Doctor's Office Is Source of Many Infections

Doctor's Office Is Source of Many Infections

By Crystal Phend, Senior Staff Writer, MedPage TodayPublished: July 15, 2011

Physician offices need to up their game to meet basic infection control standards, according to the CDC.

Safe injection practices, good hand hygiene, and a trained infection prevention leader should be standard at every ambulatory care center, the public health agency urged in guidelines for the outpatient setting.

Repeated infectious outbreaks and breaches uncovered by Centers for Medicare and Medicaid inspections suggest there's plenty of room for improvement, Michael Bell, MD, deputy director of CDC's Division of Healthcare Quality Promotion, pointed out in a press release.
"Patients deserve the same basic levels of protection in a hospital or any other healthcare setting," he said. "Failure to follow standard precautions, such as correct injection practices, cannot be tolerated."

One of the investigations -- at an endoscopy clinic in Nevada -- showed that clinicians not only contaminated vials of propofol by double-dipping to draw additional doses during procedures but then reused those single-dose vials on other patients, noted Melissa Schaefer, MD, of the same CDC division.

This unsafe practice put more than 40,000 patients at risk of a blood-borne virus, with hepatitis C virus transmission to at least seven patients on two separate days, she said in an invited expert commentary posted online.

Ambulatory practices often don't have the same infrastructure or resources to devote to infection control, but they have taken on a greater share of healthcare delivery over the past several decades, the CDC guide pointed out.

The recommendations in the document held no surprises, largely rehashing existing CDC and related federal advisory committee guidelines. They include:
Ensure that at least one individual with infection prevention training is employed by or regularly available to the facility.

Go beyond Occupational Safety and Health Administration (OSHA) requirements for blood-borne pathogen training for infection prevention programs.
Develop practice-appropriate written infection-prevention policies and procedures based on evidence-based guidelines, regulations, or standards.

Provide job- or task-specific infection prevention education and training to all healthcare personnel, including volunteers and those employed by outside agencies, at orientation and annually or on a regular basis.

Follow procedures for the safe handling of potentially contaminated medical equipment and for the use of personal protective equipment (such as gloves, gowns, and face masks).
Make sure sufficient and appropriate supplies necessary for adherence to standard precautions are available.

Regularly audit staff adherence and competency on infection prevention practices.
Use the CDC infection prevention checklist.

Adhere to local, state, and federal requirements regarding healthcare-associated infection surveillance, reportable diseases, and outbreak reporting.
Aside from uses to protect healthcare professionals from bodily fluids, face masks should be worn to protect patients when placing a catheter or doing injections into the epidural or subdural spaces, including for epidural anesthesia and myelography.
Ignoring that advice has resulted in some patients developing bacterial meningitis, the CDC warned.

Regarding hand hygiene, the CDC reiterated that alcohol-based hand sanitizers remain the preferred method unless hands are visibly dirty or after caring for patients with or suspected of having infectious diarrhea.

Surfaces in the medical office need attention, too, the agency noted.
The emphasis should be on cleaning and disinfecting frequently contaminated objects, such as bed rails and other surfaces in close proximity to the patient, and frequently-touched surfaces, like doorknobs.

For medical equipment, the recommendations were:
Sterilization prior to use for surgical instruments and other tools that enter sterile tissue or the vascular system.

Sterilization or at least high-level disinfection for items like endoscopes that contact mucous membranes or breaks in the skin.

Clean away debris before disinfection or sterilization.
Practices should have policies in place for how to quickly address spills of blood or other potentially infectious materials, the CDC added.

Primary source: Centers for Disease ControlSource reference:
"Guide to infection prevention for outpatient settings: Minimum expectations for safe care" CDC 2011.