The risk of nosocomial infection has been thought to be minimal in ambulatory surgical settings because of the short stay in the facility, the short duration of anesthesia, the 'minor' nature of the surgical procedures and the general good health of the patient.
Times have changed. More and more procedures are being performed on an ambulatory basis. Surgical site infections (SSIs) remain an important cause of morbidity and mortality even in ASCs. Excess hospital costs during the postoperative period in cases when patients must be admitted to an acute care facility for treatment of SSIs are also a concern of ASCs.
As the shift toward more ambulatory surgery continues and more procedures are performed on an outpatient basis, ASCs will need to verify and monitor that high-quality services are being provided in same-day surgery centers.
Based on this, each facility must evaluate its own needs for licensure and accreditation and choose which guidelines suit them best. The accreditation standards applied by the Accreditation Association for Ambulatory Health Care (AAAHC) and The Joint Commission (TJC) assist an organization's quality and patient safety program, including their infection control program, in becoming stronger and better able to provide high quality care to their patients.
In this article, we will explore some tips for setting up an infection control program and meeting the regulatory requirements of AAAHC and TJC.
Establish a true culture of patient safety
First and foremost, efforts to reduce or eliminate health care-associated infections (HAIs) will not succeed until the entire organization is on board with implementing a true patient safety culture in their organization. Every employee and stakeholder must understand that the organization provides a work climate that promotes patient safety and shows that patient safety is a top priority. In other words, "The patient needs to be the FOCUS of everything we do." In order to reach this position, it is essential to develop and continually enhance a quality program that permeates through all the products and services provided by or through the organization. Infection control needs to be an integral part of the quality assessment and performance improvement program. Facilities must have a plan of action for preventing, identifying and managing infections and communicable diseases and for immediately implementing corrective and preventative measures that result in improvement
Designate an infection control professional
A designated and qualified professional who has training in infection control is a necessary component of any program. It is very important to have an infection control professional (ICP) available for consultation, if there is an issue or question, and this person will maintain oversight of the program that complies with the local, state and federal requirements. The ICP is required to maintain his/her qualifications through ongoing education and training, and demonstrate competency by participating in infection control courses or in local and national meetings. There is not a limit as to the number of hours that the qualified individual must devote to the infection control program.
Consider the types of services you offer and your patient population
In establishing its infection control program, the ASC should consider the type of surgical services offered at the facility as well as the patient population in determining the size and scope of the resources it commits to infection control. According to TJC, a successful infection control program identifies the following:
According to the Association for Professionals in Infection Control and Epidemiology guidelines, the first step in identifying the infection control needs of an ASC is to determine the following:
Make sure your infection control program covers standard precautions
These are the basics of any infection control program and facilities need to make sure that the proper materials, products and resources are available so that employees and patients can adhere to the proper measures. Standard precautions include:
Some common issues TJC looks for during surveys
Depending on which accreditation organization you work with, it is important to understand some of the common issues and areas they scrutinize when inspecting a facility. Knowing those areas, you can ensure it is an integral, understood and implemented part of your infection control plan. Common issues during TJC surveys include:
You can't Improve what you don't measure
An evaluation and measurement process is a must for any infection control program. ASCs must conduct monitoring activities throughout the entire facility in order to identify infection risks or communicable disease problems and document their monitoring/tracking activities, including the measures selected for monitoring, as well as collection and analysis methods. Monitoring should include follow-up of patients after discharge, in order to gather evidence of whether they have developed an infection associated with their stay in the ASC.
As referenced earlier, the goal of accreditation standards applied by organizations including AAAHC and TJC is to make an ASC's patient care, including its infection control program, stronger and better able to provide high quality care to patients. A proper program involves all levels of the organization working together with a true patient safety focus, clear responsibility for infection prevention and control, a program that identifies specific goals, ways to decrease transmission of infections, plans to prevent and control infections and detailed responses to a possible influx of infectious patients. These policies and procedures should include a comprehensive quality improvement program and be subject to an annual assessment to ensure the highest quality of care and safety.
Learn more about Amerinet.
Times have changed. More and more procedures are being performed on an ambulatory basis. Surgical site infections (SSIs) remain an important cause of morbidity and mortality even in ASCs. Excess hospital costs during the postoperative period in cases when patients must be admitted to an acute care facility for treatment of SSIs are also a concern of ASCs.
As the shift toward more ambulatory surgery continues and more procedures are performed on an outpatient basis, ASCs will need to verify and monitor that high-quality services are being provided in same-day surgery centers.
Based on this, each facility must evaluate its own needs for licensure and accreditation and choose which guidelines suit them best. The accreditation standards applied by the Accreditation Association for Ambulatory Health Care (AAAHC) and The Joint Commission (TJC) assist an organization's quality and patient safety program, including their infection control program, in becoming stronger and better able to provide high quality care to their patients.
In this article, we will explore some tips for setting up an infection control program and meeting the regulatory requirements of AAAHC and TJC.
Establish a true culture of patient safety
First and foremost, efforts to reduce or eliminate health care-associated infections (HAIs) will not succeed until the entire organization is on board with implementing a true patient safety culture in their organization. Every employee and stakeholder must understand that the organization provides a work climate that promotes patient safety and shows that patient safety is a top priority. In other words, "The patient needs to be the FOCUS of everything we do." In order to reach this position, it is essential to develop and continually enhance a quality program that permeates through all the products and services provided by or through the organization. Infection control needs to be an integral part of the quality assessment and performance improvement program. Facilities must have a plan of action for preventing, identifying and managing infections and communicable diseases and for immediately implementing corrective and preventative measures that result in improvement
Designate an infection control professional
A designated and qualified professional who has training in infection control is a necessary component of any program. It is very important to have an infection control professional (ICP) available for consultation, if there is an issue or question, and this person will maintain oversight of the program that complies with the local, state and federal requirements. The ICP is required to maintain his/her qualifications through ongoing education and training, and demonstrate competency by participating in infection control courses or in local and national meetings. There is not a limit as to the number of hours that the qualified individual must devote to the infection control program.
Consider the types of services you offer and your patient population
In establishing its infection control program, the ASC should consider the type of surgical services offered at the facility as well as the patient population in determining the size and scope of the resources it commits to infection control. According to TJC, a successful infection control program identifies the following:
- At-risk patient populations
- At-risk procedures, such as those requiring invasive devices
- Causes, risks and patterns of infections that arise in a particular healthcare setting
According to the Association for Professionals in Infection Control and Epidemiology guidelines, the first step in identifying the infection control needs of an ASC is to determine the following:
- Type of practice and all surgical specialties involved
- Patient case mix
- Patient caseload
- Healthcare worker level of training and education
- Level of nursing support for the practice
- Types of invasive procedures performed and where they are usually performed
- Specific instruments and equipment used
- Facility design
Make sure your infection control program covers standard precautions
These are the basics of any infection control program and facilities need to make sure that the proper materials, products and resources are available so that employees and patients can adhere to the proper measures. Standard precautions include:
- Hand hygiene
- Infectious waste management
- Sharps safety devices
- Personal protection equipmentRespiratory hygiene/cough etiquette
Some common issues TJC looks for during surveys
Depending on which accreditation organization you work with, it is important to understand some of the common issues and areas they scrutinize when inspecting a facility. Knowing those areas, you can ensure it is an integral, understood and implemented part of your infection control plan. Common issues during TJC surveys include:
- Proper compliance with and measurement of hand hygiene
- Frequency of and items requiring flash sterilization
- Red bag trash compliance
- Mop water compliance including proper changing during room cleaning
- High level disinfectants
- Proper procedure
- Proper precautions
You can't Improve what you don't measure
An evaluation and measurement process is a must for any infection control program. ASCs must conduct monitoring activities throughout the entire facility in order to identify infection risks or communicable disease problems and document their monitoring/tracking activities, including the measures selected for monitoring, as well as collection and analysis methods. Monitoring should include follow-up of patients after discharge, in order to gather evidence of whether they have developed an infection associated with their stay in the ASC.
As referenced earlier, the goal of accreditation standards applied by organizations including AAAHC and TJC is to make an ASC's patient care, including its infection control program, stronger and better able to provide high quality care to patients. A proper program involves all levels of the organization working together with a true patient safety focus, clear responsibility for infection prevention and control, a program that identifies specific goals, ways to decrease transmission of infections, plans to prevent and control infections and detailed responses to a possible influx of infectious patients. These policies and procedures should include a comprehensive quality improvement program and be subject to an annual assessment to ensure the highest quality of care and safety.
Learn more about Amerinet.