The rules of infection control have changed: AAAHC surveyor highlights 3 compliance issues & APIC's role in ASC compliance

As the healthcare industry becomes more regulated, ambulatory surgery centers will have to comply with increasingly strict guidelines for infection control. With good reason, as a lack of compliance can compromise patient safety, which may yield poor patient outcomes and financial repercussions.

marcia aaahcMarcia Patrick, an Accreditation Association for Ambulatory Health Care Accreditation surveyor, has worked in infection prevention for 33 years, and has firsthand experience working with ASCs to ensure they are compliant with government infection control standards.

"I have always done ambulatory care in hospitals, but I have chosen to focus on ASCs because there is such a need," she says. "So much of what used to be inpatient is now done in the outpatient setting, and there often is not the qualified infection control oversight that is necessary."

With more cases comes greater responsibility for ASCs to implement infection control standards that maintain patient and staff safety. Ms. Patrick explains three common challenges ASC face with infection control compliance.

1. Multidose vials. Misuse of multidose medication vials has been implicated in a number of outbreaks of viral and bacterial diseases. The CDC developed a set of protocols regarding multidose vials to prevent disease transmission and maintain safety in facilities after the agency identified many cases where multidose vial use compromised safety. CDC guidelines say, whenever possible, providers should only use a multidose vial for one patient. However, if providers need to use multidose vials for more than one patient, the vial should be kept and accessed in a medication preparation area located away from the patient's bedside.

"If the vial gets left in the same room as the patient, the provider could access the vial using the same syringe, contaminating the vial," says Ms. Patrick. "CDC wanted to put as many steps between accessing the vial and the patient as possible to avoid patient harm. This was a huge change for most of us and people had a hard time wrapping their heads around it."

2. Economic concerns. Using a new vial for different patients may be costly, and ASCs with limited resources at their disposal may fail to comply with CDC's guidelines due to such concerns.

"If you have enough medication in a vial for five patients and you only use the vial once and it costs $1,000 a vial, that has a big economic impact," Ms. Patrick says.

3. Old habits die hard. Infection prevention compliance is a team effort, and if a team member is slow to adopt various protocols, the entire facility could suffer the consequences.

"It is hard to get people on board when they say, 'I have done this for 30 years and I haven't had a problem,'" Ms. Patrick says. "The reality is half the time you don't know if you've had a problem."

Ms. Patrick says physician resistance to change may be difficult for administrators, as the physicians bring in the cases to the center. If physicians are slow to adopt updated protocols, Ms. Patrick recommends emailing them, emphasizing the need to follow safe practices to protect patients.

"I will print or send an email to non-compliant physicians and tell them if you have information that shows what you are doing is safe and effective, I will look at it. But, until then, you need to follow your professional organization's guidelines," she says.

An ASC's staff should undergo infection control training at least once a year, especially if the ASC implements changes in procedures, policies, products or if the center's infection preventionist identifies infection control gaps or failures.

"The support has to come from the top," she adds. "Administrators need to support the infection preventionist and the infection control program or the program will not succeed."

How APIC is helping ASCs with infection compliance
Due to various compliance issues in facilities throughout the nation, CMS came out with the Infection Control Surveyor Worksheet, which Ms. Patrick says "hit the majority of critical things ASCs need to be aware of and do correctly."

Various areas the worksheet addresses, but are not limited to, include:

•    Hand hygiene
•    Unsafe injection and vial practices
•    Disinfection and sterilization of endoscopes and instruments
•    Environmental cleaning

To help ASCs' surveyors and infection preventionists better understand the updated requirements, the Association for Professionals in Infection Control and Epidemiology hosts two courses, ASC 101 and 102. Infection preventionists and other ASC personnel can attend to learn about issues their centers are facing as "most infection preventionists were thrust into this role without a lot of warning, and quickly realize they need training," Ms. Patrick says.

Ms. Patrick has been an APIC member for more than 30 years, serving on the organization's board of directors from 2009 to 2012. She played an integral role in devising the educational tools for surveyors.

 "A lot of time you don't know what you don't know," Ms. Patrick says. "This is why APIC courses are so valuable. We go through all the pitfalls and provide assessment tools so people can make sure they are compliant. We also give them contacts to their local APIC chapter. We really supply an abundance of resources."

Throughout her career, Ms. Patrick has seen infection control evolve and practices continually trying to ensure they are complaint.

"The questions we get today are far different than the past, as there are fewer truly awful practices," she says. "The infection prevention environment has improved over the past five years, but we aren't done yet. We all want the best outcomes for our patients — infection control is all about patient and staff safety."

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