Joint Commission Updates Position on Steam Sterilization

Sarah Kearns, for HealthLeaders Media , July 8, 2009

After working with multiple professional and trade organizations on the common and proper use of sterilization using steam, the Joint Commission has decided to refocus its survey efforts on all critical processes, including sterilization, according to a recent announcement by The Joint Commission. The accrediting body will consider an effective sterilization method if a complete and effective process of sterilization is used.

Three issues arose during The Joint Commission's discussion: the terminology used to describe the sterilization process, the indication-related issues that involve the selection of the sterilization cycle or method, and the process-related issues involving the way that a given sterilization method is executed.

In addition, Joint Commission surveyors will focus on the critical steps of reprocessing. These steps include the cleaning and decontamination of all visible soil, because steam cannot remove these compounds. Any sterilization must meet the parameters by the manufacturer of the sterilizer and the surgical instrument, and the maker of any packaging. Also, each sterilized instrument must be carefully protected and stored in a sterile field.

Joint Commission surveyors are also being asked to perform other activities, which include observing instruments from the time they leave one operating room to when they are returned to the next, observing the cleaning of the instruments, and reviewing the sterilization logs.

Marsha Barnden, MSN, RNC, director of standards and infection control at Adventist Health in Roseville, CA, praises The Joint Commission's updated position on steam sterilization.

"I am delighted with The Joint Commission's direction related to interpreting and surveying specific infection control standards in the operating room," says Barnden. "The issue of sterilization is a guaranteed survey topic and over the past several years, flash sterilization has been particularly problematic for many hospitals."

Oftentimes the reason for the increased incidence of flash sterilization is directly related to insufficient instrument trays, most commonly trays used for specialty cases such as eye or ortho surgeries, explains Barnden.

"The mere fact that The Joint Commission has formally recognized the critical steps in the multi-faceted sterilization process and are focusing on all three [cleaning/decontamination, sterilization, and packaging/storage with return to the sterile field] is further evidence of the paradigm shift we have been experiencing with Joint Commission surveys: it is all about process and the details therein-drilling down to get the entire picture rather than piecemeal," says Barnden. "Complicated processes involving multiple steps are processes begging for short-cuts which can be ill-afforded in the infection control arena."

Sarah Kearns is an editor for HCPro in the Quality and Patient Safety Group. Contact Sarah at

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