Infection control surveyors will be knocking on the doors of more than 125 ambulatory surgical centers in 12 states over the next couple of months, thanks to an influx of federal stimulus money allocated by the Department of Health and Human Services last week.

HHS Secretary Kathleen Sebelius released the first batch of American Recovery and Reinvestment Act funds - a total of $572,250 - to Maine, New Jersey, Maryland, Florida, North Carolina, Indiana, Michigan, Arkansas, Oregon, Utah, Wyoming and Kansas. Officials in those states will use the money to help fund onsite reviews of infection prevention and control protocols at ASCs by Sept. 30, 2009.

"Keeping patients healthy is one of the requirements of the Recovery Act, and the first 12 states that have volunteered to focus attention on these surgical centers are taking a giant step in helping to reduce infections that affect millions of patients every year," says Ms. Sebelius.

State surveyors will use a new tool developed specifically for the ASC setting by the Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention. Speaking to Congress in April, Don Wright, MD, principal deputy assistant secretary for health at HHS, said the survey tool "demonstrated superior results in the ability to detect deficient infection control practices" during a pilot run last year.

HHS will provide an additional $9 million in stimulus funds in October to assist all states in conducting infection control surveys of ASCs using the new tool.

Irene Tsikitas

In the wake of several well-publicized breaches in injection and infusion practices - which have infected more than 500 patients with hepatitis B and C - the Association for Professionals in Infection Control and Epidemiology has published recommendations emphasizing the safe use of syringes, IV infusions and medication vials.

Besides strongly discouraging the use of syringes, IV supplies and medication vials for more than a single patient, the 48-point position paper urges healthcare workers to:

Hosting 15,000 cases a year wasn't enough to boost the bottom line of the Central Louisiana Ambulatory Surgical Center in Alexandria, La. That's why the 37 surgeons hope that converting the ASC into a surgical hospital will give it the jumpstart it needs.

"We had been a very successful ASC," explains Renick Webb, MD, an otolaryngologist and chairman of the new project, the Central Louisiana Surgical Hospital. But Dr. Webb says that even with a large volume of cases, growth was elusive. A payor mix that included 45 percent Medicare and Medicaid patients didn't help revenues, leading the surgery center's physician-owners to conclude they "weren't going anywhere," says Dr. Webb.

Local neurosurgeons and OB-GYN physicians were looking to get involved with facility ownership, but couldn't bring their complex cases to an outpatient surgery center. They could, however, get behind a surgical hospital project. This helped convince the ASC's physican-owners to take the plunge.

Construction has begun on the new surgical hospital, which will feature 6 more ORs and 46,000 more square feet than its predecessor. It's scheduled to open in July 2010.

"We're going to become a surgical hospital, with all the foibles that go along with it," says Dr. Webb. Louisiana does not have a Certificate of Need law regulating new surgical construction, but surgical hospitals operate under the constant threat that federal legislation will ban surgeons' self-referrals to the facilities and/or prevent them from receiving Medicare and Medicaid reimbursements.

Dr. Webb says his group is rushing to a structure in place and hoping that the project can be grandfathered into the current legislative landscape. He admits that he and his fellow surgeons are taking sizable risk, but notes that they're jumping in with eyes open and with backup plans in store, including the possibilities of teaming up with a local hospital or enacting a negotiated buyout agreement with a corporate partner. "No one knows what's going to come down," says Dr. Webb, "but we're reading and reacting, and being very proactive."

Daniel Cook

Which low-temperature sterilization method do you use in your facility? Go to our home page to register your choice - peracetic acid, hydrogen peroxide gas plasma, glutaraldehyde or ethylene oxide (EtO) - and to see real-time results.

Last week's InstaPoll, prompted by our August issue's cover story, asked whether a staff member had ever stolen controlled substances from your facility.

Of the 122 responses, 43% said they had caught drug diverters. Another 11% suspected that drugs were being diverted, but couldn't prove it. The remaining 46% said they didn't think their staff members had ever stolen drugs.

Dan O'Connor