Routine flash sterilization in ambulatory surgery centers is acceptable, the Centers for Medicare and Medicaid Services has clarified, as long as the load is wrapped or contained and the facility follows manufacturers' instructions for all the devices involved.

In a memo to state survey agencies, CMS provides a list of 7 questions that its infection control surveyors can use to determine the appropriateness of a facility's sterilization practices:

"1. Is the sterilizer labeled for this cycle by the manufacturer?

"2. What is the sterilizer manufacturer-recommended load for that cycle?

"3. Is the containment device used labeled by its manufacturer for use in that cycle?

"4. For what load is the containment device recommended by its manufacturer?

"5. Is the chemical indicator used labeled for use in this cycle by its manufacturer?

"6. If a biological indicator is used is it labeled for use for this cycle by its manufacturer?

"7. If the cycle is used frequently, is it checked regularly with a biological indicator?"

ASCs will not be cited for "properly using short sterilization cycles for wrapped/contained loads," the memo states. The routine flashing of unwrapped or uncontained loads, however, will be cited as a violation. Flashing such loads should only be done when there is "an urgent and unprecedented need for a specific device," such as when an instrument is dropped.

CMS says its clarification is a response to issues with the sterilization portion of its Infection Control Surveyor Worksheet, which does not specifically address the practice of flashing.

Irene Tsikitas

Which skin prep is the most effective? Depends on which study you read. In a study published in the October issue of the journal Infection Control and Hospital Epidemiology, an iodophor-based skin prep bested povidone-iodine and a chlorhexidine solution in a comparison of each agent's effectiveness against surgical site infections.

This outcome runs counter to the clinical evidence building behind the antiseptic effects of chlorhexidine gluconate skin prep formulations.

For the ICHE study, researchers at the University of Virginia Health System in Charlottesville, Va., tracked 30-day post-op infection rates among 3,209 general surgery patients over the course of 18 months. For the first 6 months' worth of surgeries, patients' surgical sites were scrubbed and painted with povidone-iodine (and treated with isopropyl alcohol between the steps). For the next 6 months, surgical teams used a 2% chlorhexidine, 70% isopropyl alcohol prep. Then, for the last 6 months, they used a prep made up of iodine povacrylex in isopropyl alcohol.

According to the study, the SSI rate 30 days after surgery among the iodophor patients was 3.9%. The povidone-iodine group's rate was 6.4% and the chlorhexidine group's 7.1%. "Iodophor-based compounds may be superior to chlorhexidine for this purpose in general surgery patients," the researchers conclude.

David Bernard

The physicians who presented research at the American Academy of Orthopaedic Surgeons' 2008 annual meeting failed to report more than 20% of the money they received in consulting fees from medical device manufacturers whose products were directly related to conference presentations.

In a study published in the Oct. 8 issue of the New England Journal of Medicine, researchers compared the presenters' disclosure statements to the consultant payment disclosures posted on the Internet by 5 manufacturers.

While the study found that 71.2% of the 344 manufacturer-reported payments were disclosed by surgeons presenting research at the meeting, 20.7% of the non-reported payments were from manufacturers with products directly related to a presenter's research.

"We were a little surprised at how high the nondisclosure rate was," co-author Mininder S. Kocher, MD, MPH, told the Wall Street Journal.

Dr. Kocher and colleagues surveyed the surgeons who failed to disclose all their consulting income, netting a response rate of nearly 40%. Among them, approximately 39% of respondents said the payment was unrelated to their research presentation; 14% said they had misunderstood the disclosure requirements; and 11% said they had disclosed payments, but the information had been mistakenly omitted from the conference program.

Kent Steinriede

It's been argued that among legislators and policymakers, ASCs suffer from a brand-identity crisis: That is, they're not that well-known in general, and where they're known, they're not particularly well-liked. Tell us in this week's InstaPoll whether you agree or disagree with this statement. We'll report the results in this space next week.

Last week we asked you which area of your facility most needs a renovation. Your waiting rooms (29%) edged out your ORs (26%) as the most deserving among 73 respondents. Also receiving votes: PACU (18%), pre-op (15%) and business office (12%).

Dan O'Connor