June 9, 2010

Outpatient Centers Have Issues With Infection Control

A new federal study has discovered that many same-day surgery centers have serious problems with infection control.

The report said that people failed to wash hands, wear gloves or provide clean blood glucose meters.  Clinics reused devices meant for one person or dipped into single-dose medicine vials for multiple patients.

Experts said the findings, appearing in Wednesday's Journal of the American Medical Association, suggest lax infection practices may pervade the nation's over 5,000 outpatient centers.

"These are basic fundamentals of infection control, things like cleaning your hands, cleaning surfaces in patient care areas," said lead author Dr. Melissa Schaefer of the Centers for Disease Control and Prevention. "It's all surprising and somewhat disappointing."

A hepatitis C outbreak in Las Vegas sparked the study, which was caused by unsafe injection practices at two now-closed clinics.

This was the first push to more vigorously inspect U.S. outpatient centers, which is a growing segment of the health care system that performs over 6 million procedures and collects $3 billion from Medicare.  Procedures performed at these centers include exams of the esophagus, colonoscopies and plastic surgery.

Kathleen Sebelius, U.S. Health and Human Services Secretary, said in a statement that her department is expanding its hospital infection control action plan to include ambulatory surgical centers and dialysis centers.

State inspectors visited 68 centers in Maryland, North Carolina and Oklahoma for the study.  The inspectors followed at least one patient through an entire stay at each site.  Inspections were not announced ahead of time, but staffs were notified once inspectors arrived.

The study found 67 percent of the centers had at least one lapse in infection control and 57 percent were cited for deficiencies.  The study did not look at whether any of the lapses actually led to infections in patients.

"These people knew they were under observation, had the opportunity to be on their best behavior and yet these lapses were still identified, some of which potentially are very dangerous and have been warned against explicitly," Dr. Philip Barie of Weill Cornell Medical College in New York told The Associated Press (AP).  Barie was not involved in the study but wrote an accompanying editorial in the journal.

A few of the centers in the study had not been inspected in 12 years.  State agencies have the main responsibility for making sure centers comply with federal standards.  However, states often get behind.

Officials notified 63,000 patients in the Nevada outbreak that might have been exposed to blood-borne diseases.  Nine cases of hepatitis C were linked to the clinics, as well as over 100 other cases that may also be related.

States are now required to use a new audit tool that focuses on infection control.  Sixty one percent of the centers surveyed have been cited for an infection control deficiency.

The new findings will cause centers to "redouble our efforts to improve patient care," Dr. David Shapiro of the Ambulatory Surgery Center Association, a trade group, told AP. "Any incident is one too many."


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