HHS turning to outpatient, long-term care next
GAO already investigating ambulatory HAIs
Having cast a cold eye on hospitals, the U.S. Department of Health and Human Services (HHS) will next develop plans to improve infection prevention in ambulatory settings and long-term care, Hospital Infection Control & Prevention has learned.
The HHS "Action Plan to Prevent Healthcare-Associated Infections" focuses solely on hospitals, but that will change as federal health officials continue to target HAIs, says Don Wright, MD, MPH, principal deputy assistant secretary for health at the HHS.1
"We plan to continue our activities to reduce health care-associated infections and we will be looking in the future both at ambulatory care sites as well as long-term care facilities, " he tells HIC.
The HHS plan emphasizes that HAIs occur in all settings of care, including acute care within hospitals and same-day surgical centers, ambulatory outpatient care in health care clinics, and in long-term care facilities, such as nursing homes and rehabilitation facilities
"I realized that we needed to take a tiered approach," Wright says. "This is a very large issue. In tier one, which was what was just released, we limited the scope of to hospitals."
In a significant related development, the Government Accountability Office (GAO) — which spurred the HHS action after issuing a highly critical report last year on HAIs — now is taking on the issue of infection control in ambulatory care settings.
In the considerable wake of the hepatitis C outbreak at a Las Vegas endoscope center, the GAO will conduct a study to determine what role the facilities play in the spread of HAIs. Infection preventionists have long warned that freestanding clinics and medical offices may have little infection prevention training and less oversight. The Nevada outbreak led to the largest look-back study in medical history, with some 50,000 patients urged to be tested for HIV and other bloodborne infections that could have been transmitted by improper needle practices.
"[Our primary] research objective is to find out the extent to which data are available about the frequency and characteristics of HAIs in ambulatory surgical centers," says Cynthia Bascetta, MA, MPH, director of health care for the GAO.
The GAO will report its findings to Rep. Henry Waxman (D-CA), who has been spearheading Congressional investigations into HAIs. In addition, political officials in Nevada asked the agency to look into the issue after the Las Vegas HCV outbreak. "We don't do specific investigations of particular locations, but we told them we will find out what is known about HAls in these settings," she says. "The CDC does these outbreak investigations, but by definition they are not nationally representative."
Bascetta concedes the GAO will likely find what is well known in the infection prevention community: infections in ambulatory care are rarely reported unless they occur in the context of an outbreak that spurs a public health investigation.
"The likelihood of us finding any systematic [surveillance system] is pretty remote, and we already know that," she says. After this necessary first step, the GAO will consider options and recommendations, but it is too early to say whether heightened oversight of outpatient settings will be the result.
"I don't think we're at that point," she says. "If we don't know what the extent of the problem is yet, I think we would be looking at a more preliminary step than making specific recommendations. "
Reference
- U.S. Department of Health and Human Services. Action Plan to Prevent Healthcare-Associated Infections. 2009; Washington, DC. Available at: http://www.hhs.gov/ophs.
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