Monitoring high-level disinfection with 0.55% ortho-phthalaldehyde (OPA)

ISSUE: Our clinical center (CC) strives to provide a consistent standard of care across its continuum of clinical services. At the time of our last accreditation survey in 2003, questions were raised about the consistent use of OPA. PROJECT: As part of its mission, the CC must address standards of practice for high-level disinfection including documentation standards. The CC already had in place an OPA education system. Because of the concern raised by accreditation surveyors, the hospital epidemiology service worked with the 11 users of OPA and hospital central supply to design and implement a flow sheet to facilitate documentation. We developed infection control guidelines for the use of OPA test strips based on recommendations from the manufacturer and the available literature. RESULTS: We convened a small task force to identify where documentation was inadequate. This group met in person initially, but subsequently only by e-mail. The group crafted a three-page flowchart that followed the manufacturerʹs recommendations and CDC guidelines, but which was tailored to the unique needs of our existing infrastructure. This process was reviewed by: 1) hospital infections committee, 2) hospital central supply, and 3) an expert in hospital epidemiology. Detailed follow-up sessions were conducted with all product users. To ensure compliance with new documentation requirements, a detailed check sheet for monitoring OPA documentation and process was also developed. LESSONS LEARNED: To ensure standard care across the continuum, development of a hospital-wide documentation system requires constant monitoring and detailed ongoing assessment to ensure both understanding and compliance. Monitoring use of OPA in our organization created a dialogue with our ancillary services and improved the compliance for documentation but also served as a model for improving organizational communication.