The Compliance Doctor, LLC SM

"Troy, Thank you so much. Because of your help we now have our Medicare plus Accreditation until 2011. YES!!" —Juanita Rodriques, Administrator BHP

Learn Five Ways You Can Cut Infections in Your ASC

Editor's note: The following is an article from a series about accreditation by Troy Lair, CEO of Los Angeles-based consulting company The Compliance Doctor, LLC.

Proper terminal cleaning is critical to protecting your patients from infections, but confusion abounds at many ambulatory surgery centers (ASC) about reducing microbial loads.

Incorporate the following guidelines to keep your patients safe and your facility free from infectious agents:

1. Never use the same cleaning device for the OR to clean any other room.

For example, if you have two ORs, each OR should have its own device. The recovery room should have its own, and so forth. When you use the device in multiple locations, you have essentially cross-contaminated the entire space.

If you have an infectious or potentially infectious patient, perform his or her surgery at the end of the day. This gives your staff members time to perform deep terminal cleaning versus the lighter cleaning done between noninfectious cases. (Note: This is not to say that all patients should not be treated as though they are infectious, as the Occupational Safety & Health Administration teaches us to do.)

3. Use appropriate cleaning devices for the OR floor, such as devices that are disposable or easily disinfected. Never use a mop or mop head unless it can be replaced each week.

The preferred tool is a device much like a wet/dry vacuum that is easily cleaned and can reduce your microbial loads by 50%, according to the Centers for Disease Control and Prevention.

4. Direct staff members cleaning the ORs to wear scrubs or scrub-like clothing that can be changed and placed in the soiled linen receptacles.

Staff members should never wear the same clothes to clean the OR. To clean separate areas in the same clothing permits cross-contamination and increases your patients' risk of a hospital-acquired infection.

5. Perform periodic cultures of the OR surfaces and floors-areas that patients touch are most important. You can use these cultures to measure the effectiveness of the cleaning that is being provided.

If you are failing to provide a low microbial load, or if you have infectious results as demonstrated by the culture, immediately begin a quality study. Use the cultures as your baseline for determining the problem and then perform a root cause analysis to determine the causes for the infection.

By reculturing the space after you have implemented the changes, you can measure the effectiveness of your quality plan for resolution.

Be sensitive to the vendors who say they are doing this task for you via an outside contract. Cleaning crews sometimes say they do this task but often know little about terminal cleaning or its purpose.

Editor's note: Lair has more than 18 years of executive healthcare experience, from running an ICU in a Louisville, KY, hospital to working as the chief nursing officer for a Pasadena, CA-based acute care facility. He entered the ambulatory arena while serving as the corporate director of clinical services for the world's largest plastic and cosmetic surgery company. Visit www.thecompliancedoctor.com for more information.