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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

CDC targets ambulatory care

In language clear enough to any plaintiff’s attorney, the Centers for Disease Control and Prevention has released a new guidance document for outpatient settings emphasizing that clinic administrators “must ensure that sufficient fiscal and human resources are available to develop and maintain infection prevention and occupational health programs.”

That includes the availability of sufficient and appropriate equipment and supplies necessary for the consistent observation of Standard Precautions, including hand hygiene products, injection equipment, and personal protective equipment (e.g., gloves, gowns, face and eye protection), the CDC notes.

“Ongoing education and training of health care personnel are critical for ensuring that infection prevention policies and procedures are understood and followed,” the CDC stated.

The message couldn’t be much clearer, particularly for settings that have tried to cut costs by skimping on infection control or outright ignoring it. While voluntary, the CDC guidelines establish a clear standard of care for outpatient settings, which have been hit with a series of national hepatitis outbreaks fueled by reckless disregard of basic infection control. Moreover, the Centers for Medicare and Medicaid Services has stepped up inspection oversight of ambulatory settings and will certainly look to these new guidelines in enforcing infection prevention. Tens of thousands of outpatients have been advised to be tested for HIV, hepatitis B and hepatitis C in a series of shocking outbreaks over the last decade that culminated in a Las Vegas endoscopy clinic in 2008.

The guidelines are drawn from the evidence-based guidelines created by the CDC’s Healthcare Infection Control Practices Advisory Committee. Most of the outbreaks involved inappropriate use of sharps and vials, so accordingly, the document includes a section underscoring the single use of syringes and extreme caution with multidose vials.

In addition to emphasizing standard precautions, the CDC guidelines also outline the rudiments of infection surveillance systems in outpatient care, basic environmental cleaning, and disinfection and sterilization practices. The guideline should be considered as the minimum protocol followed in ambulatory care, where more and more patients are now receiving invasive medical care.

Vulnerable patient populations rely on frequent and intensive use of ambulatory care to maintain or improve their health,” the CDC concluded. “For example, each year more than one million cancer patients receive outpatient chemotherapy, radiation therapy, or both. It is critical that all of this care be provided under conditions that minimize or eliminate risks of healthcare-associated infections.”