Sterilization and Disinfection Practices in Ambulatory Settings

best possible care

As a consultant, speaker and expert witness, I am constantly surprised when I hear comments like “We are an ambulatory surgery center (ASC) or a free standing dental clinic so these guidelines or standards do not apply to us,” or “Those are only recommendations, so we don’t have to follow them.”

Let’s clarify.  No matter where surgery and other invasive procedures are performed, the published guidelines, standards and recommended practices from The  Association of periOperative Registered Nurses (AORN),1 the Association for the Advancement of Medical Instrumentation (AAMI)2,3  and the Centers for Disease Control and Prevention (CDC),4 guidelines or standards for reprocessing should be followed.  These recommended practices are evidence based and considered best practices.

Regardless of what type of procedure or where it is preformed, we as healthcare professionals have an ethical responsibility to provide our patients with the best possible care.  The Centers for Medicare and Medicaid Services, as well as other accreditation agencies (e.g., The Joint Commission, The American Association for Accreditation for Ambulatory Surgery Facilities) are surveying to these standards.5

Some of the recommendations like the OSHA bloodborne pathogen regulations are law and must be followed or your facility will have to pay a penalty.  One such incident happened last year when a facility was fined for unsafe practices relating to how contaminated surgical instruments were sent to Sterile Processing.6

In addition, if your facility finds itself in a court of law relating to reprocessing reusable medical devices, one question that is sure to come up is “Were you following the published standards from AORN, AAMI and the CDC?”  These evidence-based recommended practices and guidelines are built on sound principles, published research, scientific data and experts in the field.  Therefore, these best practices are considered the minimal standard of care and should be followed or your facility may be “on trial by 60 minutes,”as I like to say.

TJC National Patient Safety Goal (NPSG) Number 7 states, “Reduce the risk of Healthcare-associated infections (HAI).”  Specifically, NPSF.07.05.01: Implement evidence-based practices for preventing surgical site infections.  Therefore, policies and practices should meet regulatory requirements and be aligned with published standards, guidelines and recommendations in order to reduce the risk of HAI in the ambulatory setting.7

Any facility that performs surgery or other invasive procedures should followed the AORN, AAMI and the CDC published standards, guidelines or recommended practices no matter what the facility size is or if the patients are admitted.  After all, our responsibility to the patients are to provide the best possible care – what if that was you or a loved one on the table?








  1. Guidelines for Perioperative Practice. Denver, CO: AORN, 2015.
  2. Association for the Advancement of Medical Instrumentation. Comprehensive guide to steam sterilization and sterility assurance in health care facilities. ANSI/AAMI ST 79:2010 &A1:2010 & A2:2011 & A3:2012&A4:2013 (consolidated text)
  3. Association for the Advancement of Medical Instrumentation. Chemical sterilization and high-level disinfection in health care facilities. AAMI ST58:2013
  4. Centers for Disease Control (CDC). Guideline for Disinfection and Sterilization in Healthcare Facilities. 2008.
  5. R. Sterile Processing In Healthcare Facilities: Preparing for Accreditation Surveys, 2nd edition, AAMI 2014
  6. United States Department of Labor. Occupational Health and Safety Administration. Inspection 974812.015 – Hallmark Health – Melrose Wakefield Hospital. Accessed January 2, 2015
  7. National Patient SAFETY Goals Effective Jan. 1, 2014. Ambulatory Health Care Accreditation Program. The Joint Commission


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