Joint Commission Softens Stance on Flashing Cataract Instruments

The Joint Commission is set to soften its stance on flashing cataract surgery instruments, saying that it's OK to use steam to sterilize uncovered instruments under certain conditions. The American Society of Cataract and Refractive Surgery, the American Academy of Ophthalmology and the Joint Commission are expected to release a joint statement today.

"This is a clarification of the appropriateness of rapid-cycle sterilization under controlled processes," Robert Wise, MD, vice president of standards at The Joint Commission, told E-Weekly. "We have a better understanding of rapid-cycle sterilization. If it's appropriately used and applied as part of an infection-prevention process, we have no problem with it. It is possible that one would be able to flash sterilize using steam sterilization as one of the components of a complete sterilization process."

Dr. Wise calls The Joint Commission's previous stance of looking solely at how much heat was being applied for how long "inadequate." He says surveyors will look beyond the strict definition of flashing — 3 minutes at 270°F under 29 pounds of pressure — to a facility's entire sterilization process. "We will move away from focusing simply on the method of steam sterilization to looking at the process in a broader and more rigorous way — from the time the instruments leave the OR to their return to the OR," says Dr. Wise.

Dr. Wise stresses that flashing would have to be a component of a complete sterilization process, not to be performed for convenience, as an alternative to purchasing additional instrument sets or to save time. You'll still be cited, he says, if you flash and then reuse instruments repetitively and routinely.

Dan O'Connor

HHS to Survey ASC Infection Control Practices

The Department of Health and Human Services plans to use $50 million from the economic stimulus package passed in February to fund infection prevention efforts in hospitals, ASCs and other healthcare facilities.

The Centers for Medicare and Medicaid Services will use $10 million of the stimulus money to conduct surveys of infection control practices at ambulatory surgery centers nationwide, says Don Wright, MD, principal deputy assistant secretary for health at HHS. In testimony before a House appropriations subcommittee last week, Dr. Wright said the stimulus funds will let CMS hire more surveyors to conduct national ASC inspections using a survey tool piloted by CMS and the CDC last year, which "demonstrated superior results in the ability to detect deficient infection control practices."

Dr. Wright's announcement comes on the heels of a recent Government Accountability Office report recommending periodic, random HHS surveys of ASCs in response to incidents like last year's hepatitis outbreak at 2 Las Vegas endoscopy centers.

The remaining $40 million in stimulus funds will go to state-level efforts to implement HHS' Action Plan to Prevent Healthcare-Associated Infections, which targets six categories of HAIs, including surgical site infections, Clostridium difficile and methicillin-resistant Staphylococcus aureus. CDC Acting Director Richard Besser, MD, told the House panel that the money would be used to set up infection prevention collaboratives among state hospital associations, quality improvement organizations, physicians and hospitals.

Irene Tsikitas

N.Y. Bars Doc Who Infected 11 Patients

Brian Goldweber, MD, an anesthesiologist who infected at least 11 GI patients with hepatitis B and C, has been barred from practicing in New York.

The New York state Department of Health spent nearly 2 years investigating Dr. Weber, who double-dipped syringes in vials of propofol and stored open vials overnight to be reused rather than discarding them after 6 hours as recommended, according to a press report.

The patients were infected in 2005 and 2006. Dr. Weber stopped practicing in May 2007 when the health department began its investigation and urged 4,500 patients from GI centers in Manhattan to be tested for hepatitis and HIV.

"This is a serious outbreak — and it was preventable," Sharon Balter, MD, a New York City epidemiologist, told the New York Post last year.

Dr. Weber was disciplined in 1999 for improper anesthesia administration and then again in 2002 because he didn't disclose the 1999 citation on a job application. Several patients are suing Dr. Weber, who declared bankruptcy in 2007 and began working as a car salesman in the suburbs of New York City.

Kent Steinriede

Instapoll: More ORs Are Going Green

More than half (57 percent) of the 35 readers who answered last week's online poll said their ORs are ecologically friendly, and another 14 percent said their facilities are planning to go green. Nearly one-third (29 percent) said their ORs are anything but eco-friendly. You'll find plenty of practical advice for creating eco-friendly ORs in the "2009 Manager's Guide to Going Green," a special supplement that will arrive in the mail with your April edition.

This week's poll asks how your capital equipment purchases are most often funded. Go to our front page to participate in the poll and view real-time results.

Dan O'Connor

News & Notes
  • Tip of the week If late starts are hampering your facility's workflow, try documenting the cases that don't start on time and the reasons why they're delayed. At the Physicians Surgical Center in Lebanon, Pa., charts are labeled with numbers that correspond to an organized list of common delays, says Monica Ziegler, MSN. This information can then be compiled into a report that calculates the number of delayed cases over time and aims to resolve frequent obstacles. "Our physician-owners take the report seriously and place particular emphasis on first-case-of-the-day delays," says Ms. Ziegler.

  • Coding 101 The American Academy of Professional Coders will launch a training program in September, giving providers, payors and coders a step-by-step guide to implementing the new ICD-10-CM code system. The program will provide annual, benchmarked steps from 2009 to 2013. Each year, coding experts will run Webinars, audio conferences and on-site training sessions, as well as regional and national conferences. AAPC members will be able to measure their progress against benchmark deadlines and schedules with an online tracking tool.

  • Implant industry scrutiny ends The U.S. Attorney's office for the District of New Jersey has halted its oversight of 4 major orthopedic implant manufacturers 18 months after the companies agreed to federal monitoring to settle charges that they violated anti-kickback laws. The government has also dismissed criminal charges that the companies — Zimmer, Depuy Orthopaedics, Biomet Orthopedics and Smith & Nephew — paid tens of thousands of dollars to surgeons to use their products. Acting U.S. Attorney Ralph Marra Jr. says the government is "confident that the industry√Č has made significant changes in their practices" to increase compliance with anti-kickback laws.