June 8, 2010 -- Lapses in procedures aimed at fighting infections are common in ambulatory surgical centers, a study shows. The lapses include safe hygiene methods and improper handling of medications and equipment.
The study by the CDC is published in the June 9 issue of The Journal of the American Medical Association.
Researchers say they found at least one lapse in infection control practices in 46 of 68 ambulatory surgical centers studied, endangering patients.
The surgical centers examined were located in three states: Maryland, North Carolina, and Oklahoma. The types of procedures performed at these centers included dental, endoscopy, gynecology, ophthalmology, orthopaedics, otolaryngology, pain, plastic surgery, and podiatry.
Practices in which lapses in infection control were detected included hand hygiene, injection safety, medication handling safety, equipment reprocessing, environmental cleaning, and handling of blood sugar monitoring equipment.
Among other problems found in the study:
- 6% of facilities inappropriately reprocessed and used items that were packaged and labeled as single-use devices.
- 21% of facilities used a single lancing penlet device for multiple patients in blood glucose testing.
- 28% of facilities used medications in single-dose vials for multiple patients.
- 32% of facilities performing blood glucose testing failed to clean and disinfect the blood glucose meter after each use.
In an accompanying editorial, Philip S. Barie, MD, MBA, of New York-Presbyterian Hospital/Weil Cornell Medical Center, writes that such lapses cannot be tolerated and that problems must be corrected to avoid putting millions of patients at risk for health care-associated infections.
According to background information in the CDC study, ambulatory surgical centers are facilities that operate exclusively to provide surgical services to patients who do not require hospitalization or admission to such facilities lasting longer than 24 hours.
Between 2001 and 2008, researchers say there was a 50% increase in the number of Medicare-certified ambulatory surgical centers, called ASCs, in the U.S., along with a significant rise in problems related to hygiene and safety health procedures.
More than 5,000 ASCs participate in the Medicare program; CDC researchers say that in 2007 more than 6 million procedures were performed in these centers, with services extending beyond what is traditionally considered surgery.
The CDC's Melissa K. Schaefer, MD, and colleagues conducted a study to determine compliance with basic infection control practices, as well as with other Medicare health and safety standards.
They found that:
- 19.4% of facilities had problems with proper hand hygiene or appropriate use of personal protective equipment, such as gloves.
- 28.4% failed to adhere to recommended practices regarding reprocessing of surgical equipment.
- 18.8% did not clean high-touch surfaces in patient care areas appropriately.
In addition, the researchers also say they found that 39 of 68 ASCs, or 57.4%, were ultimately cited for deficiencies in infection control, and 20 of 68, or 29.4%, of centers were cited for deficiencies related to medical administration, including use of single-dose medications for multiple patients.
The researchers say the findings mean infection control practice measures should be improved and that the ASCs must play a more active role. Public health agencies at the state and federal levels, the researchers say, must work closely with the surgical centers to improve infection control practices.
Barie writes in his accompanying editorial that the study's findings suggest infection control mistakes may be pervasive.
If that is the case, "then among the estimated six million patients who undergo procedures in ASCs annually in the United States, it is possible that several million patients could be at potential risk for health care-associated infection each year," Barie writes.
"This risk is not acceptable and must be corrected immediately and definitively," he writes. "Federal regulatory intervention is already occurring. Ambulatory surgical centers must now maintain infection control programs directed by a designated health care professional with training in infection control, and audited adherence will be conducted through a modified infection control tool."