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Federal infection laws on horizon for clinics
Broad-based coalition begins needle safety campaign
In a move that may clear the way for federal legislation aimed at preventing outbreaks of bloodborne diseases in ambulatory care, a broad-based coalition of patient safety advocates and health care groups has launched a national education campaign on needle safety.
Adding political clout is Majority Leader Harry Reid (D-NV), who represents the state where some 50,000 people were urged to be tested for hepatitis and HIV after undergoing treatment at an endoscopy clinic in Las Vegas. Indeed, plans call for the campaign to start in Nevada and then look to expand nationally, using the highly publicized Vegas outbreak as a springboard for broader educational and legislative action.
The "One & Only Campaign" will focus on the recurrent theme of the outbreaks — reuse of syringes and contaminated medication vials — by educating health care providers and patients about standard injection safety practices that ensure patient safety.
"Basically, the tenet is one needle, one syringe, and one time," says campaign co-chair Evelyn McKnight, who founded the group HONOReform after being infected with hepatitis C virus in an outpatient cancer center in Nebraska in 2000. "[Reid] is very interested in securing funds to go the CDC to move forward this national education campaign. We're developing a training video, handouts, and we will have a web site."
Though McKnight has every reason to be outraged about acquiring HCV while seeking treatment for cancer, she sees the ongoing outbreaks as primarily an education problem that can and must be addressed.
"Of course, there are also some bad actors driven by greed or indifference; but for the most part, the providers are not thinking through the process," she says. "They feel safe once they have switched out the needle but they are not thinking of the downstream consequences of the syringe being contaminated."
The education campaign is expected to set the stage for federal legislation toughening regulatory oversight of infection prevention in ambulatory care offices and clinics, McKnight tells Hospital Infection Control & Prevention.
"That is a separate [campaign] involving our patient advocacy, nonprofit [branch]," she says. "We have been meeting since November and thinking about putting together a piece of legislation that would go toward preventing these types of outbreaks. There are lots of different pieces and lots of different ways of looking at this, so we are still in the process of picking out two or three things that are priorities. We can't change the world all at once."
Oversight hindered by IP shortage
Among the proposals under discussion is a federal bill requiring oversight of ambulatory clinics by infection preventionists and/or accrediting organizations such as The Joint Commission. "We have to vet that to see if that would be in a federal purview or if we have to take that in a state-by-state march," she says. "The number of outpatient procedures has grown exponentially. We need more oversight of these clinics."
As this issue went to press, The Joint Commission was meeting with the Nevada legislature about expanding its role in the state and had already agreed to report any infection control deficiencies it uncovers to public health officials. The problem is that many freestanding clinics do not have Joint Commission accreditation, a situation that may be subject to change as the negotiations progress. The idea of enlisting IPs into oversight roles has been discussed by state lawmakers in Nevada as well, but there is one compelling snag: There is a shortage of IPs.
"It's a resource and work force issue," says Marion Kainer, MD, MPH, FRACP, medical epidemiologist and director of the hospital infections and antimicrobial resistance program at the Tennessee Department of Health in Nashville. "We have a shortage of infection preventionists. I think these areas would all benefit from having infection preventionists' [oversight]. I know that these are tough times and resources are limited, but this is basic patient safety. I am sure people would not mind spending an extra two dollars a visit if they could be assured that the most basic infection control measures are taken care of."
While very involved in the issue, Kainer is not a member of the education campaign. Some kind of continuing education credits in infection control for all health care providers also could be part of the solution, she says. More funding for health departments to conduct more aggressive investigations and follow-up on single cases certainly would help define the magnitude of the problem and help interrupt subsequent transmission, Kainer adds. "Ideally, we would like to have more staff to follow up on these and ask questions in greater detail," she says. "I think most health care departments would — it is totally resource-dependent."
Though it cannot be part of any legislative initiative, the Centers for Control and Prevention will be a key partner in the education campaign through its advocacy group the CDC Foundation. Indeed, campaign materials specifically point to a recently published CDC review article that documents 33 outbreaks of viral hepatitis in nonhospital health care settings over the last decade.1
"There is something lacking in terms of pre-service education," says Joseph Perz, PhD, a co-author of the study and acting team leader for prevention in the CDC's division of health care quality promotion. "The basic understanding of how pathogens like HCV virus are transmitted is lacking among many providers. Basic aseptic technique and related concepts are perhaps not being taught or emphasized, as they need to be. Really, an emphasis on just basic infection control may have been lost in the process of trying to educate [workers] about increasingly complex health care delivery."
As a result, the education campaign includes a set of training materials designed to remind health care workers that syringes must be used one time only. It also will produce a set of patient-focused materials designed to empower patients, helping erect another layer of protection.
"While providers ultimately must be held responsible for following all safety standards, we want patients to feel empowered and able to speak up if they have a concern," says Charlie Stokes, CEO/president of the CDC Foundation and campaign co-chairman.
Attacking the problem from both the patient and provider angle fits the "wide net" approach many see as the only solution to the problem.
"It's going to take a comprehensive approach," says Nicole Thompson, PhD, MS, lead author of the CDC study and an epidemiologist in the division of viral hepatitis. "It's not going to be one thing that is going to prevent these outbreaks from occurring. There is a need for better and more enhanced hepatitis surveillance and case investigation. There needs to be improved professional oversight, better licensing and more uniform regulations over these facilities."
In addition to the aforementioned groups, the education campaign is funded by multiple partners, including the Accreditation Association for Ambulatory Health Care, American Association of Nurse Anesthetists, Ambulatory Surgery Foundation, Association for Professionals in Infection Control and Epidemiology Inc., BD (Becton Dickinson & Co.), Nebraska Medical Association (NMA) and the Nevada State Medical Association (NSMA).