Infection Control Assessment of Ambulatory Surgical Centers

A recent CDC report published in the Journal of the American Medical Association (JAMA) discusses “Infection Control Assessment of Ambulatory Surgical Centers.” The report, published on June 9, 2010, found that among a sample of U.S. ambulatory surgical centers (ASCs) in 3 states, lapses in infection control were common. Five categories of infection control were assessed: hand hygiene and personal protective equipment, injection safety and medication handling, equipment reprocessing (e.g., sterilization and high-level disinfection), environmental cleaning, and handling of blood glucose monitoring equipment.

Ensuring the safety of healthcare for patients in all settings is a priority for CDC and the Centers for Medicare and Medicaid Services (CMS). Lapses in infection control in any healthcare setting, including Ambulatory Surgical Centers (ASCs), put patients at risk. Typical surgical procedures conducted in ASCs include endoscopies and colonoscopies (including removal of identified polyps), orthopedic procedures, plastic/reconstructive surgeries, and eye, foot, and ear/nose/throat surgeries.

The study’s main findings include the following:

• Of the 68 ASCs assessed, two-thirds (67.6%) had at least one lapse in infection control.
• Common lapses included: using single-dose medication vials for more than one patient (28.1%), failing to adhere to recommended practices regarding reprocessing of equipment (28.4%), and lapses in handling of blood glucose monitoring equipment (46.3%).
• More than half (57%) were ultimately cited for deficiencies in infection control and around 30% (29.4%) were cited for deficiencies related to medication administration, including use of single-dose medications for multiple patients. (This represents six times the deficiencies reported to CMS nationally the year before).
• Serious deficiencies, as determined by CMS, required a follow-up inspection to determine whether the ASC had come into compliance. Failure to adequately address and correct all citations could result in termination of the ASC’s participation in the Medicare program.

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What is being done to address these findings?

• CMS is now requiring all states to use the infection control audit tool and case tracer method for ASC inspections.
• ASCs cited for deficient practices are required to correct them; ASCs that fail to correct serious deficiencies risk termination of their participation in Medicare.
• CMS and CDC have provided in-depth infection control training sessions for surveyors, making CMS Regional Office physicians available to accompany surveyors on inspections, and arranging consultations with experienced personnel when questions arise.
• CMS updated several ASC health and safety standards, effective May 2009.
• CMS committed to inspect one-third of all ASCs nationwide this year, including a nationally representative subsample for an updated analysis of infection control practices, as recommended by the GAO.
• To assist ASCs in their self-evaluation, CMS has made the ASC infection control audit tool [PDF 108 KB] available on-line.

For more about what CDC is doing in regards to improve injection safety, go to CDC’s Role in Safe Injection Practices.

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