In 2008, an outbreak of hepatitis C infection at an ambulatory surgery center in Las Vegas led to a call for thousands of former patients to be tested for the virus. In the aftermath of the outbreak, statewide audits of outpatient surgical centers uncovered widespread problems that were putting patients at risk on a daily basis.
A year later, the Centers for Medicare and Medicaid Services (CMS) launched a stringent oversight program for ambulatory surgery centers (ASCs) and issued a set of infection control regulations that are mandatory for any center wishing to participate in the Medicare program. According to a recent article in Infection Control Today, however, there are still compliance problems at these outpatient centers.
For context, more than 5,000 ASCs in the U.S. accept Medicare patients and the outpatient setting is now preferred for surgeries that do not require hospital stays of more than 24 hours. Despite this shift in health care delivery, attention to infection control at ASCs appears to be lacking, according to a CDC report that was published in 2010 in the Journal of the American Medical Association (JAMA). The study looked at five separate areas of infection control and found that lapses were common in each: hand hygiene and use of personal protective equipment, injection safety and medication handling, equipment sterilization and disinfection, environmental cleaning, and handling of blood glucose monitors.
Shockingly, 28 percent of the ASCs audited used medications packaged in single-use vials for multiple patients – probably as a cost-saving measure. Single-use vials and IV bags are not designed to inhibit bacterial growth once opened, and re-using them has resulted in bloodstream infections. Additionally, 21 percent of the facilities that used glucose monitoring equipment were found to be using a single-use lancet on multiple patients. Another six percent of the facilities studied were found to be reprocessing and re-using items that were labeled as single-use devices, instead of discarding them after use. Only FDA-approved facilities are cleared to sterilize and reprocess single-use devices.
As a result of breaches like this, CMS regulations now require every ASC to have a designated person who is in charge of the facility’s infection prevention and control program. This person must be a licensed professional, such as an RN, who has also received specialized training in infection control. CMS also requires every ASC to base its infection control plan on nationally recognized guidelines and to apply them consistently. It does not mandate a particular set of guidelines, so an ASC may put together its own infection prevention program from recommendations issued by the CDC, Society for Healthcare Epidemiology of America (SHEA), or Association for Professionals in Infection Control (APIC).
Nursing traditionally has put a huge focus on patient advocacy. Nurses and nurse leaders, can advocate for patients’ safety and comfort by providing strong leadership when it comes to infection control and prevention polices. They can identify where policies are lacking, work to establish and promote needed policies, and take the lead on ensuring that every member of the multi-disciplinary care team complies with them. As HAIs remain a hot topic in health care, strong nursing leadership will be instrumental in reducing their incidence.
And if you’re interested in planning, implementing, and evaluating infection prevention and control measures, consider making this field your career specialty. As a first step, you can develop new skills and empower yourself with knowledge through an online RN to MSN degree with a specialization in infection control from American Sentinel University, an innovative, accredited provider of online nursing degrees.