I was recently very excited to learn of the CDC release entitled Guide to Infection Prevention in Outpatient Settings. Since a large portion of my time is spent in infection prevention I am always looking for new and updated information to share in order to help practices provide a safer patient encounter. Just to clarify, the out-patient setting in this document refers to all delivery systems in the medical community in which the patients do not remain overnight with the exception of dialysis centers. While this document’s focus is on the medical environment, it certainly can apply to the dental environment as well. But, keep in mind, dental practices have Guidelines for Infection Control in Dental Health Care Settings, a very clearly outlined set of infection control standards which were published by the CDC in 2003.
So pen in hand, ready to take notes, I dug in and was surprised to find the document is a review of the most current CDC and Heathcare Infection Control Practices Advisory Committee (HICPAC) recommendations published in 2007. So, while the information is not new it is vastly important. The focus of the document if I could sum it up in a few words is: let’s all get back to basics.
You may be surprised to note the following facts:
- More than three quarters of all operations in the US are delivered in an out-patient setting
- Most individuals will visit their physician practice on average three times each year
- Physician office visits approached one billion annually in 2007
When you add all these facts together and understand that in most out-patient environments infection control resources are not at the same level as those provided in the in-patient environment, reminders about infection control basics are of utmost importance.
Changing the Culture
Infection prevention is not simply a list of tasks, provision of appropriate equipment, and policies and procedures. We will review the most important elements and while all are necessary, there must be a culture in the organization of patient safety. From leadership to volunteers each must be committed to improved patient outcomes and also a safe environment for employees, protecting them from transfer of infection.
Basic Principle #1 – Implement Administrative Controls
- Development of policies and procedures addressing infection control needs. These documents should support the types of services provided by the facility. Areas of need may include: hand hygiene, employee immunization status, appropriate use of PPE, surface disinfection, sterilization, and last but not least post exposure management.
- Availability of supplies including hand-hygiene products, PPE, surface disinfection products, safety needles/devices, and sterilization supplies (wraps, pouches, chemical indicators, spore test).
- Assigned individual to monitor infection control compliance who is on-site the majority of the time. The ideal candidate would have training in infection control principles. This is a requirement in the State of North Carolina and for all Medicare Certified Ambulatory Surgery Centers and additionally in the state of South Carolina, if providing sedation.
Basic Principle #2 – Provide Education and Training
- All staff members should be reminded frequently of the need for stellar infection control procedures. This can be handled through monthly staff meetings, informational posters placed in prominent areas as reminders, and on an annual basis with other compliance training. TMC newsletters are a great source of infection control information. To review past editions of the newsletter sign in using your user name and password and select Newsletters.
- Task specific training for employees as well as contract labor and volunteers is recommended.
- Competency documentation is critical for high risk tasks such as operation of the autoclave or spore testing.
Basic Principle #3 – Enforce the Appropriate Use of PPE
- Accessibility of PPE to include gloves, face protection and if indicated protective gowns.
- Employee education on the appropriate use is not only important from an infection control standpoint it is required in the Bloodborne Pathogen standard on an annual basis (1910.1030(2)(vii)F).
- A surgical mask should be utilized when injecting or placing a catheter in the epidural or subdural space.
Basic Principle #4 – Focus on Injection Safety
- Use aseptic technique when preparing and administering medications. Always cleanse the diaphragms of medication vials/IV access ports with a sterile alcohol pad prior to access.
- Single use vials should be utilized whenever possible.
- When using multi-dose vials, ensure a sterile needle/syringe is utilized each time the vial is accessed.
- Never administer medication from a single syringe to multiple patients.
- Fluid infusion and administration sets should be utilized for one patient only.
Basic Principle #5 – Monitor and Report
- Collection and evaluation of data related to infection prevention is indicated to improve overall function of the facility. Information may include patient infection rates, hand hygiene compliance, and spore test results.
- All local, state, and federal reporting requirements must be met to include reporting of diagnosed communicable diseases.
This has been but a brief review of some of the concepts clearly outlined in the most recent CDC publication. Download the new CDC Guide to Infection Prevention in Outpatient Settings.
Infection control is critical to the success of your organization and to the safety of patients who literally trust you with their lives. The resources outlined here will help you create a safe environment for employees and patients if you will go back to basics!
By Karen Gregory, RN
Director of Compliance & Education
Total Medical Compliance