ASC Infection Control Starts with Hand Hygiene. Home » ASC Infection Control Starts with Hand Hygiene. Strategies to Fully Implement Infection Control Practices in Pennsylvania Ambulatory Surgical Facilities. Sharon Bradley, RN, CICSenior Infection Prevention Analyst. Pennsylvania Patient Safety Authority ABSTRACT Pennsylvania ambulatory surgical facilities (ASFs) requested education on infection control practices and on the Centers for Medicare and Medicaid Services’ (CMS) Infection Control Surveyor Worksheet after CMS revised the ambulatory surgical centers interpretive guidelines in 2. Condition for Coverage. Review of events submitted by Pennsylvania ASFs to the Pennsylvania Patient Safety Reporting System (PA- PSRS) were combined with a survey of representatives of Pennsylvania ASFs at infection control workshops to focus on targeted strategies to fully implement infection control practices in ASFs. Strategies for ASFs to fully implement infection control practices focus on surveillance techniques, sterilization, disinfection, safe injections, standardized educational programs, and environmental control. Background. In 2. Centers for Disease Control and Prevention (CDC) initiated the One and Only Campaign to prevent unsafe injection practices that have impacted over 1. Among those partnering with CDC in this campaign are the Accreditation Association for Ambulatory Health Care, the Ambulatory Surgery Center Association, the Institute for Safe Medication Practices, and the New Jersey Department of Health. This campaign is a response to documentation of outbreaks of healthcare- associated infections (HAIs) and patient notification events by CDC1 and the United States Government Accountability Office. Patients have been exposed to viral and bacterial pathogens resulting in infectious outbreaks of life- threatening systemic and localized infections such as hepatitis, HIV, septicemia, meningitis, epidural abscesses, and joint infections. Outbreaks have been identified in virtually all healthcare settings, including ambulatory surgery centers (ASCs) and other ambulatory facilities such as pain clinics. In 2. 00. 8, the Centers for Medicare and Medicaid Services (CMS) assessed compliance with five categories of infection control in ASCs in three states, piloting the Infection Control Surveyor Worksheet developed by CDC based on nationally recognized guidelines. Of the 6. 8 ASCs inspected by CMS, 6. Surveyors found 1. In 2. 00. 9, CMS also revised the ASC interpretive guidelines, adding an infection control Condition for Coverage. Pennsylvania ambulatory surgical facilities (ASFs) have requested education on infection control practices and on the CMS Infection Control Surveyor Worksheet from the Pennsylvania Patient Safety Authority. In accordance with the Medical Care Availability and Reduction of Error Act,8,9 Pennsylvania medical facilities (defined as ambulatory surgical facilities,1. Incidents and Serious Events to the Authority through its Pennsylvania Patient Safety Reporting System (PA- PSRS), including HAIs that meet the definition of a Serious Event, breaks in sterile technique, and sterilization problems due to equipment, supplies, or devices. ASCs fall within the Pennsylvania classification of ASFs, along with other facilities such as pain clinics and endoscopy centers. Pennsylvania ASFs reported 7. March 2. 00. 4 through July 2. SSIs) and sterilization issues. As of July 2. 01. ASFs in Pennsylvania. Pennsylvania SSI Reports from ASFs. Healthcare- associated SSIs reported as a “complication of a procedure/treatment/test” by Pennsylvania ASFs accounted for 8. PA- PSRS. SSIs most commonly reported by ASFs included infections of the knee or shoulder joints, ankle or foot, eye, abdomen, or hand or wrist (see the Table for the most common surgical procedures related to these sites). Top Five Infection Sites for Surgical Site Infections (SSIs),as Reported to the Pennsylvania Patient Safety Authority,Occurring from March 2. July 2. 01. 2 ASFs reported positive cultures in 4. SSI event reports. Staphylococcus accounted for 5. Methicillin- resistant Staphylococcus aureus accounted for 2. Staphylococcus organisms reported. Treatment with antibiotics was the most frequent narrative notation. Thirty- six percent (n = 2. SSI required secondary medical procedures to treat the infection, and 2. Figure 1). Pennsylvania Ambulatory Surgical Facility Healthcare- Associated Surgical Site Infection (SSI) Report Characteristics, Occurring from March 2. July 2. 01. 2 (N = 6. Infection events reported by ASFs to the Authority included the following: After knee arthroscopic surgery, the patient developed pain, redness, and purulent drainage from the incision requiring hospital admission for surgery . Disinfection or sterilization events accounted for the majority of these events, followed by contamination of the sterile field, expired or recalled products, and breaks in sterile technique. More than 5. 0% of the errors reached the patient in each of the four event categories. New Infection Control Requirements for ASCs. In 416.51 Conditions for coverage—Infection control, an ASC must maintain an infection control program that minimizes infections and communicable diseases. Infection Control Program. Infection Control Program. ASC INFECTION CONTROL SURVEYOR WORKSHEET 1 of 15 Name of State Agency or AO (please specify). Does the ASC’s infection control program follow nationally recognized infection control guidelines? Leaders from the ambulatory surgery center (ASC) industry and associations with a focus on healthcare quality and safety have formed the ASC Quality Collaboration. Environmental Infection Prevention Toolkit. Perform a self-assessment using the same tool CMS surveyors use when evaluating environmental infection control practices in the ASC setting. Environmental Cleaning Audit Template. Introduction: Oregon Ambulatory Surgery Center Infection Prevention & Control Toolkit. The Oregon Ambulatory Surgery Center Infection Prevention & Control Toolkit is specifically designed to provide guidance on the development. Section 1: Infection Prevention Program Development. Assess compliance with infection control practices. Document infection prevention plan to assess ASC-specific infection prevention risks associated with the. Strategies for ASFs to implement infection control practices focus on surveillance techniques, sterilization, disinfection, safe injections, standardized educational programs, and environmental. Prevention Program Tools. 10 Most-Read Infection Control Articles. 6 steps to create & maintain an outstanding ASC infection control program. Bundle lowers SSI infection risk — 6 findings. Expired or recalled product events were most frequently associated with errors reaching the patients (see Figure 2). Pennsylvania Ambulatory Surgical Facility Sterilization Error Reports, Occurring from March 2. July 2. 01. 2Sterilization procedure and equipment events reported to the Authority included the following: The flush step in the sterilization process of cleaning colonoscopes was omitted. All staff were reeducated to the endoscopy cleaning process. The nurse noticed 2. It was noted that the antireflux valve was missing from the 2. At the end of the day, the technician collecting the autoclave sheets discovered that a set of instruments was put in the autoclave to be sterilized but for some reason the autoclave was not run. The instruments were removed from the autoclave unsterile and used for a patient. Pennsylvania ASF Infection Control Education and Practice Survey. As mentioned previously, Pennsylvania ASFs requested, through their Pennsylvania patient safety liaisons, education on methicillin- resistant Staphylococcus aureus (MRSA), general infection control practices, and the CMS Infection Control Surveyor Worksheet. Based on that request, the Authority presented a series of three regional workshops in 2. MRSA for ASFs and a Pennsylvania Patient Safety Advisory article on the prevention of MRSA in ASFs. The Authority followed in 2. SSIs and outbreaks, as well as to assist ASFs with preparation for their next CMS visits. The workshop covered the components of the CMS worksheet, including hand hygiene, safe injections, disinfection and sterilization, single- use devices, surveillance, environmental cleaning, and point- of- care devices. It also covered other infection control practices, such as standard and transmission- based precautions, operating room traffic, leadership and education, employee health, bloodborne pathogen and tuberculosis exposure control plans, and infection control risk assessments. The personnel that ASFs selected to attend the workshop included directors of nursing, patient safety officers, quality improvement staff, administrators, clinical managers, clinicians, and personnel responsible for infection prevention. In addition to assessing the workshop,1. The Authority then presented an infection control update and education about the CMS worksheet at the 2. Pennsylvania Ambulatory Surgery Association annual conference. The survey from the 2. The results of this survey and the review of sterilization and SSI reports in Pennsylvania ASFs became the basis for this article, which focuses on targeted strategies to fully implement infection control practices in ASFs. Strategies to Fully Implement Infection Control Practices in ASFs. CMS has defined specific infection control process measures, consistent with nationally recognized guidelines, both in its ASC Conditions for Coverage. Infection Control Surveyor Worksheet. Those strategies include the following: Implement surveillance techniques. Follow sterilization and disinfection standards. Integrate safe injection and point- of- care medical- device- use standards into clinical practice. Require standardized education and training requirements. Ensure strict environmental control practices. Surveillance As noted, over an eight- year period, ASFs in Pennsylvania reported 6. SSIs. Improvement in standardization of the surveillance process may facilitate recognition of SSI events and consistent reporting. CMS requires ASCs to have systems in place to follow up with all patients after discharge to identify, track, and document infections associated with their stay in the facility. Infections can be detected via ongoing data collection and analysis using nationally recognized guidelines to investigate, rule out, or classify SSIs. The US Department of Health and Human Services’ (HHS) chapter on ambulatory surgical centers in its National Action Plan to Prevent Healthcare- Associated Infections indicates there are currently no standardized surveillance definitions for many of the higher- volume procedures performed in the ambulatory care setting. The National Healthcare Safety Network (NHSN) is the current standard for definitions of superficial SSI, organ/space SSI, and deep incisional SSI and for surveillance activities 3. HHS proposes that by December 3. ASC procedures will be identified for which SSI definitions and methods should be developed for use by ASCs. SSI tracking and analysis. Methods to track ASC- related infections include conducting postdischarge patient questionnaires by telephone or e- mail or providing postdischarge instructions asking the patient to call the facility if symptoms such as pain and swelling occur. Knaust et al. This may facilitate identification of trends and opportunities for intervention, measurement of success or failure of implementation of best practices, and improved patient outcomes. CMS requires documentation to support surveillance activities, which can be standardized in the facility’s infection control plan, medical record entries, and contact attempt records.
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