Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop A-31, Atlanta, GA 30333, USA.
More than 5000 ambulatory surgical centers (ASCs) in the United States participate in the Medicare program. Little is known about infection control practices in ASCs. The Centers for Medicare & Medicaid Services (CMS) piloted an infection control audit tool in a sample of ASC inspections to assess facility adherence to recommended practices.
To describe infection control practices in a sample of ASCs.
All State Survey Agencies were invited to participate. Seven states volunteered; 3 were selected based on geographic dispersion, number of ASCs each state committed to inspect, and relative cost per inspection. A stratified random sample of ASCs was selected from each state. Sample size was based on the number of inspections each state estimated it could complete between June and October 2008. Sixty-eight ASCs were assessed; 32 in Maryland, 16 in North Carolina, and 20 in Oklahoma. Surveyors from CMS, trained in use of the audit tool, assessed compliance with specific infection control practices. Assessments focused on 5 areas of infection control: hand hygiene, injection safety and medication handling, equipment reprocessing, environmental cleaning, and handling of blood glucose monitoring equipment.
Proportion of facilities with lapses in each infection control category.
Overall, 46 of 68 ASCs (67.6%; 95% confidence interval [CI], 55.9%-77.9%) had at least 1 lapse in infection control; 12 of 68 ASCs (17.6%; 95% CI, 9.9%-28.1%) had lapses identified in 3 or more of the 5 infection control categories. Common lapses included using single-dose medication vials for more than 1 patient (18/64; 28.1%; 95% CI, 18.2%-40.0%), failing to adhere to recommended practices regarding reprocessing of equipment (19/67; 28.4%; 95% CI, 18.6%-40.0%), and lapses in handling of blood glucose monitoring equipment (25/54; 46.3%; 95% CI, 33.4%-59.6%).
Among a sample of US ASCs in 3 states, lapses in infection control were common.
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[Show abstract][Hide abstract]ABSTRACT: Recently, multiple regulations and recommendations for safe infection control practices and safe injection and medication vial utilization have been implemented. These include single dose and multi-dose vials for a single patient and regulations. It is a well known fact that transmission of bloodborne pathogens during health care procedures continues to occur because of the use of unsafe and improper injection, infusion, and medication administration. Multiple case reports have been published illustrating the occurrence of infections in interventional pain management and other minor techniques because of lack of safe injection practices, and noncompliance with other precautions. However, there are no studies or case reports illustrating the transmission of infection due to the use of single dose vials in multiple patients when appropriate precautions are observed. Similarly, the preparation standards for simple procedures such as medial branch blocks or transforaminal epidurals have not been proven to be essential. Further, the effectiveness or necessity of surgical face masks and hats, etc., for interventional techniques has not been proven.
To assess the rates of infection in patients undergoing interventional techniques.
A prospective, non-randomized study of patients undergoing interventional techniques from May 2008 to December 2009.
An interventional pain management practice, a specialty referral center, a private practice setting in the United States.
All patients presenting for interventional techniques from May 2008 to December 2009 are included with documentation of various complications related to interventional techniques including infection.
May 2008 to December 2009 a total of 3,179 patients underwent 12,000 encounters with 18,472 procedures. A total of 12 patients reported suspicion of infection. All of them were evaluated by a physician and only one of them was a superficial infection due to the patient's poor hygienic practices which required no antibiotic therapy.
Limitations include the nonrandomized observational nature of the study.
There were no infections of any significance noted in approximately 3,200 patients with over 18,000 procedures performed during a 20-month period in an ambulatory surgery center utilizing simple precautions for clean procedures with the use of single dose vials for multiple patients and using safe injection practices.
[Show abstract][Hide abstract]ABSTRACT: The paper describes the application of the predetermined interaction list octree (PILOT) algorithm in expediting the solution of full-wave electric field integral equation (EFIE) based scattering problems for 3D arbitrarily shaped conductors. PILOT combines features of the fast multipole method (FMM) and QR decomposition-based matrix compression techniques to optimize setup times, solve times, and memory requirements. A quantitative study is also included to address the expected, but gradual, degradation of QR-based compression techniques for electrically large structures.
[Show abstract][Hide abstract]ABSTRACT: Since the establishment of the first ambulatory surgical centers (ASCs) in 1970, the number of these facilities and the volume of procedures physicians perform in them have increased substantially. In parallel, during this time, there has been a marked shift to the outpatient setting for many common, low-risk operations that do not require hospitalization or a postoperative stay of more than 24 hours. Since 1991, according to the Ambulatory Surgery Center Association, more surgical procedures have been performed in the outpatient than the inpatient setting in the United States, and outpatient procedures now represent more than three-quarters of all operations performed.1 Putative advantages of ASCs include more convenient scheduling, increased patient and surgeon satisfaction, and lower costs.1
No preview · Article · Jun 2010 · JAMA The Journal of the American Medical Association