Picture this: It’s Monday morning at 10 a.m., and you have all rooms running smoothly at your office-based surgery center. The FedEx truck arrives with your weekly shipment of supplies, and you head out to accept it. As you are checking off items, you get called away to an urgent situation. You quickly take the boxes inside to the supply room and go address the issue.

The boxes remain in sterile supply until the following day, when Accreditation Commission for Health Care (ACHC) Surveyors arrive at your organization for survey and deliver citations for the presence of “corrugated” boxes in the sterile supply room and you have no idea why.

Is this really considered a finding? Let’s talk trash.

OBS Standard 05.00.06 Sanitary Environment

Standard 05.00.06 states, “The organization must provide a functional and sanitary environment for the provision of services by adhering to professionally acceptable standards of practice.” How does this relate to cardboard boxes? What exactly is a “corrugated” box?

Corrugated boxes contain multiple layers of materials for added durability and strength – in other words, cardboard shipping boxes. Non-corrugated boxes are typically made of a single-layer cardboard or even paper stock (think of a box of surgical gloves).

The infection control concern arises from the presence of corrugated boxes within the semi-restricted and restricted areas of surgical services.

Cardboard shipping boxes are manufactured without any means of decontamination. They are stored in multiple areas without protection from the environment. They often arrive on pallets, which could carry rodents, vermin, dirt, or other pathogenic organisms along with your supplies. Delivery workers do not typically wear personal protective equipment (PPE) when handling items. Cardboard boxes can shed, contributing to dust that could carry multiple microorganisms throughout your facility. If the boxes become wet, they provide a great environment for bacterial or fungal growth. Finally, cardboard cannot be sanitized, therefore it cannot be a part of your regularly scheduled environmental cleaning program. What can you do?

Tips for Compliance

Planning, communication, and education can help your organization get a handle on corrugated cardboard boxes for safety and compliance.

• Form a multi-disciplinary team to gather insight, discuss challenges, and develop potential solutions from multiple perspectives.
• Educate the team on the risks of corrugated cardboard/shipping boxes within semi-restricted and restricted areas. Make sure to include examples of corrugated and non-corrugated material for reference.
• Outline the current process and any barriers or concerns (multiple entries, no defined policy, etc.). Draw out the process and identify “hard stop” areas (“No cardboard beyond this line.”).
• Post signs. Make sure that all employees, providers, and industry representatives are aware. Develop a policy addressing the best way for your organization to transfer items from a loading dock/non-restricted area, out of external shipping boxes, and into your sterile storage area. Get input from key players.
• Document your efforts. Add this to your annual infection control and/or QAPI plan. Be sure to celebrate improvements!

Here to Help

We are here to help. If you have questions or wish to access the most recent ACHC Office-Based Surgery Accreditation Standards Manual, contact your Account Advisor or email us at [email protected].