Surgery center field stung by infection control remarks
Do ambulatory surgery centers (ASCs) and other freestanding health care facilities resemble the Wild West when it comes to infection control practices? This appears to be the perception among at least some members of the infection control profession.
Julie Louise Gerberding, MD, MPH, director of the Centers for Disease Control and Prevention (CDC), said in a conference call that two factors contributed to a hepatitis C outbreak in Nevada: improperly trained medical workers and a tremendous incentive for employees to take shortcuts.1 She said ambulatory clinics are more likely to have problems than hospitals.
"[In hospitals,] they acknowledge when there is a problem. They all have a piece of it," Gerberding said. "It would be difficult to make an error and have people notice. It's much easier for someone to have a bad practice [in an ambulatory clinic]."1
Response came quickly from the ASC community. "I don't think there's any iota of data that show that," says Kathy Bryant, president of the Ambulatory Surgery Center Association. Bryant points out that such comments often are made from persons who have come from a hospital or academic background and never worked in an ASC. "Any time we've looked at infection rates in ASCs, they are incredibly low," she says. "Surely if we had shoddy infection control practices across the board, we would have higher rates of infections."
Gerberding's comments came in response to an outbreak of hepatitis C virus (HCV) that recently sparked a massive testing effort affecting 40,000 patients in Las Vegas. An endoscopy center there was using unsafe needle safety practices, such as reusing syringes, with new needles, and reusing vials during administration of anesthesia, according to a CDC investigator. The center lost its business license and was given a $500,000 fine.
A story by The Associated Press (AP) reported that Michael Bell, MD, associate director for infection control at the CDC, said such improper procedures appear to be more commonplace in freestanding surgery centers such as the Las Vegas endoscopy center.2 However, when contacted by Same-Day Surgery, he restated his position. When asked whether freestanding surgery centers have more infection control problems than hospitals, Bell said, "I think they have more challenges."
Large hospitals often have designated infection control personnel, he pointed out. "There is a lot more support to make sure everything is done right every time," Bell said. "It's harder in freestanding ambulatory care facilities where that level of staffing and infrastructure isn't always present." Traditional hospitals have required staffing levels for infection control professionals, Bell said. "That's not the case for ambulatory care facilities where they may have a contract, part-time, or no one at all as the infection control professional."
He went on to say health care providers can't take shortcuts, even with time pressures. "When that's the case, it becomes easier for mistakes to slip by," Bell said.
He pointed out that ambulatory surgery has grown from a few hundred facilities in the 1980s to more than 4,000 freestanding facilities today. "That kind of growth is an indicator that we need to pay attention," he said. "Alongside building the capacity to deliver care, we need to build in the capacity to ensure care is given safely."
The potential problems aren't limited to endoscopy and other surgery centers, but expand to radiology, pain therapy, and other places that require frequent or intensive use of injection therapy, Bell said. "They are all potential places where slipups can occur and where increased attention to infection control is warranted," he said.
That opinion of potential problems in ambulatory care settings is seconded by Marcia Patrick, RN, MSN, CIC, infection prevention and control director at MultiCare Health System in Tacoma, WA. Patrick's system includes two freestanding surgery centers affiliated with the hospital, plus a hospital-based outpatient surgery program. When asked if ASCs across the country have more infection control problems than hospitals, she says, "My experience has been that yes, that is the case." While some centers are doing a "fabulous job," that's not true across the board, she says.
Patrick worked with primary care clinics before taking her current position. "These were well-intentioned people who were willing to bring people in to critique and make suggestions," she says. "However, they had practices that were downright scary." One clinic was using a dishwasher to sanitize a vaginal specula. "Those have to be high-level disinfected, or sterilized, or disposed of," Patrick says. Another clinic was soaking critical instruments in an environmental cleaner. While the label indicated it could be used to clean medical instruments, the label apparently was referring to the outside of the instrument, she says. Some clinics were sterilizing instruments in an autoclave and wrapping them afterward, Patrick says.
"Because there was no [required] regulation, when a patient goes to one of those centers — this will sound harsh — but you're betting your life on the goodwill and knowledge of the people who work at that center," she says.
References
- Pridgen A. Hepatitis C scare puts health officials on national alert. Nevada Appeal. March 13, 2008. Accessed at www.nevadaappeal.com.
- Hennessey K. Shoddy practices at Las Vegas clinic may have sickened thousands of patients. March 6, 2008. Accessed at www.waxahachiedailylight.com.
Source
For more information on infection control practices, contact:
- Marcia Patrick, RN, MSN, CIC, Infection Prevention and Control Director, MultiCare Health System, Tacoma, WA. E-mail: [email protected].
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