Infection Prevention and Control
June 25, 2013 | Ambulatory Care Risk, Quality, & Safety Guidance
Although ambulatory providers see 300 times as many patients as hospitals each year, most patient safety efforts focus on the hospital setting, including infection prevention initiatives. Yet the opportunity for infection is greater in ambulatory care due to the number of patients served (Sokol and Neerukonda). Significant infection control lapses have been reported for outpatient settings over the past decade. For example, data from the Centers for Disease Control and Prevention (CDC) indicates that about 90% of bloodborne pathogen outbreaks, such as outbreaks of hepatitis B virus (HBV), hepatitis C virus, and HIV, are associated with unsafe injection practices in outpatient settings (Freedman). Because the infection risk in ambulatory settings is the same as in hospitals, CDC recommends that ambulatory facilities follow similar infection prevention procedures as those required in hospitals. (Rutala “Guideline”)
Physician offices may be held liable for infections that patients acquire while receiving health services from the practice if the infection can be traced to a lapse in infection control practices. This Guidance Article provides an overview of infection prevention and control in the office setting. Strategies are provided to reduce infection-related liability by being able to demonstrate that the office has effective policies and procedures in place to prevent and manage infections.
Microorganisms that cause infections can be spread in the physician office through direct or indirect contact. Transmission can occur when a provider or staff member touches an infected patient (direct contact) or a contaminated object (indirect contact) and then touches themself, another patient, or an object in the office. Airborne transmission occurs when infected droplets enter the body via the respiratory route. It can occur even if two individuals simply share the same air in a waiting room, but coughing and sneezing facilitate transmission. Vehicles that can transmit infection include sharps, reused devices and equipment, and multiuse drug vials. (CPSO)
Healthcare organizations should monitor personnel adherence to infection prevention practices (e.g., hand hygiene, standard precautions) to identify areas in need of improvement and provide training when necessary (see Potential Topics for Staff Education and Training). Organizations should designate personnel who will regularly restock infection control supplies (e.g., gloves, gowns, face masks) and replenish dispensers of alcohol-based handrub and soap. (Siegel et al.).
Healthcare providers, including physicians, nurses, and other personnel, are subject to mandatory state and local reporting laws for infectious and noninfectious diseases, such as HIV, cancer, and foodborne illness. For a list of the specific infections and conditions that must be reported, providers may contact their local and state health departments. Failure to report may subject a provider to criminal and/or civil penalties or professional disciplinary action. See the Guidance Article Mandatory Reporting Laws for...