4 steps that can improve infection control practices
While there are no quick-and-easy solutions to ensuring effective infection control practices in the ambulatory surgery setting, there are steps managers can take, say infection control experts. Consider these suggestions:
• Access infection control expertise.
Consulting with an infection control professionals can provide "an extra layer of safety," says Michael Bell, MD, associate director for infection control at the Centers for Disease Control and Prevention. "You can have an extra set of eyes looking at things to make sure they're safe," he says.
If obtaining or sharing a consultant isn't possible due to financial constraints, consider membership in the Association for Professionals in Infection Control and Epidemiology (APIC) and/or attending infection control seminars so you have access to information, suggests Stephen Trosty, JD, MHA, CPHRM, a risk management consultant in Haslett, MI.
Use these sources/resources to determine the following: when and how infections occur in ambulatory surgery, the areas of greatest concern, the areas that should be monitored, the products that should be used, and steps that should be taken to avoid infections, Trosty advises. "APIC can provide some of that information," he says.
• Change the infection control culture.
Managers must work to overcome the prevalent believe that infection control is the role of the infection control professional, Bell says. "Actually, it's the role of everyone in the health care facility, from the persons pushing wheelchairs who need to wash their hands after they sneeze to the doctors using sterile infection control practices," he says.
Ensure that all staff members see infection control as part of their jobs, Bell says. "It's an important cultural shift that needs to occur and I think is occurring," he says.
• Comply with accepted standards of practice.
The autoclave should be regularly monitor to ensure time, temperature, and pressure parameters are met, says Marcia Patrick, RN, MSN, CIC, infection prevention and control director at MultiCare Health System in Tacoma, WA, and a committee chairwoman with APIC. Also, it should be spore tested at least weekly, she says. Use a biological indicator.
Additionally, the autoclave should be serviced annually, Patrick says. The inner components should be pulled out and cleaned, and the autoclave should be refilled with distilled water, she says.
• Ensure staff are educated and monitored.
Some ambulatory surgery staff may not show serious concern about infection control because they may assume that in this setting, there are fewer opportunities for infection, Trosty says. However, that is untrue, he emphasizes. Managers must provide regular inservice training for employees that is documented in personnel files, Trosty says. At least annually, review the most significant ways that infections are spread, he says. (For handouts that can be used for education, see "Patient Safety Threat — Syringe Reuse," and "Unsafe Injection Practices and Disease Transmission,".)
Role of the manager
Managers should cover these areas: universal precautions; use and disposal of instruments contaminated with blood; proper cleaning and sterilization products, solutions, and methods; and the importance of not reusing single-use instruments.
Managers also must periodically review the infection control practices in the facility, he says. Perform an inventory, Trosty suggests. "If you know how many syringes you've used and how many procedures you've done, and you've used more syringes than you should have, that's probably an indication that some have been reused," he says.
Every staff person involved in processing should be knowledgeable and supervised, says Patrick. Ensure that central service techs are certified, she advises. "Surgery centers need to be aware, when they're hiring, that they need experienced people who really know what they're doing," she says.
In Patrick's health system, administrators determined that staff turnover resulted in processing staff not being trained to the expected level. "We moved out all of the sterilization and disinfection in the smaller clinics and went to an exchange system," she says.
Staff in the smaller clinics perform a gross wash in which they remove visible debris, dry the instruments, and send them by courier in a Rubbermaid-covered rigid plastic container to a central service location, such as the surgery centers.
"It's been fabulous," Patrick says. "We know every instrument has been processed by a trained central service tech who is supervised."
While the change did require the purchase of extra instruments, "cost was less of a concern than patient safety," she says.
When there are poor infection control practices in an ambulatory setting, it's not because staff are lazy, stupid, or have ill intent, Patrick says. "People believe they're doing the best for their patients, but often there is a lack of knowledge," she says. "We all want good patient outcomes."
Resources
The Association of periOperative Registered Nurses (AORN) offers members a tool kit on safe medication administration that includes AORN's official guidance and position statements. It also offers 4.8 free contact hours. Go to www.aorn.org.
The Association for Professionals in Infection Control and Epidemiology has a consensus report on infection control in out-of-hospital settings. Go to www.apic.org. Under "Guidelines and Standards," click on "Reports." Under "Consensus Reports," click on "Requirements for infrastructure and essential activities of infection control and epidemiology in out-of-hospital settings: a consensus panel report."
While there are no quick-and-easy solutions to ensuring effective infection control practices in the ambulatory surgery setting, there are steps managers can take, say infection control experts. Consider these suggestions:You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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