Improper injection practices, equipment reprocessing errors and poor environmental cleaning are some of the most common lapses identified at ambulatory surgery centers during government infection control surveys, says a leading researcher at the Centers for Disease Control and Prevention.
In a presentation at the Association for Professionals in Infection Control and Epidemiology (APIC) Annual Conference in Baltimore this week, CDC Medical Officer Melissa Schaefer, MD, unveiled the notable findings from state surveyors who are using a CDC/CMS infection control worksheet to identify lapses as ASCs.
Persistent problems
Reprocessing errors. Failure to follow manufacturers' instructions; failure to pre-clean instruments and equipment before disinfection and sterilization; inappropriate connectors used between endoscopes and automated endoscope reprocessors.
Environmental cleaning lapses. Communication breakdowns between nursing and environmental services staff leave questions as to who is cleaning what and when.
Point of care devices. Inadequate cleaning and disinfection of devices between patients; use of single-use glucose meters for more than 1 patient.
Injection safety. Reuse of single-dose vials; reuse of syringes on multiple patients; "double dipping" into medication vials, bags and other containers.
"If there's one thing we've all learned from Seinfeld, it's that you should never, ever double dip," Dr. Schaefer told a packed meeting room of infection prevention professionals from ambulatory care settings Monday. The one-liner, a reference to the practice of reentering a vial or IV bag of medication with a used needle or syringe, helped to lighten the mood, but the chuckles gave way to audible gasps when Dr. Schaefer laid out some of the real-world consequences that have been reported just in the past few months. For example, in April a Colorado clinic notified parents of children who received flu shots that they should be tested for HIV and hepatitis after it was discovered that a medical assistant was splitting vaccine doses and reusing syringes on multiple patients.
Ongoing efforts
Dr. Schaefer listed a number of ways government agencies are continuing to address the issues identified during ASC infection control surveys.
The Centers for Medicare and Medicaid Services just appointed Karen Hoffmann, RN, MS, CIC, as its resident infection preventionist. Ms. Hoffmann, former associate director of the Statewide Program of Infection Control and Epidemiology based at the University of North Carolina, says she will work collaboratively with the CDC and CMS on infection prevention initiatives.
You can download the CDC's new, printable "Guide to Infection Prevention in Outpatient Settings" for an easy-to-read summary of existing evidence-based guidelines from the CDC and the Healthcare Infection Control Practices Advisory Committee. Dr. Schaefer says a new checklist tool is on the horizon.
The CDC has also updated information and guidelines on injection safety, available here.
Have you had your infection control survey yet? OSM has advice on how to ace your next inspection here.
Irene Tsikitas
