CDC Releases Infection Prevention Guide to Promote Safe Outpatient Care

Medical care in outpatient settings has surged in recent years, yet in many cases, adherence to standard infection prevention practices in outpatient settings is lacking. To protect patients and help educate clinicians about minimum expectations of safe care, the Centers for Disease Control and Prevention (CDC) today released a new, concise guide and checklist specifically for health care providers in outpatient care settings such as endoscopy clinics, surgery centers, primary care offices, and pain management clinics.

"Patients deserve the same basic levels of protection in a hospital or any other healthcare setting," says Michael Bell, MD, deputy director of CDC's Division of Healthcare Quality Promotion. "Failure to follow standard precautions, such as correct injection practices, cannot be tolerated. Repeated outbreaks resulting from unsafe practices, along with breaches of infection control noted in ambulatory surgical centers during inspections by the Centers for Medicare and Medicaid, indicate the need for better infection prevention across our entire healthcare system, including outpatient settings."

The Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care is based on existing, evidence-based CDC guidelines that apply to a wide range of health care facilities but are mostly used by hospitals. The easy-to-reference guide is accompanied by an Infection Prevention Checklist for Outpatient Settings and supporting materials including a new, no-cost, certified continuing medical education course titled Unsafe Injection Practices: Outbreaks, Incidents, and Root Causes and offered on Medscape.org for clinicians in all healthcare settings. The video course was developed in collaboration with the Safe Injection Practices Coalition, a partnership of health care-related organizations formed to promote safe injection practices in all U.S. healthcare settings.

Among other important recommendations, the guide states that all outpatient practices should ensure that at least one individual with specific training in infection control is on staff or regularly available. This individual should be involved in developing a written infection control policy and have regular communication with health care providers to address specific issues or concerns.

The guide and supporting materials can be used for internal assessment within a facility or practice. They complement ongoing work by CDC and CMS to integrate CDC guidelines into CMS surveys used during inspections of outpatient settings including ambulatory surgery centers.

Outpatient settings, facilities where patients do not stay overnight, include non-hospital based clinics and physician offices, urgent care centers, outpatient surgical centers, public health clinics, imaging centers, oncology clinics, outpatient behavioral health and substance abuse clinics, physical therapy and rehabilitation centers, as well as hospital-based outpatient departments and clinics.

More than three-quarters of all operations in the United States are performed at outpatient facilities. In addition, between 1995 and 2007, the average person made three visits each year to physician offices. By 2007, the total number of physician office visits approached 1 billion. Vulnerable patient populations make up a significant portion of healthcare users, and it is critical that care be provided under conditions that minimize the risk of healthcare-associated infections (HAIs).

These new materials reinforce that healthcare personnel should always:

- Follow procedures for the safe handling of potentially contaminated medical equipment

- Ensure safe medical injection practices are followed

Outpatient facilities and practices should:

- Develop and maintain infection prevention and occupational health programs

- Ensure that at least one individual with training in infection control is employed by or regularly available to the facility. This person should be responsible for overseeing the facility's infection prevention program

- Develop written infection-prevention policies and procedures appropriate for the services provided by the facility and based upon evidence-based guidelines, regulations, or standards

- Provide job- or task-specific infection prevention education and training to all health care personnel

- Make sure sufficient and appropriate supplies necessary for adherence to standard precautions are available

- Perform regular audits and competency evaluations of staff's adherence to infection prevention practices

- Utilize CDC's infection prevention checklist for outpatient settings to assess infection control practices

- Adhere to local, state, and federal requirements regarding HAI surveillance, reportable diseases, and outbreak reporting

To access the guide, checklist, and supporting materials including the CME course, CDC and external commentary about the guide, clinician and patient education materials, a CDC Safe Surgery feature, and additional information, visit http://www.cdc.gov/HAI/settings/outpatient/outpatient-care-guidelines.html.