Continuous Quality Improvement

Concurrent Education Session - 60 minutes

3606 - From Novice to Expert in 2.0: Advancing Through the Stages of Competency in Cleaning, Disinfection, and Sterilization in the Ambulatory Setting

Friday, June 16
2:45 PM - 3:45 PM
Location: Oregon Convention Center, B 113-114

Background: In the ambulatory setting, cleaning, disinfection, and sterilization may be performed by staff with no Central Services (CS) oversight. This presents a unique challenge for infection preventionists with oversight responsibilities. In 2013, two infection preventionists transitioned to the ambulatory setting to oversee a health system’s more than 180 ambulatory sites with approximately 50 percent performing instrument reprocessing. This required the infection preventionists to obtain competency in instrument reprocessing through the stages of professional development.
Methods: The infection preventionists performed self-assessments to determine areas requiring focus. They partnered with a CS representative for guidance on current guidelines and standards and inpatient processes. An experienced ambulatory infection preventionist at an out-of-state organization also served as mentor. From 2013–2014, the infection preventionists attended training courses, reviewed literature, and received hands-on training from CS technicians. Joint site visits and clinic staff educations were conducted with the CS representative until the infection preventionists obtained competency.
Results: Within 2 years, the infection preventionists advanced their knowledge and skills from novice to expert and functioned independently to oversee ambulatory reprocessing. They implemented performance improvement initiatives and centralized sterilization (40 of 47 sites), standardized offsite transport processes for sites established with CS services (37), and developed ambulatory-specific material (i.e., four policies, six competencies, standard monitoring logs and products). Remaining sites performing sterilization (7) or high-level disinfection (19) received training and competencies. During the 2015 accreditation survey, surveyed sites received no reprocessing deficiencies as compared to the 2012 survey. The infection preventionists continue to evaluate all aspects of ambulatory reprocessing from point-of-use handling and onsite or offsite reprocessing.
Conclusions: The specialized skill of instrument care requires training; but infection preventionists considered novice in the APIC Competency Model can advance to experts. As experts, infection preventionists can then assume leadership of continuously monitoring and improving instrument reprocessing practices in the ambulatory setting.

Learning Objectives:


Carolyn Kiefer

Infection Preventionist, Ambulatory Care
Carilion Clinic
Roanoke, Virginia

Carolyn Kiefer has been a registered nurse since 2004 and has a background in acute care and home health. She has been devoted to infection prevention and control for five years, which includes long-term and skilled nursing care, acute care, ambulatory care, and emergency preparedness. In 2013, she transitioned to ambulatory care to develop and oversee the ambulatory infection prevention and control program for the health system’s more than 180 sites.

Presentation(s):

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Barbara Schultz

Ambulatory Infection Preventionist
Carilion Medical Center
Roanoke, Virginia

Barbara Schultz is Clinical Laboratory Supervisor Transfusion Service; ARC Assistant Director, Education Coordinator; Carilion Clinic Quality Management RCA Facilitator; Carilion Clinic Infection Control, Hospital and Ambulatory. 

Presentation(s):

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Beth R. Wallace

Manager, Infection Prevention and Control
Methodist Charlton Medical Center
Dallas, Texas

Presentation(s):

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3606 - From Novice to Expert in 2.0: Advancing Through the Stages of Competency in Cleaning, Disinfection, and Sterilization in the Ambulatory Setting

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