CDC Updates Guide to Infection Prevention for Outpatient Settings

By on 12:20 PM

The ever-changing landscape of healthcare has resulted in many more patients being treated in the outpatient care setting during the past decade. Community-acquired infections have increased exponentially, and the most common cause of skin and soft tissue infections diagnosed in outpatient settings, which includes the emergency room, clinics and private doctor's offices, is methicillin resistant Staphylococcus aureus (MRSA).

In 2012, the Centers for Disease Control and Prevention (CDC) published a "Guide to Infection Prevention for Outpatient Settings," which highlighted "minimum expectations for safe care." In November 2015, CDC updated the guidelines, which includes a detailed checklist for outpatient facilities to monitor their infection prevention best practices.

With the ongoing transmission of multi-drug resistant organisms and other infection prevention issues seen not only in the hospital setting but extending to outpatient care as well, it is imperative that all outpatient care centers develop infection prevention policies and procedures. Infection prevention in the healthcare setting extends well beyond OSHA's bloodborne pathogen exposure control requirement for protection of healthcare workers.

The following are components of an effective infection prevention program for outpatient settings:
  • At least one individual with training in infection prevention is employed by or regularly available (e.g., by contract) to manage 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 healthcare personnel (HCP), including those employed by outside agencies and available by contract or on a volunteer basis to the facility.
  • Competencies should be documented following each training.
  • Monitor and report healthcare-associated infections (HAIs) by conducting surveillance for the purpose of identifying outcome measures such as infections acquired as a result of a visit to the outpatient center.
  • Monitor and report adherence to specific process measures (e.g., hand hygiene, environmental cleaning)
  • Outpatient facilities need to adhere to local, state and federal requirements regarding reportable disease and outbreak reporting. Certain types of facilities (e.g., ambulatory surgical centers (ASCs)) may also be subject to additional HAI surveillance or process measure reporting requirements, for example as part of accreditation, Medicare certification or state/local statutes.
  • Regular focused practice surveys or audits (e.g., audits of infection prevention practices, including hand hygiene, medication handling, reprocessing of reusable devices) offer a means to ensure ongoing compliance with recommended practices.
  • Educate patients who have undergone procedures at the facility regarding signs and symptoms of infection that may be associated with the procedure and instruct them to notify the facility if such signs and symptoms occur.
  • Adhere to standard precautions, which are the minimum infection prevention practices that apply to all patient care, regardless of suspected or confirmed infection status of the patient, in any setting where healthcare is delivered. These practices are designed to both protect HCP and prevent HCP from spreading infections among patients. They include but are not limited to:
    - Hand hygiene, use of personal protective equipment (e.g., gloves, gowns, masks), safe injection practices, safe handling of potentially contaminated equipment or surfaces in the patient environment and respiratory hygiene/cough etiquette.

Infection Control Consulting Services (ICCS) provides outpatient facilities with exemplary services, including, but not limited to, developing comprehensive programs according to nationally recognized guidelines, assisting with risk assessments for both ASC infection prevention program and other outpatient care infection prevention programs, onsite visits to assess "best practices," healthcare personnel/employee infection prevention education and much more.

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.