Ambulatory care: Guidance but lack of compliance?

A recent article by investigators at the Centers for Disease Control and Prevention (CDC) reiterated the following basic infection control measures to prevent patient-to-patient transmission of bloodborne pathogens in ambulatory care settings.1

Injection safety

  • Use a sterile, single-use, disposable needle and syringe for each injection and discard intact in an appropriate sharps container after use.
  • Use single-dose medication vials, prefilled syringes, and ampules when possible. Do not administer medications from single-dose vials to multiple patients or combine leftover contents for later use.
  • If multiple-dose vials are used, restrict them to a centralized medication area for single patient use. Never reenter a vial with a needle or syringe used on one patient if that vial will be used to withdraw medication for another patient. Store vials in accordance with manufacturer’s recommendations and discard if sterility is compromised.
  • Do not use bags or bottles of intravenous solution as a common source of supply for multiple patients.
  • Use aseptic technique to avoid contamination of sterile injection equipment and medications.

Patient care equipment

  • Handle patient care equipment that might be contaminated with blood in a manner that prevents skin and mucous membrane exposures, contamination of clothing, and transfer of microorganisms to other patients and surfaces.
  • Evaluate equipment and devices for potential cross-contamination of blood. Establish procedures for safe handling during and after use, including cleaning and disinfection or sterilization as indicated.

Work environment

  • Dispose of used syringes and needles at the point of use in a sharps container that is puncture-resistant and leak-proof, which can be sealed before completely full.
  • Maintain physical separation between clean and contaminated equipment and supplies.
  • Prepare medications in areas physically separated from those with potential blood contamination.
  • Use barriers to protect surfaces from blood contamination when blood samples are obtained.
  • Clean and disinfect blood-contaminated equipment and surfaces in accordance with recommended guidelines.

Hand hygiene and gloves

  • Perform hand hygiene (i.e. hand washing with soap and water or use of an alcohol-based hand rub) before preparing and administering an infection, before and after donning gloves for obtaining blood samples, after inadvertent blood contamination, and between patients.
  • Wear gloves for procedures that might involve contact with blood and change gloves between patients.


  • Infection-control measures should be tailored to the individual practice setting.
  • Responsibility for oversight and monitoring should be clearly designated.
  • Periodic reviews of staff practices should be conducted.
  • Procedures and responsibilities should be established for reporting and investigating breaches in infection control policy.


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