Much attention has been paid to improving safety of inpatient care, but for outpatient care, conditions have not been as rigorously policed, according to guidelines issued Wednesday by the Centers for Disease Control and Prevention. Even safe injection practices cannot be taken for granted.
The evidence-based guidelines and checklist are designed to help educate clinicians about minimum expectations for safe care to prevent errors and protect patients, especially since procedures are even more frequently being performed in ambulatory settings rather than inside hospitals, the CDC said in a statement.
"Patients deserve the same basic levels of protection in a hospital or any other health care setting," said Michael Bell, deputy director of CDC's Division of Healthcare Quality Promotion.
Ambulatory care settings traditionally lack the infrastructure and resources to prevent and track infections, and data describing risks for healthcare associated infections are lacking, the CDC said.
Nevertheless, increasing numbers of reports describe transmission of gram-negative and gram-positive bacteria, mycobacteria, viruses and parasites in healthcare environments where patients do not spend the night.
"In many instances, outbreaks and other adverse events were associated with breakdowns in basic infection prevention procedures (e.g., reuse of syringes leading to transmission of bloodborne viruses)," the CDC said.
Among its recommendations, the guide calls for outpatient practices to ensure that at least one individual with specific training in infection control is on staff or regularly available and that this person should help develop an infection control policy that is in writing.
A qualified infection control specialist should "have regular communication with healthcare providers to address specific issues or concerns."
This individual should be involved in developing a written infection control policy and have regular communication with health care providers to address specific issues or concerns.
Many of the guidelines sound basic, such as a recommendation that the outpatient setting assure sufficient supplies to adhere to hand hygiene protocols and personal protective equipment, and should provide infection prevention education and training to all healthcare providers.
But the CDC's document goes into more detail with the topic of injection safety, calling for more attention to increasing the percentages of people receiving vaccinations against hepatitis B and implementation of safety devices designed to reduce the risks of injuries from needlesticks is needed.
"Further attention to patient protection is also needed as evidenced by continued outbreaks in ambulatory settings resulting from unsafe injection practices" that have led to patient harm including:
- Use of a single syringe with or without the same needle, to administer medication to multiple patients,
- Reinsertion of a used syringe, with or without the same needle, into a medication vial or solution container (e.g., saline bag) to obtain additional medication for a single patient and then using that vial or solution container for subsequent patients and
- Preparation of medications in close proximity to contaminated supplies or equipment."
Also detailed in the new guideline is a lengthy list of recommendations for proper environmental cleaning and disinfection.
"Emphasis for cleaning and disinfection should be placed on surfaces that are most likely to become contaminated with pathogens, including those in close proximity to the patient (e.g. bedrails) and frequently-touched surfaces in the patient-care environment (e.g. doorknobs)," the CDC said.
"Disinfectant products should not be used as cleaners unless the label indicates the product is suitable for such use."
The CDC recommends guidelines for cleaning medical equipment, such as endoscopes, which can lead to life-threatening infections if improperly decontaminated.
The CDC said in its new guidelines that healthcare personnel should always:
- Follow procedures for the safe handling of potentially contaminated medical equipment
- Ensure safe medical injection practices are followed
It also said that outpatient facilities and practices should:
- Develop and maintain infection prevention and occupational health programs
- Ensure that at least one individual with training in infection control is employed by or regularly available to the facility. This person should be responsible for overseeing the facility's infection prevention program
- Develop written infection-prevention policies and procedures appropriate for the services provided by the facility and based upon evidence-based guidelines, regulations, or standards
- Provide job- or task-specific infection prevention education and training to all health care personnel
- Make sure sufficient and appropriate supplies necessary for adherence to standard precautions are available
- Perform regular audits and competency evaluations of staff's adherence to infection prevention practices
- Utilize CDC's infection prevention checklist for outpatient settings to assess infection control practices
- Adhere to local, state, and federal requirements regarding HAI surveillance, reportable diseases, and outbreak reporting