical equipment.
2. Follow all manufacturer instructions. Manufacturer instructions are meant to promote optimal infection control, and disregarding any steps can leave an ASC vulnerate. For instance, generally, GI/endoscopy-driven ASCs go through a multi-stage high-level disinfection process. The first stage requires removal of gross contamination by suctioning the scope's channel with a high volume of water and detergent in addition to wiping down the exterior of the scope after a procedure.
Shaun Sweeney, vice president of sales and marketing for Cygnus Medical, said GI/endoscopy-driven ASCs often fall into the trap of skipping this crucial first step with the belief that jumping ahead to the second stage of brushing the scope will be sufficient enough in removing gross contamination.
"One of the biggest misnomers that I've come across is ASCs believe there is no need to suction the channel and wipe down the scope before soaking and brushing the equipment," Mr. Sweeney said. "To this day, a lot of people don't understand this first step is critical to make sure there is no gross contamination because simply brushing is not intended to remove that amount of bioburden."
3. Be proactive about G-code reporting. Since October, ASCs have been required to report five quality measures on Medicare claims forms using G-codes, part of Medicare's Quality Reporting Program. The Centers for Medicare and Medicaid Services is interested in knowing if ASCs are administering intravenous antibiotics in a timely fashion to avoid infections, said Sandra Jones, MBA, CEO and COO of ASD Management.
Ms. Jones suggested ASCs run reports to know the frequency of G-codes used to report the specific care provided and review it against set goals and external benchmarks.
"Assessment findings can lead to quality improvement opportunity," she said.
She encouraged ASCs to set up a system to report data and then send it as soon as possible.
4. Create processes to avoid using out-dated supplies. Staff members can use stickers marked with dates to show when certain supplies have been opened, which helps others avoid the potential of using supplies that have been open for too long and compromising patient safety.
"At the end of every day, we make sure everything's thrown away properly and cleaned up," said Karen Smith, nursing director at Central Illinois Endoscopy Center in Peoria. "Also, to make double sure someone hasn't forgotten to dispose of something that's old, there are stickers on everything. So every time a staff member has to open a supply, there are pre-printed stickers with the staff member's name, time and date. Putting that on the object ensures they aren't using something that's been out for too long, like sterile water."
5. Be compliant. Ms. Jones said ASCs should "know what they do so they can check what they do." She suggested setting up a checklist to document compliance of clinical quality guidelines to help everyone stay on the same page. It's also important to review with staff how to document, maintain manufacturer's instructions for equipment and practice the details, she said.
Ms. Jones suggested using free resources to stay up-to-date on quality control and infection prevention, including guidelines from the Centers for Disease Control and the National Institute for Occupational Safety and Health.
More Articles on Infection Control:
Study: Low Adherence to IOM Standards in Clinical Practice Guidelines
Medical/Surgical Hospitals to Meet Additional Joint Commission Requirements
Institute for Safe Medication Practices Issues Guidelines on Sterile Compounding
1. Make sure pre-owned equipment is in good condition. Making sure pre-owned equipment is in good condition before using it is imperative in preventing infection at your ASC, said Ray Midlam, product manager, certified pre-owned equipment for Olympus America. Be sure to find out if the model is still supported by the original equipment manufacturer, otherwise you may end up with a product with no access to replacement parts. "Certified" or "CPO" labels are no guarantee. Those are unregulated terms with no standards to support them. Ask the supplier what, in fact, their "certified" label means and how the product was repaired.
For example, if the equipment is an endoscope, did it undergo a rigorous refurbishment process with all parts inspected? Were the insertion tube and other worn or damaged parts replaced with OEM parts? If not, buyers beware: A scope that has been altered with third-party parts — even those purporting to be reverse engineered or "OEM-like" — is no longer FDA 510(k) compliant, which means it is no longer validated for reprocessing. Therefore, unless you are purchasing the pre-owned scope from the OEM, make sure to ask the seller for reprocessing validation for any of its modified parts. Also check with your facility's infection control department for any specific instructions relative to modified medical equipment.
2. Follow all manufacturer instructions. Manufacturer instructions are meant to promote optimal infection control, and disregarding any steps can leave an ASC vulnerate. For instance, generally, GI/endoscopy-driven ASCs go through a multi-stage high-level disinfection process. The first stage requires removal of gross contamination by suctioning the scope's channel with a high volume of water and detergent in addition to wiping down the exterior of the scope after a procedure.
Shaun Sweeney, vice president of sales and marketing for Cygnus Medical, said GI/endoscopy-driven ASCs often fall into the trap of skipping this crucial first step with the belief that jumping ahead to the second stage of brushing the scope will be sufficient enough in removing gross contamination.
"One of the biggest misnomers that I've come across is ASCs believe there is no need to suction the channel and wipe down the scope before soaking and brushing the equipment," Mr. Sweeney said. "To this day, a lot of people don't understand this first step is critical to make sure there is no gross contamination because simply brushing is not intended to remove that amount of bioburden."
3. Be proactive about G-code reporting. Since October, ASCs have been required to report five quality measures on Medicare claims forms using G-codes, part of Medicare's Quality Reporting Program. The Centers for Medicare and Medicaid Services is interested in knowing if ASCs are administering intravenous antibiotics in a timely fashion to avoid infections, said Sandra Jones, MBA, CEO and COO of ASD Management.
Ms. Jones suggested ASCs run reports to know the frequency of G-codes used to report the specific care provided and review it against set goals and external benchmarks.
"Assessment findings can lead to quality improvement opportunity," she said.
She encouraged ASCs to set up a system to report data and then send it as soon as possible.
4. Create processes to avoid using out-dated supplies. Staff members can use stickers marked with dates to show when certain supplies have been opened, which helps others avoid the potential of using supplies that have been open for too long and compromising patient safety.
"At the end of every day, we make sure everything's thrown away properly and cleaned up," said Karen Smith, nursing director at Central Illinois Endoscopy Center in Peoria. "Also, to make double sure someone hasn't forgotten to dispose of something that's old, there are stickers on everything. So every time a staff member has to open a supply, there are pre-printed stickers with the staff member's name, time and date. Putting that on the object ensures they aren't using something that's been out for too long, like sterile water."
5. Be compliant. Ms. Jones said ASCs should "know what they do so they can check what they do." She suggested setting up a checklist to document compliance of clinical quality guidelines to help everyone stay on the same page. It's also important to review with staff how to document, maintain manufacturer's instructions for equipment and practice the details, she said.
Ms. Jones suggested using free resources to stay up-to-date on quality control and infection prevention, including guidelines from the Centers for Disease Control and the National Institute for Occupational Safety and Health.
More Articles on Infection Control:
Study: Low Adherence to IOM Standards in Clinical Practice Guidelines
Medical/Surgical Hospitals to Meet Additional Joint Commission Requirements
Institute for Safe Medication Practices Issues Guidelines on Sterile Compounding
