4 Pillars of Establishing Successful Standardized Infection Prevention Programs in ASCs

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In a March 14 webinar, hosted by Becker's ASC Review, Chuck Peck, MD, managing director, Navigant Consulting and T.K. Miller, MD, medical director, Roanoke Ambulatory Surgery Center and Carillion Outpatient Surgery, discussed the importance of infection prevention protocols and gave their thoughts on best practices for implementing a standardized infection prevention program.

According to the Centers for Disease Control and Prevention, approximately 1.7 million people acquire healthcare-associated infections, and about one-third of these are preventable. "The increase in healthcare associated infections has even been attributed to unsafe medical practices," said Dr. Miller. But the spread of these infections can be controlled by implementing a standardized infection prevention program. Standardized infection prevention protocols help reduce waste, result in fewer errors, increase cost effectiveness, result in better quality outcomes and prevent healthcare-associated infections.

Dr. Peck outlined the CDC guidelines for infection prevention that include seemingly basic, but extremely important protocols, such as, instructing patients to take an antiseptic shower the day before the procedure, ensuring that the surgical team is washing their arms and forearms in an antiseptic solution and implementing policies that prevent transmission from personnel to patient.  

Dr. Peck also outlined CDC recommendations for administrators. These include developing and maintaining infection prevention programs and assuring at least one individual trained in infection prevention is regularly available to the facility. Many facilities now have a dedicated infection preventionist, and this "goes a long way," he said.

In May 2009, CMS began enforcing new conditions for coverage for ASCs that require adherence to revised infection prevention practices. Dr. Peck spoke about these and also said that having a written program is the best way to implement infection control practices. Repeatedly bringing up infection control protocols with the staff, monitoring policies, getting feedback and addressing concerns from patients and staff are other essential aspects of implementing infection control practices, said Dr. Peck. The CDC conditions for coverage also stress the designation of a qualified, licensed healthcare professional to lead the infection control program. The organization must have documentation proving the professional's qualifications.

However, standardizing infection prevention protocols in ASCs, in particular, are challenging. The two major challenges, according to Dr. Miller, are:

1. High risk of inconsistencies in ASCs. The fact that there are a number of different physicians and surgeries spanning different subspecialties makes it hard to standardize protocols. "There is pressure to move quickly, and habits may develop that are not in the best interest of the patients," said Dr. Miller.

2. Surveillance for outcome measures is hard in ASCs. This is because patient encounters tend to be brief. Also, evaluation and treatment of infections may take place in a different healthcare setting.

Challenging though it may be, it isn't impossible. Four pillars of establishing a standardized infection control program in ASCs, according to Dr. Miller and Dr. Peck, are:

1. Understanding the culture of the community. "You need to know where your patients are coming from," said Dr. Miller. In particular, recognizing that there are high-risk patients, either because of patterns of infection or co-morbid infection risks, is important for ASCs, so that they can know when to take extra precautions or recognize that it may not be best for some to receive care at the facility.

2. Understanding the culture of the ASC. If the culture of the organization does not include following rigorous infection prevention practices, it must be instilled. This can be done by making sure that infection prevention is a part of all staff materials. "Infection prevention starts with the staff," said Dr. Peck. ASCs must ensure that they are maintaining current facility protocols regarding communicable diseases and that they are keeping appropriate records.

3. Complying with regulatory guidelines and policies. Some of the important areas that ASCs should continually assess are protocols regarding hand hygiene, skin antisepsis, use of injections, wearing jewelry and nails. According to Dr. Peck, the CDC and CMS consider protocols regarding these basic elements to be the first line of defense. He recommends being proactive and looking into tools and memos on the CMS website that outline the guidelines ASCs are expected to follow. Ensuring that the environment is clean and disinfected is also essential, said Dr. Peck. Additionally, performing appropriate instrument decontamination and effective cleaning, particularly for instruments with "lumens", is necessary to allow effective sterilization, according to Dr. Miller. Assessing these areas regularly will ensure that the ASC is in compliance with CMS and other federal guidelines relating to infection control.

4. Monitoring and tracking infections.  "Tracking results is essential to demonstrate effectiveness," said Dr. Miller. CMS requires at least four weeks of tracking results, but Dr. Miller suggests tracking six weeks. Other ways to monitor infections is to track products' lot numbers, review all procedures each quarter and consider tracking nurses or teams.

Ultimately, establishing a successful standardized infection prevention program, using these recommendations, will be possible if physicians and the facility collaborate and adhere to patient needs, said Dr. Peck.

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Download a copy of the presentation by clicking here.

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