Infection control lapses at outpatient surgery centers

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© Holger Winkler/A.B./Corbis

Infection control is often inconsistent and ill-enforced at outpatient surgical centers, according to a new study conducted by researchers at the Centers for Disease Control and Prevention. For the study, researchers examined the results of inspections of 68 different ambulatory surgical centers in three different U.S. states between June and October 2008. In more than two thirds (67.6%) of the facilities that underwent inspection surveyors noted at least one lapse in infection control, and ultimately more than half (57.4%) were cited for gaps in infection prevention protocol.

The study, led by Dr. Melissa Schaefer and published this week in the Journal of the American Medical Association, focused on five specific aspects of infection control: safe handling of medication and injections, hand washing and routine use of gloves, equipment sterilization, cleaning high traffic areas and high-touch surfaces, and appropriate handling of blood sugar monitoring equipment. They found that while more than two thirds of the facilities included in the study broke with infection control protocol at least once, more than 17% had lapses in three or more of the infection control categories.

Of 62 facilities included in the study, nearly one in five (19.4%) got poor marks for hand hygiene, and nearly the same proportion (18.8%) fell down when it came to consistently cleaning commonly touched surfaces. Schaefer expressed her dismay at the findings to the Associated Press:

“These are basic fundamentals of infection control, things like cleaning your hands, cleaning surfaces in patient care areas… It’s all surprising and somewhat disappointing.”

In an editorial accompanying the study, Dr. Philip Barie, a professor of surgery at Weill Cornell Medical College, points out that given the growing trend toward outpatient surgical procedures — which now represent more than 75% of all operations performed in the U.S., he points out — as well as the increasing prevalence of outpatient surgical centers paint a grim portrait of the potential for increasingly lax infection control enforcement. With more than 5,000 outpatient surgery centers nationwide, Barie xtrapolates from the findings, which were based on ambulatory surgical centers in Maryland, North Carolina and Oklahoma, to suggest that:

“… among the estimated more than 6 million patients who undergo procedures in [ambulatory surgical centers] annually in the United States, it is possible that several million patients could be at potential risk for [hospital-acquired infections] each year. This risk is not acceptable and must be corrected immediately and definitively.”