Ambulatory care centers and outpatient surgery facilities all seem like ideal settings to receive healthcare. A patient can be seen, treated and sent back home in half the time of a hospital visit. Therefore, it might appear that the risk of infection would be lower because the patient is only there briefly. So why has there been so much concern over these facilities recently? There are many reasons.
Because many outpatient clinics are not accredited, they may not have extensive quality improvement monitoring, infection surveillance or patient follow-up procedures. These facilities are usually small, and are therefore allowed to combine several services in one area – a practice that hospitals do not allow.
Recent investigations have exposed many of these issues. More than 60,000 patients in the United States were advised to get tested for hepatitis B and C because healthcare personnel failed to follow basic infection prevention practices, according to a January 2009 Centers for Disease Control and Prevention (CDC) report which described 33 infection outbreaks outside of the hospital setting in 15 states from 1998 to 2008. Reuse of syringes and blood-contamination of medications, fluids, equipment and devices caused these infections.
In reality, such errors have occurred for many years without discovery for two main reasons. First, there is a time lapse between exposure and development of symptoms for hepatitis B and C. For hepatitis B, it can be as short as two weeks or as long as six to nine months before the antigen testing is positive for HBsAg. While most patients become symptomatic, a small percent may have no symptoms at all and therefore may not suspect that they are infected.
