Part I: Infection Prevention
Ambulatory surgery centers, office practices, hospital- based ambulatory services, and other services that may be a part of a hospital's network or may be completely independent, must meet the same infection prevention practices as hospitals. What does this mean to you? Think about hand hygiene, cleaning between patients, appropriate precautions, proper attire, cleaning, disinfection and sterilization of instruments, processing instruments, managing infectious waste, and the list goes on.
Here are tips for success
Regardless of the accrediting organization you use, the principles are the same and the care provided in ambulatory sites must meet the same requirements.
Point # 1:
WASH YOUR HANDS BEFORE AND AFTER SEEING PATIENTS. The single most important way to prevent infection is also the simplest. Don't think for a minute that surveyors are the only ones watching this, your patients are very aware as well. Involve your patients by asking if they have observed staff performing hand hygiene.
Point # 2
: EDUCATE EVERYONE THAT RESISTANT ORGANISMS ARE EVERYWHERE. We know that resistant organisms are also found in the community and patients may be carriers. It is critical that patient areas and equipment are cleaned with appropriate germicides between patients. That isn't just the exam table. Remember the stethoscopes and other equipment that touch the patient and also clean them with the appropriate germicidals.
Point # 3: PERFORM CLEANING, DISINFECTION AND STERILIZATION
. When sterile instruments are needed for patients, wipe them down immediately, apply enzymatic to keep moist, reapply as needed to keep them moist with a manufacturer approved solution to prevent drying of bioburden. Instruments must be contained and transported as biohazardous to prepare them for cleaning, disinfection and sterilization for reuse. The biohazard label also prevents potential adverse outcomes for both patients and staff.
Point # 4: USE STANDARD PRECAUTIONS.
WHEN? . . . Every patient - Every day, use standard precautions. If there is a concern that a patient may have something that might be contagious, isolate as quickly as possible. Preventing further potential exposure to others is the best approach until you can rule out infectious potential.
Point # 5: FOLLOW MANUFACTURER INSTRUCTIONS FOR USE (IFUs).
Too often we lose sight of this important tip. It is critical for the care of our equipment, instruments and cleaning solutions. Post IFUs to make sure staff are aware and assure their competence at least annually.
Avoid Ambulatory Survey Findings
Remember that all accreditation requirements are based in Centers for Medicare and Medicaid (CMS) standards. Infection prevention has many facets to the process which can lead to a variety of requirements for improvements (RFIs) and organizations should trace frequently to assure compliance. Below are some of the most frequent RFIs:
- Failure to perform low-level, high-level and sterilization per the IFUs
- Store equipment, supplies and other patient items incorrectly (not per policy)
- Use standard precautions inconsistently
- Lack of evidence-based guidelines to support procedures
- Failure to use transmission-based precautions, when appropriate
- Incomplete implementation of the infection prevention plan
- Inconsistent management of equipment and supplies
- Failure to assess infectious risk appropriate to your setting
- Deficient/incomplete documentation
Examples of TJC Survey Findings:
- Staff were observed leaving one patient room and entering another with no evidence of hand hygiene between patients
- Soiled instruments were not prepared in a manner that prevented instruments from drying out in ambulatory areas where instruments are frequently used, such as Dental Clinics, Surgical Clinics, Podiatry, Orthopedics, ENT and office practices
- Surgical instruments were not transported in a leak-proof, puncture-proof container
- Facility did not follow IFUs or evidence-based guidelines for instrument management
- Staff were not following organization's policy for managing soiled instruments
- Office practice was not following OSHA blood borne pathogen expectations to contain sharps during transport
- Soiled instruments received in sterile processing were dry and in a closed position
- Preventive maintenance on sterilizers does not follow IFUs
- Instruments released before biological indicator read
- Endoscopes were not wiped, flushed and inspected at point of use
- IFUs not followed for endoscope cleaning and storage
Stay Ahead of the Curve
Infection prevention is everyone's job! Look for areas, including outpatient areas, where procedures are performed and enlist staff's support in meeting IFUs and evidence-based practice guidelines for the risks in their areas. Always maintain awareness of the continuous need for standard precautions and be on the look out for situations requiring transmission-based precautions. Keep policies and procedures up to date and assure staff competence in carrying out IFUs. Impress surveyors with your implementation of infection prevention approaches and strategies that keep your patients safe in your ambulatory settings.