Ambulatory Infection Preventionists: Providing the Resource

Shannon Simmons, DHSc, MPH, CIC

The COVID-19 global pandemic has brought the importance of the infection preventionist (IP) to the forefront and has subsequently highlighted the need for infection prevention and control resources in the rapidly growing ambulatory care sector of health care. Ambulatory care is typically used as an all-encompassing term to describe a wide array of health care services performed outside of a hospital; however, these services ultimately act as a cost-effective alternative to hospital-delivered care. Although ambulatory care can provide the same services to patients at a fraction of the cost and in a fraction of the time, the requirement remains to maintain the same compliance and consistency as its inpatient counterpart. The ambulatory IP can be an important resource in translating widely accepted standards of care and patient safety into ambulatory care facilities.

As hospital systems transition to operating more ambulatory facilities, traditional health care positions should be expanding to fulfill the needs for such positions as a full-time ambulatory IP. Although the requirement for hospitals to have a full-time, dedicated IP on staff is readily maintained, resources have deterred this same regulation from being applied to ambulatory care facilities such as stand-alone clinics and urgent care centers. The quality of ambulatory services is subject to decreased quality outcomes when not provided the same or similar resources as its inpatient counterpart.

The ambulatory [infection preventionists] can be an important resource in translating widely accepted standards of care and patient safety into ambulatory care facilities.

Historically, there has been less scrutiny surrounding ambulatory care facilities, leaving this area prone to problems and errors often linked to their extreme resource constraints. Staffing shortages, the lack of physical space, and financial barriers make it difficult to implement the appropriate infection prevention measures needed for safer patient outcomes. In many clinics, especially those in rural areas, the staff are asked to act in several different capacities, ultimately decreasing the attention available for adhering to the nuances of many infection control and prevention practices, such as those associated with reprocessing instruments.

Ambulatory care facilities primarily rely on the train-the-trainer model, which is a training framework that encourages employees to become subject matter experts who can then teach other members of their team. This framework relies heavily on staff members becoming experts in areas quickly, but without continued assessment of the task or the competency of the trainer. An example would be when a single staff member is expected to carry out direct patient care in addition to performing high level disinfection or sterilization of instruments. On the other hand, in a hospital sterile processing department, these types of processes more often are performed by a certified technician because the evolution of procedural instruments and the composition of these items make sterilization a less straightforward task, requiring specific training that the ambulatory care facilities may not be able to provide. Further, the complexity and difficulty to fully sterilize many procedural instruments is a widely recognized concern that is also attached to patient outcomes.

An ambulatory IP is a resource whose primary purpose is to be an infection prevention and control expert and provide prevention specific knowledge to staff and facilitate changes in practices and protocols to meet or exceed standards and recommendations that are specific to the ambulatory sector. While ambulatory IPs are not considered the subject matter experts in areas of ambulatory care such as high-level disinfection and sterilization, they can offer the guidance associated with meticulous attention to manufacturer’s instructions for use and evidence-based recommendations. The opportunity exists for comprehensive change in the ambulatory health care sector that hinges upon amplifying the resources for both care delivery and quality improvement efforts. The ambulatory IP is an answer to the national priority of strengthening infection prevention and control programs in ambulatory care settings.