Observation of Infection Prevention Practices in Outpatient Care Settings

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A recent survey conducted by medical students at 15 outpatient settings, including specialty clinics, located in New Mexico resulted in the conclusion that infection prevention practices in this setting continue to need improvement. The survey included staff interviews and direct observations relating to hand hygiene and injection safety practices.

The survey results, published in the American Journal of Infection Control, include the following: 163 observations relating to disinfection of the medication vial rubber septum with alcohol (a standard that is addressed by the Centers for Disease Control and Prevention (CDC) and Centers for Medicare and Medicaid Services (CMS)) revealed a compliance rate of 78.4%; 330 hand hygiene observations revealed suboptimal compliance with 33.9% use of alcohol sanitizer, 29.1% handwashing with soap/water and 37% did not practice any hand hygiene.

Phenelle Segal, RN CIC, President of Infection Control Consulting Services (ICCS), a provider of outpatient infection control consulting services, notes that the suboptimal results (particularly hand hygiene) are consistent with findings of ICCS consultants during onsite visits to outpatient centers. The survey mentions that, "Little is known overall about the current status of infection prevention in the outpatient environment, because these settings are not typically regulated or inspected. Interaction between public health and outpatient clinics is infrequent and tends to occur when outbreaks are identified, infection prevention concerns are raised by the public, laboratories, or health care providers, or when notifiable conditions are reported."

However, Segal notes that there are increased efforts by the CDC and CMS to include outpatient settings in safe patient care. In 2012, the CDC, in conjunction with input from CMS, published the "Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care," with the most recent update in November 2015.

Many outpatient clinics have reached out to ICCS since 2012 to request onsite visits to assess practices as they become more aware of these minimum expectations. ICCS has also observed outpatient clinics/facilities turning to accreditation by agencies that provide outpatient services of that nature, including The Joint Commission. It remains in the best interests of outpatient centers that they follow CDC's guidance as the federal government continues to place a large emphasis on patient safety across the continuum of care.

Note: Segal points out that ambulatory surgery centers (ASCs) are not included in the general outpatient setting arena as they fall under separate guidance and regulations/inspections. ASCs are much more heavily regulated, with multiple federal, local and accreditation mandates.

Phenelle Segal, RN, CIC, FAPIC

Phenelle Segal, RN, CIC, FAPIC, is the founder and president of Infection Control Consulting Services LLC (ICCS). Phenelle has more than 30 years' experience providing customized comprehensive infection control and prevention services to healthcare facilities nationwide. Her services focus on assisting hospitals, ambulatory surgery centers, dental office and oral surgery practices, doctor's offices, nursing homes and other organizations with implementing and maintaining an infection control program that: complies with The Joint Commission, AAAHC, Centers for Medicaid and Medicare Services (CMS) and other regulatory agencies; respond to situations of noncompliance; and improve the processes for reducing risk.