Healthcare-associated infections (HAI) lead to added costs, lengthier hospital stays and are a major cause of both mortality and morbidity. According to a survey conducted by the U.S. Centers for Disease Control and Prevention, about one in 25 acute-care hospital patients develops at least a single HAI. An estimated 722,000 HAIs occurred in acute-care hospitals in the U.S. in 2011 alone. HAIs also harm more than just patients. Without a successful infection control strategy, HAI’s can lower an ASC’s revenue, tarnish its reputation and invite regulatory scrutiny. ASC staff, like hospital and clinic staff, must implement effective measures to prevent the spread of disease during daily routines. In the past several decades, the healthcare industry has seen a major shift in treatment delivery: care that was once served at acute, inpatient hospitals is now given at ambulatory-based settings. As of 2010, over three-quarters of all U.S.-based operations are performed at an outpatient setting. It’s imperative that such care is provided under conditions that minimize risks of HAI. To develop a successful infection control program, ASC staff must be aware of the fundamentals of disease and infection control, as well as the following components of an effective prevention plan:

Sterile processing and instrument care

Infection control policies should include specific procedures for immediate-use sterilization and high-level disinfection. A policy’s instrument care section should include processes for inspection and maintenance of all surgical tools. In light of the recent discovery that certain scopes harbor dangerous bacteria, industry best practices should be used to verify the cleanliness of facility scopes. There are many different products that can be used to verify cleanliness. ASC policies should be specific about facility product, procedures and documentation requirements.

Communicable disease control

This section of an infection control policy contains guidelines on treating patients who may carry illness into facilities. Furthermore, it also addresses employees and their immunity status with regards to some of the most common communicable diseases that can be found in healthcare settings, such as hepatitis and varicella.

Housekeeping and janitorial services

Processes around facility cleanliness and sanitation are contained in this section of infection control plans. Plans should include procedures for cleaning operating rooms between cases, as well as end-of-day terminal cleaning. For an infection control program to be effective, ASCs must ensure the safety of housekeeping staff. Janitorial staff should be up-to-date on Occupational Safety and Health Administration compliance standards and taught Personal Protective Equipment usage criteria. The housekeeping staff should also be immunized against and educated about the pathogens they may encounter while on the job.

Prevention

Surgical site infection (SSI) and the spread of communicable disease can be stopped with preventative procedures and protocols. Hand-washing should be a major focus of any infection control program. There should be monitoring, education for staff and patients, and sanitary products available. Policies should reflect facility hand-washing protocols and educational efforts. Pre-surgical antibiotics and their administration should also be included in a center’s infection control plan. The CDC maintains specific measures to help prevent SSIs.  Each of these measures should be included in a facility’s SSI prevention policy. The CDC recommends the following guidelines:

  • Prophylactic antibiotics should be initiated within one hour before surgical incision, or within two hours if the patient is receiving vancomycin or fluoroquinolones.
  • Patients should receive prophylactic antibiotics appropriate for their specific procedure.
  • Prophylactic antibiotics should be discontinued within 24 hours of surgery completion (within 48 hours for cardiothoracic surgery).
  • Surgical site hair removal should be appropriate for the location and procedure (e.g., clippers, depilation, no hair removal).
  • Patients undergoing colorectal surgery should be normothermic (96.8 degrees Fahrenheit [36 degrees Celsius] or greater) within the first 15 minutes after leaving the operating room.

Monitoring and reporting

Tracking HAIs is a challenging task. Patient encounters are often brief, and treatment of infections developed at one care center frequently involves treatment at a different facility. Regular facility-wide audits of infection prevention practices can serve as an assessment of personnel adherence to both state and regional regulations. Each section of an infection control program must fit the unique needs of the facility and population being served. While there are similarities between infection control programs, there is no one-size-fits-all plan or program. Program development should be based on known standards and customized accordingly. Efforts to prevent the spread of infections are successful when infection control programs are thorough and all ASC staff members are involved in carrying out facility plans. For more information about HAIs and ASC infection control programs, please contact amingus@regentsurgicalhealth.com.