Two-thirds of ambulatory surgery facilities surveyed in three states had at least one lapse in infection control, according to a recent report. Of the 68 facilities reviewed, 18 percent were lacking in three or more of five infection control measures.
"These are basic fundamentals of infection control, things like cleaning your hands, cleaning surfaces in patient care areas," said lead author Dr. Melissa Schaefer of CDC. "It's all surprising and somewhat disappointing."
The study was spurred by an outbreak of hepatitis C traced to lax infection control practices at two Las Vegas clinics. The clinics, now closed, are believed to be responsible for nine cases of hepatitis C. Some 63,000 patients were exposed, and another 100 cases may be connected to the clinics.
In the current study, shortcomings noted were in hand hygiene and use of personal protective equipment (observed in 12 of 62 facilities), injection safety and medication handling (19 of 67 facilities), and equipment reprocessing (19 of 67 facilities). Almost 20 percent (12 of 64) of facilities were faulted for environmental cleaning procedures, and almost half (25 of 64) did not adequately handle blood glucose monitoring equipment.
Citations were imposed on 57 percent of the facilities for infection control lapses; 29 percent received citations for infractions in medication administration, including using a single-dose medication for multiple patients.
The facilities in the study were in Maryland (32), North Carolina (16) and Oklahoma (20). In the inspections, surveyors followed a single patient through the entire surgical process. The inspections were not announced in advance; however, staff members were informed once inspectors were on the premises.
"These people knew they were under observation, had the opportunity to be on their best behavior and yet these lapses were still identified, some of which potentially are very dangerous and have been warned against explicitly," said Dr. Philip Barie of Weill Cornell Medical College, who wrote an accompanying editorial.
The full report, "Infection Control Assessment of Ambulatory Surgical Centers," and an editorial, "Infection Control Practices in Ambulatory Surgery Centers," were published in the Journal of the American Medical Association (2010;303(22):2273-2279 and 2010;303(22):2295-2297).