An assessment of nearly 70 ambulatory surgical centers in three states found that lapses in infection control were common, including for practices such as hand hygiene, injection and medication safety and equipment reprocessing, according to a study in the June 9 issue of JAMA.
Healthcare delivery in the United States over the last several decades has shifted toward the outpatient setting; ambulatory surgery in particular has been an area of immense growth. “Ambulatory surgery centers (ASCs) are defined by the Centers for Medicare & Medicaid Services (CMS) as facilities that operate exclusively to provide surgical services to patients who do not require hospitalization or stays in a surgical facility longer than 24 hours. Between 2001 and 2008 there was a greater than 50 percent increase in the number of Medicare-certified ASCs in the United States; currently more than 5,000 ASCs participate in the Medicare program. In 2007, these facilities performed more than 6 million procedures with services extending beyond what is traditionally considered surgery to include endoscopy, pain injections, and dental procedures among others,” the authors write. “Little is known about infection control practices in ASCs.”
Melissa K. Schaefer, MD, of the Centers for Disease Control and Prevention (CDC), and colleagues conducted a study to assess compliance with basic infection control practices as well as with other Medicare health and safety standards in ASCs. The study included the inspection of ASCs in three states, selected based on geographic dispersion, number of ASCs each state committed to inspect, and relative cost per inspection. Sample size was based on the number of inspections each state estimated it could complete between June and October 2008. Sixty-eight ASCs were assessed; 32 in Maryland, 16 in North Carolina, and 20 in Oklahoma. Surveyors from CMS, trained in use of an audit tool, assessed compliance with specific infection control practices, focusing on five areas of infection control: hand hygiene, injection safety and medication handling, equipment reprocessing, environmental cleaning, and handling of blood glucose monitoring equipment.
Overall, 46 of 68 pilot ASCs (67.6 percent) had at least 1 lapse in infection control noted by surveyors and 17.6 percent of the facilities had lapses identified in 3 or more of the 5 infection control categories. Twelve of 62 facilities (19.4 percent) were noted to have a lapse in adherence to hand hygiene or appropriate use of personal protective equipment (i.e., gloves); 28.4 percent of 67 facilities had deficiencies related to injection practices or medication handling, primarily through use of single-dose vials for more than 1 patient.
