Outbreaks draw attention to ambulatory practices

In recent years, large outbreaks of hepatitis B virus and hepatitis C virus infections have occurred among patients in private medical practices, pain clinics, endoscopy clinics, and a hematology/oncology practice.1

"Speaking generally, the vast majority have not developed a consultative relationship with anyone in infection control to come in and give them periodic guidance and oversight," says William Schaffner, MD, chairman of the Department of Preventive Medicine at the Vanderbilt University School of Medicine in Nashville.

A physician anesthesiologist in Long Island was investigated by the New York State Department of Health for allegedly reusing syringes to draw up medicine from multidose vials. The department contacted thousands of patients who had been treated by the physician and urged them to be tested for hepatitis and HIV.

Indeed, hospital systems have turned to infection preventionists (IPs) for oversight of rapidly expanding networks of affiliated clinics. Judie Bringhurst, RN, BSN, CIC, an IP who oversees infection control in ambulatory settings at Duke University Medical Center in Durham, NC, says, "I have over 80 clinics now; and a year from now, I will have over 100. We are building by leaps and bounds."

With health care delivery rapidly moving beyond the hospital, infection prevention activities must follow, providers say. "Ambulatory care has to change," Bringhurst says. "If we can't do our duty to take care of our patients properly, somebody is going to have to make us do it."

Duke insists that its affiliated ambulatory facilities be accredited by The Joint Commission accreditation, to help avoid problems such as the recent hepatitis B outbreak in Nevada, where infection control practices are under scrutiny. "Look at what happened in Las Vegas — my gosh, 50,000 people [advised to be tested]," she says. "I would hope some kind of regulation would result. But it has happened before, and nothing changed."


  1. Williams IT, Perz JF, Beel BP. Viral hepatitis transmission in ambulatory health care settings. Clin Infect Dis 2004; 38:1,592-1,598.