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Based on observation, interview, and record review, the hospital failed to ensure that the provision of services was being carried out in a safe manner as evidenced by the following:

1. Surgical instruments were not cleaned and disinfected, sterilized (removing bacteria), or stored in a fashion to ensure their sterility. (Refer to C-278, findings 1 and 7)

2. Endoscopes were not disinfected according to manufacturer's instructions for use and national guidelines. (Refer to C-278, finding 2)

3. The floors of both operating rooms were not cleaned according to national guidelines. (Refer to C-278, finding 3)

4. Environmental controls for the surgery rooms and other sterile storage areas were not monitored on a daily basis. (Refer to C-278, finding 4)

5. Routine maintenance was not performed on the primary autoclave (sterilizer) used for sterilizing surgical instruments. (Refer to C-278, finding 5)

6. The hospital clinic's policy and procedure for cleaning patient care equipment between patients was not being implemented. (Refer to C-278, finding 6)

7. Staff were not performing hand hygiene according to the hospital's policy and procedure. (Refer to C-278, finding 8)

8. Patient care equipment was not being cleaned. A layer of dust was found of an Intensive Care Unit's cart containing resuscitation equipment. (Refer to C-278, finding 9)

The cumulative effect of these systemic problems resulted in the hospital's inability to ensure the provision of services was in compliance with the statutorily mandated Condition of Provision of Services.

6. A facility policy and procedure titled, "Point of Care Equipment Cleaning", with a revision date of 5/2016, was reviewed. The purpose of the policy was to reduce hospital acquired infections and maintain patient safety.

Point of care equipment (portable thermometer, finger stick blood glucose (sugar), portable blood pressure machine, hand held oximeter (a device that measures the amount of oxygen in the blood) will be cleaned daily and in between patients.

On 8/15/16 at 2:08 pm, Clinic Staff 1 (CS 1) was observed using a tympanic thermometer (thermometer place in the ear) to take a patient's temperature. After taking the temperature, CS 1 returned the thermometer to the holder that was mounted on the wall. CS 1 did not clean the thermometer.

At 2:10 pm on 8/15/16, CS 2 was observed taking the temperature of a patient using the same thermometer that CS 1 had just used on her patient. After using the thermometer, CS 2 returned the thermometer to the wall mount. CS 2 did not clean the thermometer.

On 8/15/16 at 2:12 pm, an interview was conducted with CS 2. When asked why she did not clean the thermometer, CS 2 stated, "We don't clean them after each patient. We clean them a few times throughout the day."

On 8/15/16 at 2:16 pm, CS 1 was asked why she did not clean the thermometer. CS 1 stated that she cleans the thermometer every once in a while, "we wipe it with alcohol wipes."

On 8/15/16 at 3:55 pm, an interview was conducted with the Infection Control Nurse (ICN). The ICN was asked what the expectations were for cleaning patient care equipment between patients. The ICN stated that staff should be cleaning the thermometer after each patient use.

7. A policy and procedure titled, "Decontamination of Instruments and Equipment", with a revision date of 12/2013, was reviewed. The purpose of the policy read, "to establish a safe, non-hazardous method of transporting contaminated instruments and equipment to Central Supply". (Central Supply is the department in the hospital that cleans, disinfects, and sterilizes surgical instruments).

All instruments to be sterilized should be first decontaminated by removing blood, tissue, and/or residue.

The procedure indicated the healthcare worker shall wear protective gloves, eye wear and fluid resistant apron as appropriate while decontaminating instruments. The steps included:

a). presoak instruments for at least one minute in hot soapy water (longer if organic material is aged or dried).
b). mechanically cleanse with scrub brush.
c). rinse thoroughly.
d). items will be placed on the counter to the left of the sink in Surgery utility room.
e). Surgery will then process the instruments and return them to you sterilized.

On 8/15/16 at 1:53 pm, an interview was conducted with Licensed Vocational Nurse 1 (LVN 1). LVN 1 was asked what type of procedures are performed in the clinic. LVN stated that they do finger sticks, immunizations, toe nail removals, punch biopsies (cutting out a skin specimen), and suture removals. LVN 1 was asked if they reprocess the surgical instruments in the clinic. LVN 1 stated the main hospital resterilized the instruments.

LVN 1 was asked what their process was once the instrument had been used. LVN 1 stated they put the instrument in a plastic bag. The bag is placed in a basket located in the blood draw station. When someone is going over to the hospital, they take the instrument over to the surgery department. Other times the instruments are left on the desk. If surgery is closed, they will wait until the next morning when they come in to "run it over to them".

LVN 1 was asked if they had a dirty utility room. (A dirty utility room is used to handle dirty or contaminated equipment such as dirty linen, trash, decontaminating used instruments, etc.). LVN 1 stated that they did not have a dirty utility room.

An interview was conducted with the ICN on 8/15/16 at 3:55 pm. The ICN was not aware that the clinic was not following their policy for decontaminating the dirty instruments. When the ICN was told that the clinic did not have a dirty utility area for cleaning and disinfecting the dirty instruments, the ICN stated that they were going to have to figure out a way to do it without having a dirty utility room.

8. A facility policy and procedure titled, "Hand Washing/Hand Hygiene", with a revision date of 5/2016, was reviewed. The purpose of the policy was to have a process to prevent infections and communicable diseases to patients/residents, and personnel within the facility. Hand washing and hand hygiene removes microbial (bacteria or viruses) contamination acquired by recent contact with infected or colonized patients or environmental sources. (Colonized patients are those patients that carry bacteria on their skin or in their nose but do not have signs or symptoms of the illness).

The recommended times for hand hygiene are not limited to:
a). When arriving on duty.
b). Before and after direct patient contact.
c). Before and after touching wounds and dressings.
d). Before putting on gloves and after removing gloves.
e). After contact in inanimate sources likely to be contaminated (i.e., urinals, Foley bags, bedpans, and emesis basins).
f). After removing gloves.

During an observation on 8/15/16 at 10:30 am, Certified Nurses Assistant 1 (CNA 1) was observed in Room 26B assisting a patient who was using the bedside commode. CNA 1 came from around the drawn curtain, and removed her gloves, tossing them in the trash can as she exited the room. No hand washing was observed. CNA 1 walked across the hallway into a door marked, "clean utility room". CNA 1 immediately exited the clean utility room with a container of "wipes". CNA 1 reentered Room 26B and put on a new pair of gloves. No hand washing was observed. CNA 1 was observed in the patient's room with a clear plastic bag that she removed from the trash can, and the bucket from the bedside commode. She left the patient's room and entered the dirty utility room.

When CNA 1 exited the dirty utility room, she had on one glove which she had on the hand that was holding the bucket from the commode. She entered Room 26B replacing the bucket in the bedside commode. She removed the glove, exited the patient's room, walked across the hallway, and entered the clean utility room. No hand washing was observed.

On 8/15/16 at 10:35 am, an interview was conducted with CNA 1. CNA 1 was asked when she was required to wash her hands. She stated every time you take off your gloves. CNA 1 was told that there were several times that she had removed her gloves but no hand washing was observed. CNA 1 stated, "Yes, ma'am".

On 8/15/16 at 10:40 am, CNA 2 was observed entering Room 23A. CNA 2 was wearing gloves. CNA 2 moved the patient's overbed table from the left side of the bed to the right side of the bed. CNA 2 pulled the curtain back, and removed her gloves. No hand washing was observed. CNA 2 assisted the patient from Room 23A to the bathroom across the hall. CNA 2 returned to the patient's room, and put on a new pair of gloves. No hand washing was observed. While in the room, CNA 2 was observed making the bed, removed the trash and replaced the bag. CNA 2 left the room to dispose of the trash, took off her gloves, walked down the hallway and entered the clean utility room. Through the window, CNA 2 could be seen washing her hands at the sink in the clean utility room.

During an interview with CNA 2, on 8/15/16 at 11:48 am, she was asked how often she had infection control training. She stated, "once a month". CNA 2 was asked when are you supposed to wash you hands. She stated before and after patient care and in between patients. When asked why she did not wash her hands before putting on gloves and after removing gloves, CNA 2 stated, "we are supposed to".

9. On 8/15/16 at 11:37 am, an observation was conducted in the Intensive Care Unit (ICU). There was a red crash cart located in the hallway near the nurse's station. After running a finger across the top of the crash cart, an accumulation of a gray fuzzy material clung to my finger.

On 8/15/16 at 11:40 am, an interview was conducted with Registered Nurse 1 (RN 1). RN 1 was shown the accumulation of dust that was collected from the top of the crash cart. RN 1 acknowledged that the top of the crash cart was dusty and needed to be cleaned. When asked who was responsible for cleaning the crash carts, RN 1 stated the housekeepers were responsible for the cleaning of the carts.

On 8/15/16 at 1:43 pm, an interview was conducted with Administrative Staff 1 (Admin 1). Admin 1 was asked what cardio (heart)-pulmonary's(lung) (Cardio-staff working in respiratory therapy and those who conduct breathing and heart function tests) responsibility was for checking the crash carts. She stated Cardio checks the cardio equipment on the carts every shift and keeps track of the log. Once a month the carts are opened with pharmacy staff who check for expired medications. Admin 1 did not know who was responsible for the cleaning of the crash carts.

An interview was conducted with the Environmental Services Manager (EVS) on 8/16/16 at 10 am. The EVS manager was asked who was responsible for cleaning the crash carts. The EVS Manager stated that it was "Nursing's" responsibility.

















33399

Based on observation, interview and record review, the hospital failed to develop and implement a system for the identification, prevention and control of infections and communicable diseases, when:

1. Instruments used for surgery were not sterilized (free from bacteria) or stored to ensure their sterility.

2. Endoscopes were not disinfected according to manufacturer's instructions for use and national guidelines.

3. The floors of both operating rooms were visibly and tactilely (by feel) soiled.

4. Environmental controls for the surgery rooms and other sterile storage areas were not monitored on a daily basis.

5. Routine maintenance was not performed on the primary autoclave (sterilizer) used for sterilizing surgical instruments.

6. The tympanic thermometer was not cleaned between patient use. (Tympanic thermometers are hand-held devices with a probe that is inserted into the patient's ear canal to take a temperature).

7. The clinic was not cleaning and disinfecting surgical instruments before sending them to the hospital for resterilization.

8. Staff were not performing hand hygiene before putting on gloves and after gloves were removed.

9. The crash cart in the Intensive Care Unit (ICU) was coated with a layer of dust. (A crash cart is a cart on wheels that contains emergency equipment and medications used in the event a patient's heart stops beating or the patient stops breathing).

These failures put patients at risk for acquiring infections that could lead to a serious decline in their health status.

Findings:

1. On 8/15/16 at 10:15 am, the Infection Control Nurse (ICN) stated that the facility had adopted the Association of periOperative Registered Nurses (AORN) Guidelines for Perioperative Practice as one of the nationally recognized guidelines for their infection prevention and control program.

On 8/15/16 at 10:30 am during a tour of the surgery department, in the surgical supply storage room, peel packs (a see through paper and plastic container for use in sterilizing small instruments) were observed to be piled on top of one another on shelves. One peel pack containing a miscellaneous sharp instrument, was observed to be punctured; another peel pack had (2) peri-osteo elevators (heavy bulky instruments used for orthopedic surgery) in a peel pack; these observations were validated by the ICN and Licensed Vocational Nurse (LVN) 2.

According to the Association of periOperative Registered Nurses (AORN) Guidelines for Perioperative Practice (2016), Recommendation VI: Peel pouches should be used only for small, lightweight, low-profile items (for example one or two clamps, scissors). Heavy devices ...should not be packaged in peel pouches. Heavy or sharp items may compromise the package seal.

During a tour of Operating Room 1 at 10:10 am, a sterile minor surgery instrument tray was opened; out of 32 instruments, 2 were etched, 3 were soiled with a sticky substance, 1 instrument contained a brown stain and 23 had old instrument tape in that was irregularly applied and peeling off of some instruments. Then a sterile major surgery instrument tray was opened; 2 out of 20 hinged instruments were in the locked position, the three inch stringer (a two pronged metal device that goes through the finger holes of instruments) did not hold the instruments wide enough apart to ensure that the instruments would remain open and exposed during sterilization; these observations were validated by the ICN and LVN 2.

According to AORN Guidelines for Perioperative Practice, Recommended Practices for Cleaning and Care of Surgical Instruments (2016): Surgical instruments should be inspected and evaluated for cleanliness and correct working order after decontamination and if soiled or defective, should be removed from service until they are cleaned or repaired ....Instruments with hinges should be opened ...Proper organization will facilitate sterilant contact on all surfaces and adequate drying ...Sterilization occurs only on surfaces that have direct contact with the sterilant. Disassembly of multi-part instruments and those with sliding parts ...enables the sterilant to contact all surfaces. Cleaned surgical instruments should be organized for packaging in a manner to allow the sterilant to contact all exposed surfaces.

A designated person responsible for processing surgical instruments should review the instrument manufacturer's written Instructions for Use (IFU) to determine the requirements for replicating the validated cleaning and processing methods.

2. On 8/15/16 at 10:15 am, ICN stated that the facility has adopted the Association of periOperative Registered Nurses (AORN) Guidelines for Perioperative Practice as one of the nationally recognized guidelines for their infection prevention and control program.

On 8/15/146 at 10:30 am in the central corridor in the restricted area of the surgery department, endoscopes (an instrument that can be introduced into the body to give a view of its internal parts) were observed to be hanging in a cabinet near a Steris automated endoscopic reprocessor (disinfection machine) (AER). When asked about the disinfection of the scopes, LVN 2 stated that the AER was utilized for the high level disinfection (HLD) (defined as the destruction of most microorganisms with the exception of some bacterial spores) of all (3) scopes. When asked about the final process of running alcohol and/or air through the scopes after the AER to dry the internal chamber, she stated she was not aware that it was necessary, and this process was not performed.

During an interview with the Operating Room Manager (ORM) on 8/16/16 at 9:15 am, she stated that she did not know if the HLD process required the final steps of air and/or alcohol to be run through the interior of the scopes and she could not find the instructions for use (IFU), but she would confirm with the manufacturer. During a later interview at 1 pm, she stated that she had telephoned the device manufacturer Steris and they had verified with her that the final rinse with alcohol and the use of medical air to dry was required after the processing in the AER.

A facility policy and procedure was not provided upon request. Manufacturer's Instructions for use for the processing of the scopes after use of the Steris AER were not provided upon request.

According to AORN Guidelines for Perioperative Practice (2016), Guideline for Processing Flexible Endoscopes, Recommendation VIII: Mechanical processing should be performed in accordance with the endoscope manufacturer's IFU and the mechanical processor manufacturer's IFU. There are multiple types of flexible endoscopes and mechanical processors. Instructions for use may vary among manufacturers. Even slight deviations from the recommended protocols can lead to the survival of microorganisms and an increased risk for infection.

Many clinical practice guidelines and experts in the field recommend manual or mechanical flushing of endoscope lumens with alcohol because it facilitates drying of the endoscope lumens by binding with residual water and enhancing evaporation. Alcohol prevents colonization and transmission of waterborne bacteria.

3. On 8/15/16 at 10:15 am, ICN stated that the facility had adopted the Association of periOperative Registered Nurses (AORN) Guidelines for Perioperative Practice as one of the nationally recognized guidelines for their infection prevention and control program.

During a tour of Operating Rooms 1 and 2, there was a yellow film around the perimeter of both rooms. The areas were grimy to the touch. When asked, LVN 2 stated that the housekeepers perform terminal cleaning on Fridays, and the residue from washing down the walls, creates a collection of dried material around the perimeter of the room. Housekeeping has been informed of the problem.

On 8/16/16 at 12 pm the policy entitled: Cleaning of Operating Rooms dated 11/2015 was reviewed. The policy stated that terminal cleaning (end of day) includes ceilings walls and vents are cleaned as necessary and the entire surgical floor space is mopped with a detergent germicide.

According to AORN Guideline for Environmental Cleaning (2016), Recommendation II:
The patient should be provided with a clean, safe environment. The perioperative RN should assess the perioperative environment frequently for cleanliness and take action to implement cleaning and disinfection procedures.

Environmental cleaning and disinfection is a team effort involving perioperative personnel and environmental services personnel. The responsibility for verifying a clean surgical environment before the start of an operative or invasive procedure rests with perioperative nurses. The perioperative RN should visually inspect the OR for cleanliness before case carts, supplies, and equipment are brought into the room.

Recommendation IV: Perioperative areas should be terminally cleaned. Terminal cleaning and disinfection of perioperative areas, including sterile processing areas, should be performed daily when the areas are being used. All floors in the perioperative and sterile processing areas should be disinfected.

Floors may be terminally cleaned with a wet vacuum or a single-use mop and a disinfectant. The floor should be wet with the disinfectant for the dwell time indicated on the manufacturer's instructions for use. Cleaning should progress from the cleanest to dirtiest areas of the floor.
Floor surfaces at the perimeter of the room should be disinfected before floor surfaces in the center of the room.

4. On 8/15/16 at 10:15 am, ICN stated that the facility had adopted the Association of periOperative Registered Nurses (AORN) Guidelines for Perioperative Practice as one of the nationally recognized guidelines for their infection prevention and control program.

On 8/16/16 at 12:50 pm, during an interview with the ICN and ORM, they stated that logs for the environment of the operating rooms, decontamination and sterile supply are not measured when the rooms are not in use. They produced a log of temperature and humidity for OR 1, and out of 12 days (8/1 to 8/12/16) there were no entries for 8/1, 8/2, 8/6, 8/7, 8/8, 8/9 or 8/11/16. When asked if sterile supplies are kept in OR 1, ORM responded "yes".

According to AORN Guidelines for Practice (2016), Guideline for Sterilization, Recommendation III: Room temperature, humidity, and ventilation must be controlled and monitored in accordance with local, state, and federal policy and regulation ...Monitoring results should be readily retrievable. Monitoring and recording environmental controls in each area will assist in verification that minimum recommended parameters are met and maintained and will identify when corrective action needs to be taken.

A mechanism with memory for history of temperature and humidity can alert personnel if there was a deviation during unmanned times.

Recommendation XV: Sterilized materials should be labeled and stored in a manner to ensure sterility ...Limiting exposure to moisture, dust, excessive light or handling, and temperature and humidity extremes decreases potential contamination of sterilized items. Factors that contribute to contamination include air movement, humidity, temperature, and location of storage, presence of vermin, whether shelving is open or closed, and properties of the packaging material.

The shelf life is dependent on packaging material, storage conditions, transport, and handling. An event must occur to compromise package content sterility. Events that may compromise the sterility of a package include moisture penetration.

5. On 8/15/16 at 10:15 am, ICN stated that the facility has adopted the Association of periOperative Registered Nurses (AORN) Guidelines for Perioperative Practice as one of the nationally recognized guidelines for their infection prevention and control program.

On 8/15/16 at 11 am, on a tour of the sterile preparation area, when asked about the routine maintenance that was performed on the main Getinge sterilizer, LVN 2 stated the sediment screens were cleaned weekly. She was unable to describe any other routine maintenance activities.

On 8/16/16 at 12:50 pm, ICN and ORM stated that there was no documentation for the routine maintenance performed on the Getinge (brand name) sterilizer in the sterile processing area.

According to the manufacturer's guidelines (Getinge), the sediment screens are to be cleaned daily and the exterior surfaces, chamber interior, the accessories, [and] door gaskets are to be cleaned weekly.

According to AORN Guidelines for Perioperative Practice (2016), Guideline for Sterilization, Recommendation XIX: Policies and procedures for sterilization and sterilization-related processes and practices should be developed, reviewed periodically, revised as necessary, and readily available in the practice setting. The recommendations for sterilization should be used to guide the development of policies and procedures within individual perioperative practice settings. Policies and procedures should be developed and implemented for processes including routine cleaning of sterilizer chambers, carts, and exterior surfaces.

Based on interview and record review, the hospital failed to ensure that its policies and procedures for infection control, reprocessing surgical instruments and flexible endoscopes were evaluated to determine whether the established policies were followed and if there were any changes that were needed as part of their total program of care and services as evidenced by:
1. Surgical instruments were not reprocessed according to policy and procedure and current standards of practice. (Refer to C-278, findings 1 and 7)
2. Terminal cleaning of the operating rooms did not meet nationally recognized guidelines. The periphery of room had visibly soiled and sticky floors. (Refer to C-278, finding 3)
3. The facility was not performing the daily and weekly routine maintenance as required by the manufacturer's guidelines of the autoclave. (Refer to C-278, finding 5)
4. Flexible endoscopes (an instrument that is equipped with a camera that is used to view the inside of the body), were not being high level disinfected according to nationally recognized guidelines. (Refer to C-278, finding 2)
5. The temperature and humidity in the surgery department, where sterile instruments and supplies were being stored, was not being monitored daily. (Refer to C-278, finding 4)
6. The policy and procedure for cleaning patient equipment was not being performed between each patient use. (Refer to C-278, finding 6)
The cumulative effect of these systemic problems resulted in the hospital's inability to ensure the provision of services was in compliance with the statutorily mandated Quality Review and Periodic Evaluation.
Findings:
An interview was conducted with Administrative Staff 1 (Admin 1) on 8/16/16 at 2:32 pm. Admin 1 was asked how the facility carries out their periodic evaluation for their annual evaluation. Admin 1 stated that the Annual Report was presented at the July's Board meeting. When asked what information was reported she stated they reported statistics for the year such as the patient census for the year, the number of patient visits, HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems is a publicly reported survey of patients' perspectives of hospital care), Core Measures (Core Measures are a set of care standards, required by the Centers for Medicare & Medicaid Services (CMS), which describes the care to be provided to our patients while in the hospital), and a report on their Healthcare Associated Infections (infections that are a result of surgical site infections, catheter associated urinary tract infection, central line associated blood stream infections).
Admin 1 was asked about what services are reviewed in regards to the surgery department. Admin 1 stated they reported on how many in-patient and outpatient procedures were performed and how many scope procedures were done. When asked if any of surgery's processes were reviewed such as the reprocessing of the flexible endoscopes or the cleaning and resterilization of surgical instruments, Admin 1 stated that the quality indicators for surgery were not included.
Admin 1 stated that the managers are responsible for updating their policies every year. They do not have an automated process in place to remind the managers when their policies are up for review.
Admin 1 was asked how they audit their processes so they know when a process is not working. Admin 1 stated they have a process for their corrective action plan. It's still a new process, we haven't gotten to the end point yet. It's just not working, period.
The 2016 edition the Guidelines for Peri-Operative Practice, published by the Association of peri-Operative Registered Nurses (AORN), was reviewed.
AORN's Guideline for the Cleaning and Care of Surgical Instruments was reviewed. Recommendation XVII: " The health care organization's quality management program should evaluate the cleaning, decontamination, and care of instruments."
AORN's Guideline for reprocessing flexible endoscopes indicated, (Recommendation XIII), the health care organization's quality management program should evaluate processing of flexible endoscopes.

Based on interview and record review, the hospital failed to ensure that its policies and procedures for infection control, and the reprocessing of surgical instruments and flexible endoscopes (an optic instrument that transmits light and allows the observer to inspect and treat interior portions of the body) were evaluated to determine whether the established policies and procedures were followed and if there were any changes that were needed as part of their total program of care and services.

These failures had the potential to expose patients to infections and disease that could adversely effect their health and well being.

Findings:

An interview was conducted with Administrative Staff 1 (Admin 1) on 8/16/16 at 2:32 pm. Admin 1 was asked how the facility carries out their periodic evaluation for their annual evaluation. Admin 1 stated that the Annual Report was presented at the July's Board meeting. When asked what information was reported she stated they reported statistics for the year such as the patient census for the year, the number of patient visits, HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems is a publicly reported survey of patients' perspectives of hospital care), Core Measures (Core Measures are a set of care standards, required by the Centers for Medicare & Medicaid Services (CMS), which describes the care to be provided to our patients while in the hospital), and a report on their Healthcare Associated Infections (infections that are a result of surgical site infections, catheter associated urinary tract infection, central line associated blood stream infections).

Admin 1 was asked about what services are reviewed in regards to the surgery department. Admin 1 stated they reported on how many in-patient and outpatient procedures were performed and how many scope procedures were done. When asked if any of surgery's processes were reviewed such as the reprocessing of the flexible endoscopes or the cleaning and resterilization of surgical instruments, Admin 1 stated the quality indicators for surgery were not included.

Admin 1 stated that the managers were responsible for updating their policies every year. They do not have an automated process in place to remind the managers when their policies are up for review.

Admin 1 was asked how they audit their processes so they know when a process is not working. Admin 1 stated they have a process for their corrective action plan. "It's still a new process, we haven't gotten to the end point yet. It's just not working, period".

The 2016 edition the Guidelines for Peri-Operative Practice, published by the Association of peri-Operative Registered Nurses (AORN), was reviewed.

AORN's Guideline for the Cleaning and Care of Surgical Instruments was reviewed. Recommendation XVII: " The health care organization's quality management program should evaluate the cleaning, decontamination, and care of instruments."

AORN's Guideline for reprocessing flexible endoscopes indicated, (Recommendation XIII), the health care organization's quality management program should evaluate processing of flexible endoscopes.