TJC recently published data on the “Top Ten” compliance issues for the first half of 2015. For hospitals, it was notable that the # 2 issue is the improper cleaning and disinfection of medical equipment, devices, and supplies. 54% of hospitals were cited for this issue. Although psychiatric hospitals have much less medical equipment and supplies than acute care hospitals, we have seen the trend for more citations on this issue with our own psychiatric hospital clients over the past few years. So, it’s an important area to stay on top of as part of your continuous readiness program.
The relevant Infection Control standard for this requirement is IC.02.02.01: “The hospital reduces the risk of infections associated with medical equipment, devices, and supplies.” EP 1 specifically addresses cleaning and performing low level disinfection of medical supplies and devices. It is a Direct Impact standard. Issues that we have seen cited in psychiatric hospitals include the following:
- Improper disinfection of blood pressure cuffs (not following hospital policy.)
- Stethoscopes used on multiple patients and not disinfected between uses
- Equipment cleaned with soap and water instead of being disinfected
- Nursing staff unable to articulate hospital procedure on cleaning and disinfection of equipment
Here’s a quick review of some key terms:
Cleaning refers to the removal of visible soil and organic material (i.e., dirt, body fluids) from objects by washing or scrubbing with water and detergents or soaps and rinsing with water. Thorough cleaning is needed before disinfection or sterilization because organic material can decrease the effectiveness of those processes. A detergent is a cleaning agent that does not claim to kill microorganisms.
Disinfection refers to the process of removing some or all microorganisms that can cause disease, except bacterial spores. There are three levels of disinfection, depending on how many organisms are removed: high, intermediate, and low. A disinfectant is a chemical or a physical agent (e.g. ultraviolet radiation) that kills microorganisms, but not bacterial spores.
Sterilization refers to the complete elimination of all forms of microbial life including bacterial spores. Objects can be sterilized by physical processes (i.e., intense steam and pressure or dry heat) or by using certain chemicals.
To ensure compliance in this area, the first step is to develop an inventory of all of the pieces of medical equipment, devices, and supplies on your inpatient units and in any outpatient settings. Then, proceed with the following:
- Determine which items on the inventory require cleaning and which items require disinfection.
- Develop written procedures for the cleaning or disinfection of these items. (Surveyors requested written procedures.)
- Train all appropriate staff in the proper cleaning/disinfection procedures.
- Include this topic in the internal tracers that you conduct as part of your survey preparation. Ask staff how they clean these items and then observe whether they are following proper procedure.
Also, an excellent resource on this topic is the CDC’s guideline on Sterilization or Disinfection of Medical Devices.