Ambulatory Surgery Center Infection Prevention Education: A Necessary Evil or a Dose of Fun?

The following article was originally published in Preventing Infection in Ambulatory Care, the quarterly e-publication from the Association for Professionals in Infection Control and Epidemiology (APIC). To learn more about receiving this resource and joining APIC, visit To learn more about APIC, visit


On May 18, 2009, the Centers for Medicare & Medicaid Services (CMS) conditions for coverage for ambulatory surgery centers (ASCs) became effective for facilities that receive Medicare/Medicaid reimbursement.[1] Among many standards, CMS cites the need to educate patients, visitors, and staff regarding infections, communicable diseases, and methods of prevention in the ASC and in the community.


The Infection Control Surveyor Worksheet (pdf), which is part of this document, includes questions related to how the staff receives training (i.e., methods); which staff members receive training (e.g., medical, nursing, other direct care staff, staff responsible for onsite disinfection and sterilization, environmental services staff, and others); frequency of the training (e.g., on-hire, annually, as needed); whether the training is the same or different for all categories of staff; and whether there is documentation of training for all staff.[2]


CMS is also concerned about the training administered to the infection preventionist (IP). In fact, one of the standards requires that the ASC have a licensed healthcare professional who is designated and qualified through training to lead the center's infection prevention and control program. The IP may be an employee or contracted consultant; he/she may be certified in infection prevention and control or not. However, if the designated infection prevention professional is not certified, there must be documentation regarding the training he/she has received specific to this role.


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Even though failure to comply with these standards will lead to deficiencies and citations during a CMS audit, the most critical issue relates to the fact that untrained staff may have more opportunities for transmitting infection unknowingly to the patients entrusted to their care. Training does not have to be an arduous ordeal. Look for creative ways to transmit the information (and not the organisms).


Infection prevention orientation training for staff may be the same as training for patient care staff. However, the IP will probably need to address busy physicians separately. Providing physicians with a summary of your orientation information (in bulleted format) and administering a post test trainees submit for credit would be a quick, fun way to engage and interest trainees. Environmental services staff and other contractors may need a special orientation on infection prevention in your facility — what hospital disinfectants do you use, how do you clean a blood spill, to what schedules do your staff adhere? Adult learners want interesting issues presented that apply directly to their jobs. Real life scenarios often hold the learner's interest well.[3]


A little effort goes a long way

What have colleagues chosen to do for inservice training at other facilities? Tap into their knowledge to get ideas. You don't have to be creative; you just need to be a good "copier."


As a staff member, would you want to see the same video on infection prevention and control every year? The answer is probably "no."


Instead of showing the same stale video, consider creating a poster presentation on review of bloodborne pathogens, tuberculosis, and other infection prevention topics of interest to your staff.


When was the last time the staff and physicians have received a review of safe injection practices? Safe injection practices —in addition to respiratory hygiene and cough etiquette — are now a routine part of the Centers for Disease Control and Prevention's standard precautions. Try designing a crossword puzzle on this subject to keep the information fun and fresh.


Consider offering a self-instructional computer-based training module for staff. This may be more convenient for all; be sure to make yourself available, as per the Occupational Safety and Health Administration standards, during this time in case any questions arise. It may also be beneficial to present infection prevention case scenarios in small groups, potentially using some brief instances of role playing. It could cultivate a lively group discussion and enhance problem-solving skills by working as a team.


Think outside of the box

Although complex tasks — such as high-level disinfection and sterilization — may be assigned to one or two specific staff members, these activities may lend themselves to training through return demonstration and competencies. Give thought to who could perform these duties and supervise this area if the assigned staff members were out for a period of time. Do additional nursing staff members need to be competent in this area? If the answer is "yes," consider developing a checklist of necessary skills or a carefully structured train-the-trainer program for a large group of staff.


Many IPs have adapted games such as Jeopardy, Survivor, and Wheel of Fortune to be infection prevention-themed. Adults enjoy learning in a nonthreatening environment and sharing some of their own life experiences. Mix up the learning activities as much as possible to allow for broader participation and engagement. Instead of leading all of the teaching activities, bring in a consultant or an infectious disease physician to talk to the staff and physicians during influenza season. Take the time to develop a "Room Full of Errors" with a manikin or make use of the Association for peri-Operative Nurses cartoon "What's Wrong with This Picture" that allow the learner to detect breaks in sterile technique and safety issues.


Incorporate food, door prizes, and other incentives in the educational efforts, whenever possible. Providing treats during a brown bag lunch is a great way to break the ice and encourage staff to relax and enjoy their learning experiences. And don't forget: "just because we taught them, it does not mean they learned!" IPs should evaluate their educational programs and also ask staff to evaluate their own learning to determine overall effectiveness. Make education participatory and enjoyable — not just a requirement. Our patients' safety depends on it.



1. Centers for Medicare & Medicaid Services. State Operations Manual, appendix L. Available at:


2. Centers for Medicare & Medicaid Services. Survey and Certification Information. Available at: 37.pdf.


3. Schreck M, Watson S. Education and Training. APIC Text of Infection Control and Epidemiology, 3rd ed. Washington, DC: APIC, 2009; 11-1-110.


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