10 Thoughts on improving infection control in the ASC
1. Injection practices and instrument cleaning top the list of infection control issues. "The two biggest areas of concern with regard to risk of harm to patients are unsafe injection practices and inadequate cleaning, disinfection and sterilization of instruments and scopes," according to Marcia Patrick, RN, MSN, CIC, a consultant in infection prevention and control issues and a teacher for the Association of Professionals in Infection Control. Internalizing injection practices surrounding single-dose and multi-dose vials is particularly important.
2. Instrument reprocessing is extremely involved. In surgery centers, improper reprocessing of surgical instruments has a large potential to put patients at risk, according to Ms. Patrick. "Processing is highly complex. One must have knowledge of the device manufacturer's recommendations for reprocessing, the sterilizer operating instructions, correct wrappers and required quality control monitoring activities," she says.
3. Endoscope reprocessing presents a high infection risk in ASCs. "Thorough cleaning is essential, yet can be difficult to verify," says Ms. Patrick. To avoid problems in endoscopic reprocessing, proper use of high-level disinfectant according to manufacturer specifications is essential.
4. There is room for improvement where it concerns hand hygiene. According to Phenelle Segal, RN, CIC, president of Infection Control Consulting Services, compliance monitoring and education as to the importance of hand hygiene could be better. "Compliance with actual hand hygiene, particularly amongst the anesthesia staff continues to be a challenge across the board, but there is more awareness of the need to comply [since 2009]," she says.
5. Awareness surrounding personal technology and infection transmission remains low. Ms. Segal says infection control efforts could benefit from emphasizing items like smartphones and tablets as sources of infection transmission. "[Providers should be aware] they are a source of potential transmission of organisms during surgery and that hand hygiene must be practiced before rendering any type of patient care. I am still not seeing much improvement with respect to personal item use and consistent hand hygiene afterward," she says.
6. ASCs are doing a good job maintaining infection prevention and patient safety, on the whole. "Many ASCs have developed exemplary programs to address patient safety issues such as endoscope handling and repair, anesthesia during cataract surgery, fall preventions, sharps and scalpel safety, antibiotic reactions, hypertension, low blood sugar levels, surgical site infections and handling implants," says Naomi Kuznets, PhD, senior director and general manager of the Accreditation Association for Ambulatory Health Care's Institute for Quality Improvement. "We know this from the award-winning studies for the AAAHC Institute's annual Innovations in Quality Improvement Award program."
7. Monitoring competency remains an area for growth. AAAHC data also shows opportunities for improvement in training, competency testing and processing and anesthesia monitoring, according to Ms. Kuznets.
8. A daily huddle can expedite information exchange. It's a good way to keep a handle on patients to ensure patient safety and adherence to any relevant infection control protocols, according to Cynthia Chappell, in a Becker's Infection Control & Clinical Quality article. "Schedule overviews of procedures occurring 48 hours out are printed and reviewed during bed huddle meetings with staff. Medical conditions such as cardiac, stroke and methicillin-resistant staphylococcus aureus (MRSA) are flagged," she said.
9. Progress is a team activity. Truly emphasizing the team nature of infection prevention and control and building it into the organizational culture is crucial to success, according to Lisa Waldowski, MS, APRN, CIC, an infection control specialist for The Joint Commission, who spoke on the subject in a Joint Commission podcast.
10. Infection control needs a champion. ASCs should have a point person — a certified infection preventionist — managing the infection control program, according to Mary Post, RN and Libby Chimes, RN, BSN, in an article contributed to Infection Control Today.
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