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Response to infections: Hire an overseer
Source: Give them time to learn job and do it
Several incidents of infection control breaches have been reported in recent months among ambulatory surgery providers:
In New Jersey, more than half of the ambulatory surgery centers (ASCs) inspected in the past two years failed to meet federal safety standards, according to a media report.1 One state quality official described the results as "alarming." One surgery center didn't properly clean scopes between colonoscopies, according to the media report. Another didn't fully sterilize equipment, it said. Inspectors found staff walking through sterile operating rooms in street clothes, improperly sanitized patient beds, single-use items being used for more than one patient, and expired medications. At one center, staff failed to change the water and refill the sink with fresh cleaning solution between scope procedures. Now lawmakers are looking at passing bills that would require one-room centers to be inspected, as well as certified or accredited. The state health department is proposing the same. (See response from New Jersey ambulatory surgery association, box, below.)
A review of two Veterans Administration (VA) hospitals found staff needed more training to protect themselves and patients from infectious diseases, according to a news report.2 Of 37 staff training records that were inspected, only five had received annual education on fighting multidrug-resistant organisms and on safety practices related to bloodborne pathogens, the report said. The company that runs the hospitals responded that employees had received the training, but it was not the computer-based program required by the VA. The company has made that training part of annual performance reviews. This report follows earlier reports of improper hygiene practices at VA hospitals that resulted in testing that found eight HIV-positive patients and 61 confirmed cases of hepatitis B or C.3 Those cases have not been confirmed to have resulted from treatment at VA hospitals.
How do such problems happen? Often at surgery centers, there is person whose sole responsibility is to handle infection control, says Marcia Patrick, RN, MSN, CIC, director, of infection prevention and control at MultiCare Health System in Tacoma, WA, and board member of the Association for Professionals in Infection Control and Epidemiology (APIC).
"What we're seeing is the result of years of neglect," Patrick says. Even where there is oversight, surveyors don't always know what details to look for, such as making sure the autoclave is maintained and works, she says. "It really goes back to having someone responsible for this," she says. "That's what CMS [Centers for Medicare and Medicaid Services] guidelines call for, and that is what APIC has always promulgated." According to CMS, the person should be a licensed MD, RN, or LPN, Patrick says. This infection preventionist needs to perform risk assessments, as well as ensuring staff are "simply cleaning their hands between patients," Patrick maintains.
Blaming infection control problems on a staff member who has had no training, who doesn't understand nuances of infection control and the needs of the facility, and not giving them time to learn the job and do it, will help the facility, she says. You can't simply tell a nurse, "This is your job in addition to your patient care job, and we're not giving you time to do it," and expect to pass inspections, Patrick says. (See Resources, below, for training opportunities.)
"If you don't have trained people who know infection control, who know about processing instruments properly, cleaning hands, and cleaning the environment properly, it puts patients at risk," Patrick says. "I think we're hitting the tip of the iceberg in ambulatory care."
New Jersey group responds to ASC critics
In response to reports that more than half of the ambulatory surgery centers (ASCs) in New Jersey inspected in the past two years failed to meet federal safety standards, the New Jersey Association of Ambulatory Surgery Centers (NJAASC) responded that all surgery centers and other healthcare providers in that state "operate within a rigid regulatory environment."1
"While any violation is important and must be immediately addressed, most of those cited in the Health Care Quality Institute's report were incidental infractions and, in any case, the vast majority of all violations were corrected promptly," the association said. Additionally, in almost all cases, there were no adverse outcome, it said.
In response to legislative reforms being discussed, the association pointed out that one-room surgery centers cannot be licensed under current state law. "It's a legislative matter the NJAASC is working to address, and the association would certainly welcome more frequent inspections," it said.
In a letter to the editor of a newspaper, Larry Trenk, the president of NJAASC said, "As the association that represents ASCs across the state, we are treating these allegations very seriously because even one incident that jeopardizes patient safety is one incident too many. However, we want to reassure both state regulators and patients that proper safety protocols are in place and that our centers adhere to current state laws."2