Nursing Outreach, University of Missouri

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Best Practices in Infection Prevention and Control in Ambulatory Care Settings

Note:  Ambulatory care settings is an umbrella term to include ambulatory surgery centers as well as other outpatient settings, such as physicians’ and dental offices, and dialysis, oncology, imaging and pain management centers. (CDC, June, 2015).

The resources listed below are excerpts from a series of face to face programs held around the state of Missouri in November of 2011. All resources were reviewed and updated in July 2015. We hope these resources will be helpful in your practice.

On this page

  • Session 1: Why All the Fuss?
  • Session 2: Basic Infection Control Principles to Guide Practice
  • Session 3: Cleaning, Disinfection and Sterilization
  • Session 4: Promoting an Organizational Culture of Safety
  • Session 5: Review of State and Federal Regulations, Requirements and Guidelines

Purpose

To provide a forum for front-line staff to increase their knowledge and skills related to basic infection control practices specific to ambulatory health care settings. The importance of a culture of safety to ensure best practices will be included.

Target audience

Front-line staff in licensed ambulatory surgery centers and dialysis units and other outpatient settings including but not limited to radiology clinics, endoscopy centers, pain clinics, wound care clinics, laser liposuction centers, physician offices, oral surgery/dental offices. Registered Nurses, Licensed Practical Nurses, Dental Hygienists, Technicians (infection control, radiology, OR, etc.) and other interested staff are invited to attend.

Learning objectives

  • Explain why health care-acquired infections is such an important issue in the outpatient setting.
  • Discuss infection control and prevention principles that will assist in reducing the risks of infection in the outpatient setting.
  • Determine how to select and use the best agents /systems for cleaning, disinfection and sterilization including reprocessing of instruments and devices.
  • Describe measures to promote an organizational culture for safe care.
  • Describe the survey/inspection process for Ambulatory Surgery Centers, common infection control citations and the ASC worksheet.
 Session I

Why All the Fuss?

  • Eddie R. Hedrick, BS, MT(ASCP), CIC, former senior epidemiology specialist, emerging infections coordinator, Missouri Department of Health and Senior Services, Jefferson City. Mr. Hedrick recently retired and now serves as a consultant to MDHSS. The issue of health care-associated infections in hospitals is well known but until recently little was known about the severity of the problem in outpatient settings. Recent outbreaks in a variety of outpatient settings clearly indicate these infections do occur and are occurring in the outpatient environment. Studies have shown that they are often preventable with the application of basic infection control practices.

Handouts

 Session II

Basic Infection Control Principles to Guide Practice

  • Eddie Hedrick
    This session will discuss infection control and prevention principles that will assist in reducing the risks of infection in the outpatient setting. It will include issues such as transmission of infection especially bloodborne pathogens, standard precautions including proper use of personal protective equipment, respiratory hygiene, hand hygiene, safe medication and injection practices and other important infection control issues.

Handouts

Resources

  • CDC video on infection risks associated with sharing insulin pens
  • CDC outpatient settings
    This site is the best one-stop shopping site on the web for infection control information targeted at outpatient settings of all types. It includes a "Guide to Infection Prevention for Outpatient Settings: Minimum Expectations For Safe Care" and an accompanying checklist that you can use to assist in reviewing your facility's adherence to those minimum expectations. It also provides links to a host of prevention strategies, articles and outbreak investigations that will help you keep current.
  • CDC HAI Prevention Guidance
    This site contains the top CDC recommendations to prevent health care-associated infections in hospitals and other health care settings as well. Not specifically targeted at the outpatient setting, however you'll find a wealth of helpful IC guidance here.
  • CDC hand hygiene
    Web page provides health care workers and patients with a variety of resources including guidelines for providers, patient empowerment materials, the latest technological advances in hand hygiene adherence measurement, frequently asked questions and links to promotional and educational tools published by the WHO, universities and health departments
  • CDC injection safety — Information for providers
    Web page with slide sets, videos, posters, brochures, FAQs, educational materials and references that you can use to give outbreak examples. Recent investigations undertaken by state and local health departments and the Centers for Disease Control and Prevention (CDC) have identified improper use of syringes, needles, and medication vials during routine health care procedures, such as administering injections.
  • Injection Safety — Safe Injection Practices Prevent Transmission of Infections to Patients
    Contains specific recommendations for safe injection practices along with information about infection control procedures to be used during lumbar punctures etc.
  • Injection Safety Video (One and Only Campaign)
    This has a series of vignettes and clinical scenarios that might be helpful — Great teaching tool.
  • Point of Care Devices (Blood glucose meters)
    CDC Web page — this has a lot of great info and links to info from CMS and FDA as well as a link to some FAQs that give info about cleaning/disinfection of meters and there are a ton of references that can be used for outbreak examples.
  • CDC video on infection risks associated with sharing insulin pens
    Sharing insulin pens has been associated with transmission of infections.  This video discusses prevention strategies.
  • Personal Protective Equipment: CDC Guidelines (PDF)
    This is the most current CDC guideline for isolation precautions in health care facilities. Although outpatient settings do not usually isolate patients, knowing what procedures to follow should a patient with a known infectious disease come into the facility will be very helpful.
  • Outpatient oncology centers
    A guideline designed to help outpatient oncology centers set up an infection control program.
  • Dialysis guidelines
    This site is specifically targeted toward dialysis centers and has great information regarding the prevention of infection in both patients and health care providers.
 Session III

Cleaning, Disinfection and Sterilization

  • Blue Springs
    Meredith Shellner, MSA, BA, BSN, RN, CIC
    , corporate infection preventionist, Ambulatory Care and Dialysis, Truman Medical Centers, Inc., past-president and advisory board member, Greater Kansas City Chapter of Association for Professionals in Infection Control (APIC). Currently, Ms. Shellner serves as the Infection Preventionist Lakewood/Corporate Ambulatory/Dialysis/LTC at the Truman Medical Center in Lakewood.
  • Columbia
    Paula Bullock, MEd, MT (ASCP), CIC
    , infection control professional, Infection Control Department, University of Missouri Hospitals and Clinics. past president and chair, Ambulatory Care Section, Show-Me-Central Chapter of APIC
  • St. Louis
    Christine C. Zirges, RN, ACNS-BC, CIC
    , infection prevention consultant, Occupational Infection Control/Emergency Preparedness, BJC HealthCare. past president and board member, current member, Chapter 73, APIC. Currently, Ms. Zirges serves as Chris Zirges, Manager - Infection Prevention at SSM Healthcare - St. Louis Region.
  • Springfield
    Jovita (Jo) Micek, RN, CIC
    , infection preventionist, infection control coordinator, Liberty Hospital, Liberty. past president and board member, Greater Kansas City Chapter, APIC

Recent outbreaks of health care-associated infections associated with improper cleaning, disinfection, or sterilization of medical equipment or devices and transmission of infection from environmental sources has brought this issue into the forefront of infection prevention. It is important for all who work in health care to be familiar with the priniciples of cleaning, disinfection, and sterilization. These sessions will discuss all aspects of cleaning, disinfection and sterilization including the practical application of these principles in the outpatient setting. It will provide information that will assist in making decisions as to how to select and use the best agents /systems for cleaning, disinfection and sterilization. Reprocessing of instruments and devices will also be covered.

Handouts

Resources

 Session IV

Promoting an Organizational Culture of Safety

  • Carol Hafley, MHA, BSN, RN, FACHE, assistant director, Missouri Center for Patient Safety, Jefferson City
    This session includes an overview of concepts for establishing and maintaining an organizational culture for safe care. Concepts include leadership, management and front line perspectives on components of programs that promote an environment for individuals to speak up when they encounter unsafe practice or situations to prevent medical mistakes. Such programs include the Comprehensive Unit-Based Safety Program (CUSP), a Just Culture and TeamSTEPPS.

Handouts

 Session V

Review of State and Federal Regulations, Requirements and Guidelines

  • Dean A. Linneman, MHA, MT (ASCP), section administrator, Health Standards and Licensure, Missouri Department of Health and Senior Services, Jefferson City
    A general overview of survey/inspections for Ambulatory Surgery Centers (ASCs), a review of common infection control citations and statistics for Missouri and the nation, and a discussion of the ASC worksheet.

Handouts