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Joint Commission Data Shed Light on HLD and Sterilization Risks

Publish Date: March 11, 2020


Preventing infection transmission is always on the radar for perioperative leaders tracking safety risks and shoring up processes for survey evaluation—and these concerns should remain top focus, according to The Joint Commission’s Lisa DiBlasi Moorehead, EdD, MSN, RN, CENP, CJCP, associate nurse executive.

Ahead of her presentation at AORN’s upcoming Leadership Summit later this month, DiBlasi Moorehead spoke with Periop Today about the 2020 outlook for perioperative patient safety.

With new approaches for collecting and mining data, The Joint Commission is learning more about survey trends. The organization’s 2019 survey data based on 1,400 hospital surveys across the US show incorrect high-level disinfection and sterilization practices are among the most frequently cited standards and also represent the highest severity of cited risks.

Same Topics, New Issues

While high-level disinfection and sterilization practices have been under scrutiny by surveyors for several years, DiBlasi Moorehead says safe sterilization practices are becoming more hard-wired, particularly when sterile processing functions are more centralized across organizations. Now, most risks in this topic area are associated with high-level disinfection practices.

Whether instruments are being processed for high-level disinfection or sterilization, “we encourage organizations to evaluate each step of their process because that is what surveyors will be focusing on,” she stresses. This includes thorough pre-cleaning, safe transportation, correct decontamination and cleaning with thorough brushing and flushing, leak-testing, sterilization or high-level disinfection, drying, storage and back to thorough inspection prior to use.

“Make sure IFUs are being followed—this seems to be an area where organizations can improve,” she adds.

New Product, Old Process

While following IFUs is a process that facilities have been working to improve, surveyors are noticing that IFU-dictated processes are not being updated when new products or vendors change. The observed lack of updating IFUs goes beyond instrument reprocessing to actions in direct patient care, such as with direct oral anticoagulants, which were the subject of a recent Sentinel Event Alert.

“Not all direct oral anticoagulants are treated the same,” she cautions. “As new oral anticoagulants hit the market, perioperative nurses must be aware that typical responses to events such as intraoperative bleeding will not be the same with a patient on coumadin versus a newer anticoagulant the patient may be taking.”

She also notes that lab monitoring of anticoagulants has been added to the National Patient Safety Goal addressing safe anticoagulation therapy designed to better identify this risk.

Focus on Leadership Responsibility

Leaders have responsibility for the safety and quality of care delivered in their areas. If surveyors identify risks in surgical services, leadership practices will also be evaluated. DiBlasi Moorehead stresses. “Our survey emphasis has always focused on leadership responsibility, which leaders should expect to see highlighted often.”

Organizations can expect more in-depth evaluation of leadership awareness within surgical services, whether it’s tracking negative trends in data, risk areas in practice or level of safety culture mentality across surgical services. “We want to see staff demonstrating comfort with speaking up and communicating because this behavior is a direct reflection of leadership accountability and trust.”

Leverage Your Data

Surveyors will also be looking for transparency around quality measures, data and even physician involvement. “Being familiar with your own data will be an important reflection of your awareness with risks and areas for improvement,” DiBlasi Moorehead notes.

She suggests several resources from The Joint Commission that leaders can leverage to support data monitoring, process development, and survey success, including:


Free Resources for Members

  • AORN Journal Sterile Processing Accreditation Surveys: Risk Reduction and Process Improvement


Guideline Essentials
: Stay one step ahead of surveyors with customizable, ready-to-use tools such as implementation road maps, policies and procedures templates, gap analysis tools, and more on the guidelines for sterilization and high-level disinfection.


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