Five basic approaches can help ambulatory surgical facilities implement infection control best practices, according to expertise from Chuck Peck, MD, managing director of Navigant Consulting and leader of clinical and operational effectiveness, and TK Miller, MD, associate professor of surgery at Virginia Tech/Carillion School of Medicine and medical director of Roanoke Ambulatory Surgery Center and Carillion Outpatient Surgery.
1. Be aware of current guidelines and regulations. Before creating a program, ASCs need to know the current guidelines and regulations dictating proper infection prevention and control in a healthcare setting. Compliance with current guidelines and regulations will create the basis of your infection prevention program.
Current Centers for Disease Control guidelines state:
• Patients should take an antiseptic shower the day before arriving at surgery center
• Any necessary hair removal should be done immediately before the procedure
• The surgery site should be prepared with an antiseptic; preferred agents should provide rapid, persistent, broad-spectrum antimicrobial activity (e.g., 2 percent Chlorhexidine Gluconate/70 percent Isopropyl Alcohol formulation)
• The surgical team should wash their arms and forearms before the procedure
• ASCs and all healthcare organizations must have established protocols to prevent the transmission of infection from staff to patients
• Patients should be given an antimicrobial prophylaxis prior to the procedure
In 2009, CMS began enforcing new conditions for coverage of ASCs. The most important CMS conditions include having written policies and procedures that minimize communicable infections and maintaining contact with a trained infection prevention individual.
2. Regularly work with a licensed and trained infection prevention and control individual or team. CMS guidelines stress the need for ASCs to work with at least one person licensed and trained in infection prevention and control, if not an infection prevention team. ASCs should require that an individual or team assisting with infection prevention have documentation proving qualifications.
"Certification is not required unless specified by state laws, however the better you do at showing that your infection control officer has the best possible certification and training, the better you do if there is ever discussion about problems that occur," said Dr. Peck. A verified infection prevention expert will be able to facilitate the creation and realization of an effective program.
3. Know your patient base. Each ASC needs to be familiar with the culture of the patient population it serves. A patient community can constitute an at-risk population before any individual even enters the surgery center. If this is the case, institute protocols to mitigate the risk of patients bringing infection to the center or catching an infection at the center. The CDC requiring patients take an antiseptic shower the day before surgery "is much more difficult in an ambulatory setting to get patients to buy into," said Dr. Miller. "Assume patients won't, even given directions. Give an onsite chlorhexidine scrub the day of surgery."
4. Know your environment. Each ASC is going to have a unique environment and it is vital to understand this environment in order to create a standardized program that will work for your ASC. External housekeeping services should be spot checked to ensure outside staff is in compliance with current guidelines and regulations. Monitor the positive and negative air pressure gradients, temperature and humidity levels, number of air changes per hour and potential security risks. Ensure none of these factors contribute to an environment conducive to spreading infection.
5. Strengthen your first line of defense. Infection prevention begins with your staff. Hand hygiene and employee health are the first steps in assembling a successful infection prevention program. According to Dr. Peck, regulatory agencies prefer alcohol-based hand rubs. Dr. Miller explained that the "use of an alcohol-based hand rub can increase compliance with recommended hand hygiene practice by requiring less time and irritating hands less." Instruct your staff to begin each day with a hand scrub and place scrub stations throughout the ASC.
Enforced employee health protocols are one of the most important first steps in infection prevention. In addition to basic hand hygiene, staff should be aware of potential risks and how to mitigate these risks. A recent study of ICU nurses found that the skin beneath rings represented an area of substantial risk for gram-negative bacteria growth. Staff should always change their gloves, be aware of the risks jewelry can entail and avoid artificial nails.
The number one violation recently found in ASCs and an area CMS is heavily focusing on is the use of single-use vials for more than one patient. Your staff should strictly adhere to safe injection, infusion and medical vial practices.
To read the full article "10 Essential Elements for Excellence in ASC Infection Control Programs" click here.
