ASCs are experiencing increased pressure to demonstrate low incidence of infection and compliance to infection prevention rules and regulations. Louise Dechesser, a surveyor for the Accreditation Association for Ambulatory Health Care, says infection control is a challenge ASCs across the country are facing now that they are required to implement infection control programs without many tangible guidelines from regulatory bodies on how to achieve that goal. Still, ASCs are practicing effective methods of controlling the incidence of infection. Here are 10 steps ASCs should take achieve excellent compliance to infection control regulations.
1. Take advantage of available online resources. In light of recent outbreaks of infection in various health settings, Ms. Dechesser says various organizations have put together online infection control certification programs as more ASCs continue to install a staff member to oversee infection control at their facilities.
Marie Boyd, administrator at Cape and Islands Endoscopy Center in Hyannis, Mass., has also turned to online resources to gather additional information about best infection control practices and stay up to date on infection control regulations. Among the websites she frequents, she regularly visits the National Institutes of Health website, the World Health Organization website and the Association for Professionals in Infection Control and Epidemiology website.
2. Turn to healthcare organizations for additional guidelines and best practices. In Connecticut, all ASCs are required to be aligned with the state's Patient Safety Organization, which Ms. Dechesser says was appointed by the state Department of Public Health to be the authoritative body on infection control. Connecticut's Patient Safety Organization has worked to put together resources ASCs can use to better comply with infection control standards, such as monthly observation summaries, hand hygiene observation tools as well as infection control checklists. ASCs should look to see what roundtables, forums or resources their local organizations offer as well.
Ms. Boyd has sought out additional information from organizations such as the CDC and CMS. "We purchased a CD on CMS infection control changes for ASCs that's about a 90-minute CD our staff member can watch, which was put together by a company called Excellensia," she says. "The resource has made us really understand how serious infection control has become. There was an example on the CD of a surveyor who went as far as to check the air ducts of an ASC from the facility's rooftop. So now we do yearly maintenance on our air ducts."
3. Gather data and track trends pertaining to infection control. Ms. Dechesser says an effective infection control program will closely monitor rates of infection by gathering incidence reports and tracking any trends. Doing so will help ASCs pinpoint what exactly the rates of infection are within the facility in a more efficient manner and decide what changes can be made accordingly to improve that area of weakness.
"If I get an infection control report from 'Dr. Smith' that says over a one-month period [his patients] had a high rate of MRSA or some other infection, I'm going to take a closer look to track that trend and put my arms around it," Ms. Dechesser says. "An ASC will also want to close the loop by talking to the physician about any comorbidities, what kind of surgical prep they did and find out what harbored that infection so that it can make form better practices."
One process that was changed to prevent the incidence of infection at Cape and Islands was the use of blood pressure cuffs. "We used to clean each blood pressure cuff after measuring a patient's blood pressure each time, whether it be once in the pre-procedure room and then again in the OR by the anesthesiologist and again post procedure," Ms. Boyd says. "Now each patient has their own blood pressure cuff from beginning to end so we do not need to clean each cuff between every use."
4. Put together a comprehensive infection control program tailored to the ASC. ASCs must keep in mind that best practices will vary from facility to facility. In order to implement the best infection control program, ASCs must look to a number of factors to ensure its infection control program is effective and cost- and time-efficient.
"Everyone is struggling with infection control, and everyone is wondering how to hire an infection control officer, how many hours does this officer have to spend on infection control issues and how much money should go toward the program, but the key is to put together a succinct program that takes care of all the compliance issues and also fits the organization," Ms. Dechesser says. "Certainly, not every ASC can afford to pay a full-time infection control nurse, and there are no rules as to how many hours that nurse should spend on that issue."
5. Push for improved patient compliance. Another challenge with instituting an effective and efficient infection control program is clamping down on patient compliance to physician orders that are made to prevent infection. Ms. Dechesser says ASCs must work harder to ensure their physicians are clearly communicating with their patients the need to comply to their orders to prevent the occurrence of infection.
"ASCs are under special circumstances because all the patients go home," she says. "A physician may tell his or her patient not to get their dressing wet, but the patient might decide to go ahead and shower anyway because the dressing is on the belly button and he or she will try to shower with their back to the water. Well, of course, the dressing is going to get wet and that's a perfect breeding spot for infection. ASCs have to reiterate specific orders to patients."
6. Monitor practices and procedures for anesthetics. Anesthesia is a specific issue related to infection control that has come under increased scrutiny. With the limelight shining brighter on single-use vials, it is critical ASCs watch anesthesia-related practices and ensure policies and procedures surrounding that comply with infection control regulations.
"This always goes back to education and re-emphasizing to a facility's staff members how important it is to watch practices in handling anesthesia, leaving needles in vials, wiping equipment with alcohol and so on," Ms. Dechesser says. "ASCs have to be on their staff members' tails all the time because when they draw up medication and inject intravenously, it's possible to harbor microorganisms if they're not using good techniques."
7. Hire a sterilization technician. In the same vein as anesthesia, Ms. Dechesser emphasizes the importance for ASCs to hire a sterilization technician who is charged with making sure all pieces of equipment are kept sterile.
"Not only does an ASC's sterilization technician have to make sure all the equipment is always immaculate, but there are a lot of companies that reprocess single-use devices and sell them to healthcare facilities for a lower cost than a brand new version," she says. "So if an ASC decides to buy reprocessed drills from a third-party company instead of buying brand new drills from the original company, it's important the technicians check that the reprocessed equipment is FDA-approved."
8. Clean operating rooms thoroughly. Ms. Dechesser says even if there are no apparent signs of major spillage or blood, ASCs should be diligent in thoroughly cleaning the operating room between cases with EPA-registered disinfectants. As an added line of defense, she suggests hiring a cleaning crew to disinfect the OR at the end of the day.
"At the end of the day when an ASC is done with cases, it's good to have a cleaning crew come in and do the whole nine yards of wiping the floor, wiping the table tops, the wall and lights as an added measure for fighting infection," she says.
9. Conduct regular in-services for staff members. A good practice for ASCs to adopt is to regularly provide continuing education about infection control to staff members. Ms. Boyd says in-services are held on a monthly basis at Cape and Islands that occasionally cover infection control topics, but a weekly meeting is always dedicated to infection control discussions.
"During our monthly in-services, we may have a representative some in from OSHA to talk about infections or a representative from Olympus come in to talk about scope cleaning, but our weekly infection control meetings are entirely devoted to raising awareness on infection control," Ms. Boyd says. "Our infection control nurse, the nurse manager and myself review our facility's infection control policies during these meetings. All of our weekly sessions are documented and inserted into a book that is available in the nurse's lounge."
The infection control book also includes related articles or studies. Every time new material is added to the book, staff members are required to spend some time reviewing the material and then sign a sheet confirming they had reviewed it."
10. Cut back or eliminate flash sterilization. Additionally, Ms. Dechesser says flash sterilization is a practice that should be minimized, if not completely eliminated, as much as possible. "Flash sterilizing instruments should be a last resort kind of thing in case a physician has only that equipment to use and they are in the middle of a case. A smarter approach would be to work with supply companies to tailor instrument sets. This way, an ASC has more money to spend on sets that include instruments that are more frequently used."
Learn more about AAAHC.
Learn more about Cape and Island Endoscopy Center.
1. Take advantage of available online resources. In light of recent outbreaks of infection in various health settings, Ms. Dechesser says various organizations have put together online infection control certification programs as more ASCs continue to install a staff member to oversee infection control at their facilities.
Marie Boyd, administrator at Cape and Islands Endoscopy Center in Hyannis, Mass., has also turned to online resources to gather additional information about best infection control practices and stay up to date on infection control regulations. Among the websites she frequents, she regularly visits the National Institutes of Health website, the World Health Organization website and the Association for Professionals in Infection Control and Epidemiology website.
2. Turn to healthcare organizations for additional guidelines and best practices. In Connecticut, all ASCs are required to be aligned with the state's Patient Safety Organization, which Ms. Dechesser says was appointed by the state Department of Public Health to be the authoritative body on infection control. Connecticut's Patient Safety Organization has worked to put together resources ASCs can use to better comply with infection control standards, such as monthly observation summaries, hand hygiene observation tools as well as infection control checklists. ASCs should look to see what roundtables, forums or resources their local organizations offer as well.
Ms. Boyd has sought out additional information from organizations such as the CDC and CMS. "We purchased a CD on CMS infection control changes for ASCs that's about a 90-minute CD our staff member can watch, which was put together by a company called Excellensia," she says. "The resource has made us really understand how serious infection control has become. There was an example on the CD of a surveyor who went as far as to check the air ducts of an ASC from the facility's rooftop. So now we do yearly maintenance on our air ducts."
3. Gather data and track trends pertaining to infection control. Ms. Dechesser says an effective infection control program will closely monitor rates of infection by gathering incidence reports and tracking any trends. Doing so will help ASCs pinpoint what exactly the rates of infection are within the facility in a more efficient manner and decide what changes can be made accordingly to improve that area of weakness.
"If I get an infection control report from 'Dr. Smith' that says over a one-month period [his patients] had a high rate of MRSA or some other infection, I'm going to take a closer look to track that trend and put my arms around it," Ms. Dechesser says. "An ASC will also want to close the loop by talking to the physician about any comorbidities, what kind of surgical prep they did and find out what harbored that infection so that it can make form better practices."
One process that was changed to prevent the incidence of infection at Cape and Islands was the use of blood pressure cuffs. "We used to clean each blood pressure cuff after measuring a patient's blood pressure each time, whether it be once in the pre-procedure room and then again in the OR by the anesthesiologist and again post procedure," Ms. Boyd says. "Now each patient has their own blood pressure cuff from beginning to end so we do not need to clean each cuff between every use."
4. Put together a comprehensive infection control program tailored to the ASC. ASCs must keep in mind that best practices will vary from facility to facility. In order to implement the best infection control program, ASCs must look to a number of factors to ensure its infection control program is effective and cost- and time-efficient.
"Everyone is struggling with infection control, and everyone is wondering how to hire an infection control officer, how many hours does this officer have to spend on infection control issues and how much money should go toward the program, but the key is to put together a succinct program that takes care of all the compliance issues and also fits the organization," Ms. Dechesser says. "Certainly, not every ASC can afford to pay a full-time infection control nurse, and there are no rules as to how many hours that nurse should spend on that issue."
5. Push for improved patient compliance. Another challenge with instituting an effective and efficient infection control program is clamping down on patient compliance to physician orders that are made to prevent infection. Ms. Dechesser says ASCs must work harder to ensure their physicians are clearly communicating with their patients the need to comply to their orders to prevent the occurrence of infection.
"ASCs are under special circumstances because all the patients go home," she says. "A physician may tell his or her patient not to get their dressing wet, but the patient might decide to go ahead and shower anyway because the dressing is on the belly button and he or she will try to shower with their back to the water. Well, of course, the dressing is going to get wet and that's a perfect breeding spot for infection. ASCs have to reiterate specific orders to patients."
6. Monitor practices and procedures for anesthetics. Anesthesia is a specific issue related to infection control that has come under increased scrutiny. With the limelight shining brighter on single-use vials, it is critical ASCs watch anesthesia-related practices and ensure policies and procedures surrounding that comply with infection control regulations.
"This always goes back to education and re-emphasizing to a facility's staff members how important it is to watch practices in handling anesthesia, leaving needles in vials, wiping equipment with alcohol and so on," Ms. Dechesser says. "ASCs have to be on their staff members' tails all the time because when they draw up medication and inject intravenously, it's possible to harbor microorganisms if they're not using good techniques."
7. Hire a sterilization technician. In the same vein as anesthesia, Ms. Dechesser emphasizes the importance for ASCs to hire a sterilization technician who is charged with making sure all pieces of equipment are kept sterile.
"Not only does an ASC's sterilization technician have to make sure all the equipment is always immaculate, but there are a lot of companies that reprocess single-use devices and sell them to healthcare facilities for a lower cost than a brand new version," she says. "So if an ASC decides to buy reprocessed drills from a third-party company instead of buying brand new drills from the original company, it's important the technicians check that the reprocessed equipment is FDA-approved."
8. Clean operating rooms thoroughly. Ms. Dechesser says even if there are no apparent signs of major spillage or blood, ASCs should be diligent in thoroughly cleaning the operating room between cases with EPA-registered disinfectants. As an added line of defense, she suggests hiring a cleaning crew to disinfect the OR at the end of the day.
"At the end of the day when an ASC is done with cases, it's good to have a cleaning crew come in and do the whole nine yards of wiping the floor, wiping the table tops, the wall and lights as an added measure for fighting infection," she says.
9. Conduct regular in-services for staff members. A good practice for ASCs to adopt is to regularly provide continuing education about infection control to staff members. Ms. Boyd says in-services are held on a monthly basis at Cape and Islands that occasionally cover infection control topics, but a weekly meeting is always dedicated to infection control discussions.
"During our monthly in-services, we may have a representative some in from OSHA to talk about infections or a representative from Olympus come in to talk about scope cleaning, but our weekly infection control meetings are entirely devoted to raising awareness on infection control," Ms. Boyd says. "Our infection control nurse, the nurse manager and myself review our facility's infection control policies during these meetings. All of our weekly sessions are documented and inserted into a book that is available in the nurse's lounge."
The infection control book also includes related articles or studies. Every time new material is added to the book, staff members are required to spend some time reviewing the material and then sign a sheet confirming they had reviewed it."
10. Cut back or eliminate flash sterilization. Additionally, Ms. Dechesser says flash sterilization is a practice that should be minimized, if not completely eliminated, as much as possible. "Flash sterilizing instruments should be a last resort kind of thing in case a physician has only that equipment to use and they are in the middle of a case. A smarter approach would be to work with supply companies to tailor instrument sets. This way, an ASC has more money to spend on sets that include instruments that are more frequently used."
Learn more about AAAHC.
Learn more about Cape and Island Endoscopy Center.
