Infection control is easy to view as an administrative burden, but going forward, the stricter standards for ASCs will be instrumental to providing quality patient care. According to Robert Chase, MD, vice president of clinical quality for The Sibery Group, assigning your infection control program to a staff member with the required "training" but no real specialization may mean you do a lot of work without achieving real results. He offers three steps to take to start building a great infection control program that will improve patient care and keep your center compliant with national standards.
1. Understand what makes ASC infection control different from hospitals. The CMS ASC Conditions for Coverage 416.51 identifies the unique challenges for ASC infection control that differentiate surgery centers from hospitals. The challenges CMS names are:
- Patients remain in common areas for prolonged periods of time.
- Surgical prep, recovery rooms and ORs are turned around quickly.
- Patients with infections and communicable diseases may not be identified.
- There is a risk of infection at the surgical site.
The Conditions for Coverage also explains that, "Furthermore, due to the short period of time patients are in an ASC, the follow-up process to identify infections associated with the ASC requires gathering information after the patient's discharge rather than directly." Dr. Chase says that all these factors — patients waiting in common areas, quick room turn-around and short procedure time — mean "patients with infections with communicable diseases might not be identified as quickly or easily."
He says ASC infection control programs absolutely need to institute policies to identify infections and communicable diseases, identify sick staff members and follow up with patients on potential wound infections. "If a surgical nurse is under the weather, for example, is that really someone you want participating in the care of a patient?" Dr. Chase asks. "You need processes in place to identify [potentially ill] staff members, use a checklist to determine whether they put the center at risk and send them home if need be." ASCs also need to be vigilant in going over checklists with patients several days after surgery to ensure no infections or adverse symptoms have occurred because of the procedure.
2. Assess whether your center is meeting current standards. There are many resources for ASCs to assess where they fall on quality standards, Dr. Chase says. ASC administrators should read quality measures developed by the ASC Quality Collaboration (pdf) and CMS to determine how much work they need to do to meet industry standards. If an ASC is unsure where to start, Dr. Chase says it can help to bring in a third-party company or expert on infection control to assess the ASC's current performance and recommend future action. "When we visit ASCs, we do an evaluation and say, 'You guys either have to get this done or hire someone to come in and build your program," Dr. Chase says. "Our group can come in and provide a bridge until they get a [quality expert] in place, but the first step is to know where the center is in terms of quality. A lot of places really underestimate their weaknesses."
3. Hire an infection control specialist to make real changes rather than just follow a checklist. One of the most important steps in instituting a robust, effective infection control program is to hire a professional, Dr. Chase says. He gives the example of multi-drug-resistant organisms, a topic that ASCs should target as part of an infection control program. "Your infection control leader should be up to speed on the professional literature on how to handle [multi-drug resistant organisms]," he says. "Years ago, a great nurse knew all she needed to know about this stuff, but it's really developed into a special field with its own literature, societies and practices, and it's gone beyond what a passionate, involved, intelligent administrator or nurse can do on his or her own."
He recommends hiring a professional who regularly reads CMS guidelines, infection control research publications and learns accreditation requirements. "There's a body of literature to supply how to do these things correctly," he says. "One needs to be familiar with those to ensure that patients and staff are in a healthy environment."
Learn more about The Sibery Group.
1. Understand what makes ASC infection control different from hospitals. The CMS ASC Conditions for Coverage 416.51 identifies the unique challenges for ASC infection control that differentiate surgery centers from hospitals. The challenges CMS names are:
- Patients remain in common areas for prolonged periods of time.
- Surgical prep, recovery rooms and ORs are turned around quickly.
- Patients with infections and communicable diseases may not be identified.
- There is a risk of infection at the surgical site.
The Conditions for Coverage also explains that, "Furthermore, due to the short period of time patients are in an ASC, the follow-up process to identify infections associated with the ASC requires gathering information after the patient's discharge rather than directly." Dr. Chase says that all these factors — patients waiting in common areas, quick room turn-around and short procedure time — mean "patients with infections with communicable diseases might not be identified as quickly or easily."
He says ASC infection control programs absolutely need to institute policies to identify infections and communicable diseases, identify sick staff members and follow up with patients on potential wound infections. "If a surgical nurse is under the weather, for example, is that really someone you want participating in the care of a patient?" Dr. Chase asks. "You need processes in place to identify [potentially ill] staff members, use a checklist to determine whether they put the center at risk and send them home if need be." ASCs also need to be vigilant in going over checklists with patients several days after surgery to ensure no infections or adverse symptoms have occurred because of the procedure.
2. Assess whether your center is meeting current standards. There are many resources for ASCs to assess where they fall on quality standards, Dr. Chase says. ASC administrators should read quality measures developed by the ASC Quality Collaboration (pdf) and CMS to determine how much work they need to do to meet industry standards. If an ASC is unsure where to start, Dr. Chase says it can help to bring in a third-party company or expert on infection control to assess the ASC's current performance and recommend future action. "When we visit ASCs, we do an evaluation and say, 'You guys either have to get this done or hire someone to come in and build your program," Dr. Chase says. "Our group can come in and provide a bridge until they get a [quality expert] in place, but the first step is to know where the center is in terms of quality. A lot of places really underestimate their weaknesses."
3. Hire an infection control specialist to make real changes rather than just follow a checklist. One of the most important steps in instituting a robust, effective infection control program is to hire a professional, Dr. Chase says. He gives the example of multi-drug-resistant organisms, a topic that ASCs should target as part of an infection control program. "Your infection control leader should be up to speed on the professional literature on how to handle [multi-drug resistant organisms]," he says. "Years ago, a great nurse knew all she needed to know about this stuff, but it's really developed into a special field with its own literature, societies and practices, and it's gone beyond what a passionate, involved, intelligent administrator or nurse can do on his or her own."
He recommends hiring a professional who regularly reads CMS guidelines, infection control research publications and learns accreditation requirements. "There's a body of literature to supply how to do these things correctly," he says. "One needs to be familiar with those to ensure that patients and staff are in a healthy environment."
Learn more about The Sibery Group.