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Infection Prevention in the Outpatient Setting: Q&A With CDC's Dr. Melissa Schaefer

The Centers for Disease Control and Prevention recently released the Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. Melissa Schaefer, MD, medical officer in CDC's Division of Healthcare Quality Promotion, discusses how outpatient facilities can maximize the benefits of the guide and CDC's increasing focus on outpatient care.


Q: What are CDC's objectives with this new guide?


Dr. Melissa Schaefer: Our main objective is to ensure that patients receive safe care every time they visit an outpatient facility. The Guide, and its accompanying checklist, is a way for us to package our existing evidence-based infection prevention guidelines and make them available, in a convenient package, to outpatient settings.


Q: Why release the guide now?


MS: We're seeing the transition of healthcare to settings outside of the hospital. We're also continuing to see outbreaks and patient notifications from lapses in infection control and people not following Standard Precautions (Note: For examples of recent outbreaks and patient notification events, visit


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CDC has a number of evidence-based infection prevention guidelines that are readily available through our website, but I think a lot of people believe they only apply to hospitals and, perhaps, other settings aren't looking at them or using them as they were intended. We felt like this was an important opportunity to remind outpatient settings of these resources and the minimum infection prevention expectations for safe care - the things they should already know and should already be doing.


Q: What are the key takeaways from this guide for outpatient facilities?


MS: The bottom line is we want them to make infection prevention a priority in their facility and make it easy for the staff to do the right thing.


To help with this, we developed an infection prevention checklist to accompany the Guide. We divided the checklist into two distinct sections. Section one is geared for the facility administrator and addresses key infection prevention policies, procedures, resources and training they should have in their facility. Section two is targeted toward the frontline healthcare personnel and lists the infection prevention practices that they should be implementing in their day-to-day activities in the facility.


It's important to note that this Guide is not just targeting ambulatory surgery centers. It's for all outpatient facilities. Patients deserve safe care anywhere healthcare is provided and bad things can happen anywhere providers are not following Standard Precautions.


Q: Would you say the CDC is starting to look more closely at outpatient settings?


MS: I do think we are paying more attention to settings outside of the hospital. That's a reflection of the fact that those settings are where the majority of healthcare is being provided.


We're seeing procedures, previously only done in hospitals, being performed in doctors' offices. No matter where you have a procedure performed, the same standards should apply and the same infection prevention practices should be followed.


Q: What would the CDC like outpatient facilities to be doing and focusing on when it comes to infection prevention?


MS: It goes back to making infection prevention a priority. This includes having at least one individual, with infection prevention training, who is providing infection prevention oversight and expertise for the facility. It's one of the things we highlight in the guide — to have that leader and that resource available.


The rest of the Guide really focuses on Standard Precautions and the basics — the minimums that should be done. When we've seen these outbreaks and notifications, they are from providers not following Standard Precautions.


Q: Are you interested in hearing from facilities about the guide and the CDC's efforts?


MS: We would definitely be interested to see the feedback that comes from this and find out how it's being implemented.


One of the resources the CDC has is the "Safe Healthcare" blog (hosted at We have a blog about the Guide and the checklist which has a comments box where people can leave their feedback (hosted at We also have CDC-INFO (hosted at which can also be usedd to address questions about CDC guidance or materials.


Finally, healthcare personnel should also work with their professional organizations. We encourage professional organizations to package and distribute these materials to their members.


Related Articles on Infection Prevention:

Overcoming Infection Prevention Challenges in Ambulatory Settings: Q&A With Jan Davidson of AORN

Top 10 Roadblocks to Infection Prevention

Elements of an Award-Winning HAI Prevention Program: Q&A With Pam Strickland of Kimberly-Clark Health Care

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