By Marcia Patrick, RN, MSN, CIC
The study, "Infection Control Assessment of Ambulatory Surgical Centers," in the June 9, 2010 issue of JAMA, noted that two-thirds of 68 ambulatory surgery centers (ASCs) surveyed had one or more deficiencies in infection control practice. The survey was done to test an assessment tool to be used by surveyors conducting Medicare surveys of ASCs. Assessments covered five important areas of infection control:
-- Hand hygiene
-- Injection safety and medication handling
-- Equipment reprocessing
-- Environmental cleaning
-- Handling of blood glucose monitoring equipment
Deficiencies in any of these five areas are associated with a risk of infection transmission to patients -- from unclean hands; improper injection techniques such as reusing needles and/or syringes or contaminating multi-dose vials and using them on another patient; using single-use medication vials on more than one patient; using contaminated medical equipment such as instruments used in operations or endoscopes used to examine or treat various body areas; contaminated environmental surfaces such as unclean gurneys, OR tables and the like; and transmission of bloodborne pathogens such as hepatitis or HIV from contaminated blood glucose monitoring equipment.
Most hospitals have experienced infection preventionists on staff that monitor practices for safety. They have experienced operating room personnel who are familiar with proper OR practices. People working in instrument and scope reprocessing are well-trained and do their work well. There are dedicated environmental services or other support personnel who perform environmental cleaning to assure the environment won’t contribute to infections. Blood glucose monitoring equipment is designed to be used on more than one patient and to minimize the risk of exposure. The equipment is disinfected between patients. There are systems in place to assure all of this is being done correctly all of the time.
Over the years, procedures that were once the province of hospitals have moved to the outpatient arena. Procedures that used to require a large incision now can be done through small "keyholes" resulting in much less patient discomfort after the procedure and a much faster recuperation time. Procedures such as total knee replacements and laminectomies can be done on an outpatient basis for some patients.
The downside of this is that more and more complex, difficult-to-clean and disinfect equipment has come on the scene. Manufacturers don’t always consider the cleaning requirements before they bring a product to market. Endoscopes that enter the body are narrow and have tiny, narrow channels that must be completely cleaned with a brush to ensure all debris has been removed in order for the disinfectant to be effective. There are small ports and connectors that also must be thoroughly scrubbed before disinfection. Instruments used in "keyhole" procedures also often have small channels, instruments that are used for cutting or grasping a bit of tissue for a biopsy or other test. Some of the units used for disinfection and sterilization after cleaning have specific connectors that must be used and hooked up correctly in order for the disinfectant to reach all the areas that are contaminated. This does not always happen.
