Outpatient settings lack adequate infection control policies

Many doctor's offices do not meet basic infection control standards, according to the CDC, and outbreaks resulting from breaches in standard practice are cause for concern as more patients turn to ambulatory settings for their health needs.

"Patients deserve the same basic levels of protection in a hospital or any other healthcare setting," Michael Bell, MD, deputy director of CDC's Division of Healthcare Quality Promotion, said in a press release. "Failure to follow standard precautions, such as correct injection practices, cannot be tolerated."

Recent Centers for Medicaid and Medicare inspections have revealed repeated infectious outbreaks attributable to breaches in infection control standards of care, according to Melissa Schaefer, MD, also of the CDC's Division of Healthcare Quality Promotion.

In one investigation, clinicians at an endoscopy clinic in Nevada reused syringes to draw multiple doses of propofol from a single-dose vial, causing contamination, Schaefer wrote in a commentary accompanying recently released CDC outpatient infection control recommendations.

The Nevada incident exposed more than 40,000 patients to blood-borne viruses, and resulted in hepatitis C transmission to at least seven of the clinic's patients on two separate days.

Each year one billion Americans visit a physician's office, and more than three-quarters of all U.S. surgeries are performed in the outpatient setting -- yet these facilities often do not have the same amount of resources dedicated to infection control as hospitals, according to the CDC.

In response, the agency's outpatient guidelines simplify existing recommendations and make them more accessible, rather than introducing new infection control concepts. They include:

  • Ensuring that a least one staff member with specific infection control training is available, regularly communicates with clinicians at the practice and has created a written infection control policy based on evidence-based guidelines;
  • Following proper procedures for handling contaminated medical equipment, including the use of personal protective equipment such as gloves, gowns and facemasks;
  • Ensuring the availability of sufficient and appropriate supplies necessary to adhere to standard precautions;
  • Performing regular staff audits and competency evaluations to measure adherence to infection control policies;
  • Following local, state and federal requirements for hospital-associated infections surveillance and proper disease and outbreak reporting;
  • Utilizing the CDC's infection prevention checklist for outpatient settings to assess infection control practices.

Alcohol-based hand sanitizers remain the hand hygiene method of choice, according to the CDC, unless hands are visibly dirty or a clinician is caring for a patient with infectious diarrhea.

The guidelines also include full list of recommendations for cleaning medical office surfaces, with particular emphasis on regularly disinfecting door knobs, bedrails and other frequently touched surfaces in close proximity to patients.

To read the recommendations in its entirety, earn CME credit on infection control and access other clinician and patient education information visit the CDC's website.

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