The following article was originally published in Preventing Infection in Ambulatory Care, the quarterly e-publication from the Association for Professionals in Infection Control and Epidemiology (APIC). To learn more about receiving this resource and joining APIC, visit www.apic.org/ambulatorynewsletter. To learn more about APIC, visit www.apic.org.
Are you checking the following items in your facility rounds? If not, consider including them to maximize your infection prevention compliance and survey readiness.
1. Fans are never permitted in the operating room. Any fans must be promptly removed.
2. The instructions for use for all automated washing, disinfecting and sterilizing equipment must be readily available to staff. If you cannot locate the original copy, contact the manufacturer for a replacement. Evidence-based guidance documents from professional organizations are important resources, but do not replace the need to have a copy of manufacturer's instructions accessible to staff.
3. If your facility is performing point-of-care testing, (e.g. glucometers) you must have a Medicare Clinical Laboratory Improvement Amendments (CLIA) certificate. It is not necessary to post the certificate, but it must be available during an inspection or survey. For more information visit www.cms.gov/clia.
4. Disposable medical instruments are designed for single use only. It is a violation of federal standards to reuse them; they must be discarded. Reprocessing of single-use devices (SUDs) is only permitted when (a) the item has been labeled as being suitable for reprocessing and (b) the reprocessing is performed by a company approved by the FDA to perform this service.
5. Check for expiration dates on diagnostic items as well as disposable supplies. Dates on blood collection tubes and fecal occult blood test kits are often overlooked.
6. Make sure that bags of intravenous normal saline are never used to prefill syringes. Confirm that all bags of intravenous fluids are labeled for single patient use only. Misuse of IV bags has been implicated in outbreaks and transmission of bloodborne disease.
7. Carefully observe how syringes are used. Using a prefilled syringe for more than one patient is an immediate and serious violation. The danger is not mitigated by a claim that "I don't aspirate." Aspiration is not required to contaminate the syringe and its contents.
8. All open multiuse vials must be dated. If you discover one that is not, discard it.
9. If your facility uses a glucometer, make sure that it is designed for multiple patient use and cleaned after every use with an EPA - registered disinfectant active against HBV and HIV. A dilute bleach solution can also be used. Isopropyl alcohol is not appropriate for disinfecting glucometers in shared use situations. If you are not sure which product is best, contact the manufacturer.
10. Medication vials labeled for single use cannot be used during a second case, be returned to a medication cabinet, or have any remaining medication withdrawn and pooled with the partial contents of other vials. This is a crucial infection prevention and patient safety requirement that requires rigorous attention and enforcement.
11. Review your facility's requirements for terminal cleaning. How do you verify that cleaning practices are adequate? If facility cleaning is being done by via a contracted service, how is that vendor's performance being monitored?
12. Check carefully to make sure staff knows how to separate clean and dirty items. Storing clean items in soiled areas and vice versa are common deficiencies detected during infection prevention rounds.
13. What procedures and containment practices are in place in the event of a blood or blood-contaminated fluid spill? Interview staff to check that everyone knows the correct method for an immediate response.
14. Observe hand hygiene practices and analyze product use. Determine if staff understands when alcohol hand rubs may be used and if hand hygiene is being done correctly and consistently.
15. Make sure that medical supplies kept on countertops are far enough away from sinks and faucets so that potential splash contamination of the packaging is not a risk.
Read more from APIC:
- Common Questions: Flexible Endoscope Reprocessing in Ambulatory Care
- Overview: Infection Prevention and Control for Computers in Patient Care Areas
- Moving to a Consolidated vs. Decentralized Model for Sterile Processing
