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How to Assess Risk of Disease Transmission to Patients When There Is a Failure to Follow Recommended Disinfection and Sterilization Guidelines

William A. Rutala , PhD, MPH and David J. Weber , MD, MPH
Infection Control and Hospital Epidemiology
Vol. 28, No. 2 (February 2007), pp. 146-155
DOI: 10.1086/511700
Stable URL: http://www.jstor.org/stable/10.1086/511700
Page Count: 10
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How to Assess Risk of Disease Transmission to Patients When There Is a Failure to Follow Recommended Disinfection and Sterilization Guidelines
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Abstract

Background.  Disinfection and sterilization are critical components of infection control. Unfortunately, breaches of disinfection and sterilization guidelines are not uncommon. Objective.  To describe a method for evaluating a potential breach of guidelines for high‐level disinfection and sterilization of medical devices. Methods.  The appropriate scientific literature was reviewed to determine the frequency of failures of compliance. A risk assessment model was constructed. Results.  A 14‐step protocol was constructed to aid infection control professionals in the evaluation of potential disinfection and sterilization failures. In addition, a model is presented for aiding in determining how patients should be notified of the potential adverse event. Sample statements and letters are provided for communicating with the public and individual patients. Conclusion.  Use of a protocol can guide an institution in managing potential disinfection and sterilization failures.

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