5 Strategies for Improved Infection Control in ASCs
1. Revise instrument cleaning guidelines. No matter what type of enzymatic detergent an ASC uses to soak scopes, Shaun Sweeney, vice president of sales and marketing for Cygnus Medical, stresses the importance of changing — not reusing — detergents after each use for optimal effectiveness. Just as a household member would refill a sink with new water and new detergent to clean dirty dishes, ASCs should also be mindful of changing water and enzymatic detergent because detergent will break down, Mr. Sweeney said.
"This may be a case of someone not paying attention to the manufacturer's recommendations or trying to save money, but ASCs must not reuse enzymatic detergent with multiple scopes. Detergents absolutely break down and lose integrity after each use," he said. "ASCs will sometimes reuse a brush to clean a scope too, but they have to remember that there are disposable kinds and reusable kinds. If you use a single-use item, you're supposed to use that item just one time."
2. Create robust housekeeping policies. Surgery centers should have comprehensive housekeeping policies, said Anne Dean, RN, CEO and co-founder of The ADA Group. She recommended looking at other healthcare facilities as stepping stones for your policies and protocols. Inspect your entire surgery center from the perspective of what it tells a patient about what he can expect from the environment and your commitment to cleanliness.
"Patients know about sterility, and they strongly believe that their surgical facility should be clean if their outcome is to be good," she said. "They all have friends or family, or they know someone who contracted a post-operative infection. The condition of your center also has a huge impact on your marketing. What does it say to your patient community if you have not maintained your center through housekeeping?"
3. Remember that respiratory hygiene matters. Dotty Bollinger, RN, COO of the Laser Spine Institute, recommended supplying visual alerts to remind staff and patients to cough or sneeze into their arm and cover their mouths.
"You do not want people coughing and hacking in your waiting room," she said, because the issue matters to patients who do not want to get sick. She also recommended providing tissues and proper waste receptacles for staff and patients alike.
4. Know your options for guidelines. ASCs can select which infection control guidelines — AORN, CDC, APIC, AAMI, etc. — they will adopt. By understanding the various guideline options, ASCs can select to follow the set that is most appropriate for their center, said Sandra Jones, MBA, executive vice president of ASD Management. Ms. Jones said she prefers CDC guidelines because they are wide-ranging, free and easily accessed on the Internet.
5. Empower patients to speak up. Patients need to be educated about unsafe injection practices as well, said Gina Pugliese, RN, vice president of Premier's Safety Institute and a member of the Premier Safe Injection Practices Coalition.
"Patients are so much more prepared now than they used to be," she said. "They're asking questions and demanding information." She recommended facilities post signs that inform patients about safe and unsafe injection practices.
If the patient notices his physician is re-using a single-dose vial or using a syringe tinted with blood, then he can speak up. "If the patients from the terrible outbreak in Nevada had known what was happening, they could have said something," she said of a 2009 hepatitis C outbreak in southern Nevada that was linked to the reuse of propofol vials.
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