ABSTRACT
CONTEXT: More than 5000 ambulatory surgical centers (ASCs) in the United States participate in the Medicare program. Little is known about infection control practices in ASCs. The Centers for Medicare & Medicaid Services (CMS) piloted an infection control audit tool in a sample of ASC inspections to assess facility adherence to recommended practices. OBJECTIVE: To describe infection control practices in a sample of ASCs. DESIGN, SETTING, AND PARTICIPANTS: All State Survey Agencies were invited to participate. Seven states volunteered; 3 were selected based on geographic dispersion, number of ASCs each state committed to inspect, and relative cost per inspection. A stratified random sample of ASCs was selected from each state. Sample size was based on the number of inspections each state estimated it could complete between June and October 2008. Sixty-eight ASCs were assessed; 32 in Maryland, 16 in North Carolina, and 20 in Oklahoma. Surveyors from CMS, trained in use of the audit tool, assessed compliance with specific infection control practices. Assessments focused on 5 areas of infection control: hand hygiene, injection safety and medication handling, equipment reprocessing, environmental cleaning, and handling of blood glucose monitoring equipment. MAIN OUTCOME MEASURES: Proportion of facilities with lapses in each infection control category. RESULTS: Overall, 46 of 68 ASCs (67.6%; 95% confidence interval [CI], 55.9%-77.9%) had at least 1 lapse in infection control; 12 of 68 ASCs (17.6%; 95% CI, 9.9%-28.1%) had lapses identified in 3 or more of the 5 infection control categories. Common lapses included using single-dose medication vials for more than 1 patient (18/64; 28.1%; 95% CI, 18.2%-40.0%), failing to adhere to recommended practices regarding reprocessing of equipment (19/67; 28.4%; 95% CI, 18.6%-40.0%), and lapses in handling of blood glucose monitoring equipment (25/54; 46.3%; 95% CI, 33.4%-59.6%). CONCLUSION: Among a sample of US ASCs in 3 states, lapses in infection control were common.
Subject(s)
Ambulatory Care Facilities/standards , Infection Control/standards , Medical Audit , Ambulatory Surgical Procedures , Equipment Reuse , Health Care Surveys , Humans , Infection Control/methods , Maryland , Medicare/statistics & numerical data , North Carolina , Oklahoma , United StatesABSTRACT
Bloodborne pathogens are transmitted from person to person by sexual contact and by injection of druges and, in health-care settings, by needlesticks and, in the case of HBV, by mucous membrane exposure. Conventional disinfection and sterilization and housekeeping strategies are sufficient for the environmental control of bloodborne viruses. Environmentally mediated infection transmission of bloodborne viruses is unlikely and only HBV, because of the extraordinarily high viral concentration in blood, is thought to have a real potential for such transmission. No epidemiologic or laboratory data support the hypothesis that surgeons or other health care workers are at increased risk of infection by bloodbore pathogens. Although theoretically possible, airborne transmission does not appear likely. Studies that claim to show the potential for airborne transmission of bloodborne pathogens ignore the basic principles of aerobiology and the requirements for proving environmental transmission
