Infection Rate in Accredited Ambulatory Facilities is Lower than in Hospitals

The American Association for the Accreditation of Ambulatory Surgery Facilities (AAAASF) says that a recent article widely reported on in the press, Infection Control Assessment of Ambulatory Surgical Centers, by Melissa K Schaefer, Michael Jhung et al. (JAMA 2010;303(22):2273-2279) correctly places emphasis on the importance of adherence to infection control policies but leaves the impression that patients are at a greater risk for exposure to infections in ambulatory surgery centers, according to the AAAASF. This, simply stated, is not the case, the AAAASF adds.

The AAAASF is one of the most recognized authorities in the accreditation of office-based and ambulatory surgery centers both nationally and internationally. “Our standards thoroughly cover infection control policies. We mandate 100 percent compliance with these standards which include bi-annual reporting to our comprehensive peer review system,” says Dr. Lawrence Reed, AAAASF board president.

In a study of more than 400,000 outpatient surgical procedures performed in our accredited facilities published in 2004 ("Analysis of Outpatient Surgery Center Safety Using an Internet-Based Quality Improvement and Peer Review Program published in Plastic and Reconstructive Surgery,) 411,670 outpatient procedures were analyzed. The infection rate was 0.09 percent (one infection for every 1,061 procedures). All infections responded to conservative wound care and or antibiotics.  AAAASF data used in this study is from accredited facilities. Unfortunately, many facilities are neither accredited nor inspected on a regular basis.  “We are in agreement that standards should be followed and welcome mandatory accreditation or licensure for all outpatient surgery facilities with regularly scheduled inspections,” Reed adds.

It is not appropriate to compare the infection rate in outpatient facilities with hospitals as they exist in a totally different and more complex clinical setting.  A hospital study conducted by Gaynes, et al.2001, "Surgical Site Infection (SSI) Rates in the United States, 1992 -1998: The National Nosocomial Infections Surveillance System Basic SSI Risk Index "showed an rate of infection 33 times greater than that reported for our accredited ambulatory surgery centers. Patient safety should be the primary consideration.    

 “The challenge for instituting and enforcing infection control policies in hospitals is clearly more difficult. Patients, should however, be assured that the infection rate in accredited, ambulatory surgery centers, is very low,” concludes Reed.