High-Level Disinfection High-level disinfection (HLD) is used for semi-critical devices, such as flexible scopes and probes. It is important that endoscopy and ambulatory surgery center (ASC) staff members understand the difference between HLD and sterilization. Most people confuse the two tasks, but they are distinctly different and highly detailed. Technicians must be well trained to perform these critical tasks, and facilities must have policies that detail what is expected of technicians who perform these tasks. Additionally, facilities must have an annual competency for all staff members who perform HLD. Annual competencies with return-demonstration assure that all staff members who perform HLD—which includes pre-cleaning—do it the same way each time. Any misstep can result in unfortunate outbreaks, such as what we saw in 2015 at two large teaching facilities in Los Angeles. 1 Any lapse in this detailed practice is considered a detrimental lapse in infection prevention and can result in Immediate Jeopardy. 2 Please review the resources and links below for more information and be sure to register for our May 23, 2018, webinar. We will discuss sterilization and HLD. You do not want to miss this event!   Terhune, Chad. The Los Angeles Times. Superbug Outbreak Extends to Cedars-Sinai Hospital, Linked to Scope. Available at: http://www.latimes.com/business/la-fi-cedars-sinai-infections-20150304-story.html. Accessed on: April 20, 2018. Petersen, Melody. The Los Angeles Times. State Found Lapses in Infection Control at UCLA and Cedars-Sinai. Available at: http://www.latimes.com/business/la-fi-infections-ucla-cedars-hospitals-20160515-snap-story.html. Accessed on: April 20, 2018.

In Partnership with

Sterilization and HLD Webinar

Sterilization and HLD: Do You Know the Difference Between the Two? Wednesday, May 23, 2018 9–10 a.m. PT As part of the Knock Out Infections—ASC Infection Prevention Initiative funded by the Centers for Medicare & Medicaid Services (CMS) to help reduce surgical site infections (SSIs) in ASCs, Health Services Advisory Group (HSAG) invites you to attend a webinar that will address the difference between sterilization and HLD and when each function should be performed. Webinar Objectives: Distinguish the difference between sterilization and HLD. Describe when HLD should be used. Describe when sterilization should be used. Discover how to create an annual competency plan for staff members who perform each task. Speaker:  Angela Vassallo, MPH, MS, CIC, FAPIC, Clinical Improvement Advisor, Infection Prevention, HSAG

Physician's Corner

This month we have looked at the importance of HLD of instruments specifically pertaining to the ASC setting. Two of the least appreciated and most difficult instruments to HLD in the ASC setting are the duodenoscopes that are used for complex procedures such as endoscopic retrograde cholangio-pancreatography (ERCP) and colonoscopes used in colonoscopies. The problem of insufficient HLD was dramatically brought to light with the occurrence at two large teaching hospitals in Los Angeles of carbapenem-resistant Enterobacteriaceae (CRE) infections caused by the inadequate pre-cleaning and HLD of duodenoscopes. The methodical work by infectious disease and infection preventionists traced the source of these infections back to these scopes and led to the initiation of new disinfection protocols that eliminated these occurrences. As specialists who work in the ASC setting, it is essential that we are aware of the crucial importance HLD of instruments plays in patient safety, and the responsibility we all share with ASC staff members in safeguarding the surgical setting from the transmission of healthcare-acquired infections caused by inadequate cleaning and disinfection processes. Howard Pitluk, MD, MPH, FACS, HSAG Vice President for Medical Affairs & Chief Medical Officer

Tools & Resources

The Centers for Disease Control and Prevention (CDC) Resources Los Angeles County/UCLA Investigation of CRE Transmission and Duodenoscopes Disinfection and Sterilization Guideline for Disinfection and Sterilization in Healthcare Facilities

The Joint Commission Resources HLD and Sterilization BoosterPak The Joint Commission released its 2018 National Patient Safety Goals for ASCs. The four goals are: 1. Identifying patients correctly 2. Use medicines safely 3. Prevent infections 4. Prevent mistakes in surgery Read more.

Food and Drug Administration (FDA) Cleared Sterilants and HLD with General Claims for Processing Reusable Medical and Dental Devices

Society of Gastroenterology Nurses and Associates (SGNA) View Website

Becker's Review Human Error Source of Infection Control Breach Involving 5,800 Spine Patients at Porter Adventist: Five Things to Know

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This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for California, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. CA-11SOW-ASC-04182018-01