Maintaining infection control compliance at ASCs: 4 key strategies to yield success

Although infection control compliance is increasingly a priority for ASCs, there are still many hurdles to overcome.  Unlike their hospital counterparts, surgery centers often have not had a formal infection prevention program in place for several years.

Barb Connell"ASC infection prevention programs are really in their infancy," says Barbara Connell, VP of clinical services at Medline. "A robust and effective infection prevention program demands employee resources, such as high-quality products and clinical education."

While many surgery centers have diverted their efforts to infection prevention programs, they have several obstacles to overcome including:

1. Hand hygiene compliance. Due to hand hygiene's importance, Ms. Connell says surveyors are placing a higher emphasis on ASC staff members adhering to hand hygiene protocols. Surgery centers face many of the same challenges as the acute care setting such as having inconveniently placed dispensers and sinks as well as staff members who aren't knowledgeable about hand hygiene regulations.

2. Safe injection practices. Ms. Connell cited a 2014 study that American Journal of Infection Control published in its April 2016 edition in which medical students observed hand hygiene and injection practices in ASCs. The students made 163 injection observations in the study and found that providers disinfected medication vials' rubber septums with alcohol 78 percent or 79 percent of the time before piercing the vials with a needle.

3. Environmental cleaning. ASCs often have speedy turnover time between cases. While this allows centers to see more patients and fill up OR slots, this could also pose as a barrier to effective cleanliness of a surgical environment.

"The ASC setting is somewhat unique in that you have a steady stream of patients entering and exiting patient care areas which require quick turnover," Ms. Connell says. "A clear understanding of who is responsible for cleaning which areas and which products should be used can be difficult to remember."

4. Surveillance. ASC patients are discharged in less than 24 hours, making it particularly challenging for surgery centers to track patients. Surgery centers may lack electronic surveillance systems and IT support as well.

5. Use of personal protective equipment. "Since the patient population is generally through to be 'healthy patients,' strict compliance with appropriate PPE techniques may sometimes be lacking," Ms. Connell notes.

Key strategies
Despite the many challenges ASCs experience, they can employ various strategies to minimize infections.

1. Use products designed by clinicians. Ms. Connell notes products designed by clinicians may help ensure staff compliance as they are more intuitive to use.

2. Conduct a risk assessment. A risk assessment will help an ASC better assess areas in which they excel and areas where improvement is needed. Once these areas are designated, the ASC can focus their training on these areas.

3. Make compliance a team effort. "It all starts with leadership. They must be committed to creating a culture of safety and be proactive in providing staff with the necessary resources to implement an effective plan," Ms. Connell says.

An ASC's staff can all play a part in implementing a detailed infection prevention plan that tells staff members who will be trained, who will train them and what their training will entail. Most surgery centers do not have one person solely dedicated to compliance and a having every employee invested in an infection prevention strategy is crucial to compliance.

"Sharing the progress that's been made throughout the year is essential," Ms. Connell notes. "Let staff know that how they participate in the infection prevention program is important not only to patients, but also themselves."

4. Utilize available resources. While surgery centers can obtain information via online programs, Ms. Connell advises ASCs use several methods to stay updated on infection prevention protocols.

"The technique of 'see one, do one' is often used, but can lead to protocol drift. Competency is the more important part of education," she says.  
ASCs can provide their staff members with an influx on resources, but training should not stop there. Leaders should conduct direct observations of staff members to ensure they are engaging in protocols. Surgery centers should monitor some protocols daily, such as hand hygiene compliance, but Ms. Connell notes surgery centers can monitor others during annual training or each quarter.

"As with most infection prevention efforts, behavior changes are often needed. What's exciting is that new technology is being developed every day that can automate or make easier manual processes," Ms. Connell says. "Infection prevention is an ongoing process. It has taken time, but we have seen and continue to see an evolution in infection prevention solutions in the acute care setting. Thankfully, the ASC environment is not far behind."

If you would like more tips on developing an infection prevention plan, check out one of Ms. Connell's recent posts on optimizing your SSI plan at

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