scope:

Introduction

Today's healthcare accreditation processes are conducted with a focus on the safety and quality of patient care. Sterilization and high-level disinfection (HLD) in healthcare facilities is a major focus of the accreditation survey process.

Various agencies and professional organizations perform accreditation surveys to evaluate healthcare facilities and the healthcare professionals practicing in those facilities. During the accreditation process, surveyors assess competency, ethics, and practices to verify that current published standards are being met. If a facility meets all the necessary requirements and is appropriately qualified, it passes the survey and is awarded a certification. The accreditation process, procedures, and requirements for certification vary depending on the accrediting organization and the type of facility (e.g., hospital, medical center, ambulatory care facility, physician's office, home care provider, medical laboratory).

Accreditation is a means of peer review by professionals (e.g., administrators, physicians, nurses, engineers) and is aimed at high standards that usually exceed state and federal requirements. Accreditation is a universally accepted means of enhancing the quality of healthcare. Many private insurers require accreditation as a condition of reimbursement. To qualify for federal funding for patients in Medicare and Medicaid programs, healthcare facilities must demonstrate that they comply with the government's hospital Conditions of Participation (CoP).

One of the key advantages of accreditation is the structure that is provided for improvement of performance and safety. When there is the expectation of the measurement of performance and safety by an accrediting organization, conformance to standards and recommended practices becomes more important to healthcare facilities. Recognized standards and recommended practices are built on sound principles, scientific research and data, and the opinions of experts in the field. Following these best practices helps to ensure the quality and safety of patient care. In addition, reimbursement is affected by accreditation or lack of accreditation; therefore, lack of accreditation can put a facility out of business.

In recent years, there has been an increased focus on infection prevention in healthcare. Healthcare professionals have increased their efforts to reduce healthcare-associated infections (HAIs), particularly surgical site infections (SSIs). The Joint Commission's (TJC's) National Patient Safety Goals (NPSGs) and national initiatives by the Centers for Disease Control and Prevention (CDC) and other organizations to reduce HAIs are two examples of why sterilization and HLD are under the spotlight with accreditation agencies. In addition, both TJC and the Centers for Medicare & Medicaid Services (CMS) have clarified their expectations regarding sterile processing in health care facilities.^1,2

This guidance document covers accreditation standards that pertain to sterilization and HLD in healthcare facilities, as well as the nationally accepted standards and recommended practices that constitute best practices in reprocessing. Accreditation by TJC and CMS will be covered in some depth. Accreditation programs focusing on ambulatory care facilities and sponsored by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) and the Accreditation Association for Ambulatory Health Care (AAAHC) will also be discussed, as well as the accreditation programs of the Accreditation Commission for Health Care (ACHC), the American Osteopathic Association/Healthcare Facilities Accreditation Program (AOA/HFAP), the Community Health Accreditation Program (CHAP), and DNV Healthcare and the role of state health departments.