Preventing Infection in the Outpatient Setting

By Coverys Risk Management

The healthcare industry has experienced a major shift related to where patients receive healthcare services. Many services traditionally provided in acute care and inpatient settings have moved to ambulatory care settings, such as surgery centers and physician offices. With this shift comes the need to redouble our efforts to ensure that the standards for patient safety are as high at outpatient facilities and physician offices as they are at hospitals. One area of key concern is infection prevention and control.

According to the Centers for Disease Control and Prevention (CDC), more than three-fourths of all operations in the U.S. are performed on an outpatient basis, and the total number of physician office visits each year is nearly one billion. It’s important to acknowledge that ambulatory care settings may not have the same resources as hospitals with respect to supporting and implementing infection prevention and control practices. This disparity in resources and infrastructure can lead to outbreaks and other adverse events.
What steps can your facility or practice take to improve its ability to control and prevent infection? 

Infection Prevention and Control: Plan, Policies, and Procedures
Having appropriate policies and procedures for infection prevention and control is a requirement under OSHA and CMS. In order to develop policies/procedures, it is important for your practice to assess the types of services you offer and tailor your policies to the services, addressing necessary precautions and preventive activities. 

At a minimum, there should be a written infection prevention and control plan that reflects the existing evidence-based guidelines from the CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). This plan should be readily accessible to staff at all times and should include, but not necessarily be limited to, the following:
  • Written infection prevention and control policies, procedures, and exposure control plans that are appropriate to the services provided and rooted in evidence-based guidelines, regulations, and/or standards
  • A standard precautions policy that addresses hand hygiene; respiratory hygiene and cough etiquette; personal protective equipment (PPE); safe injection practices and sharps safety;  waste prevention; and cleaning and disinfection of devices and environmental surfaces
  • Medication storage and handling
  • Risk of exposure determinations, according to job classification
  • Staff training and education on the principles of infection prevention and control
  • Hepatitis and tuberculosis (TB) screening for all staff members
  • Procedures and follow-up for exposure to bloodborne pathogens
  • OSHA record keeping for any bloodborne exposures
  • Transmission-based precautions (e.g., ways to identify potentially infectious patients; precautions for contact, airborne, and droplet exposures) and appropriate PPE needed to protect staff members and patients
  • Reporting requirements of local and/or state health departments regarding reportable diseases, clusters of infections, and outbreaks
Standard and Transmission Precautions in Outpatient Settings
All ambulatory care and outpatient settings should have policies and procedures covering the basics for standard precautions to be followed for all patients and all settings. These include hand hygiene, respiratory hygiene, personal protective equipment, and safe injection practices.

For transmission precautions, the CDC acknowledges that “in these [outpatient] settings, adapting transmission prevention guidelines is challenging because patients remain in common areas for prolonged periods waiting to be seen by a healthcare provider.” Screening for potentially infectious conditions, especially respiratory infections, must be done at the beginning of each patient’s visit to your facility, and appropriate and timely control measures (e.g., respiratory hygiene, transmission-based precautions) should be implemented, including providing an immediate location for potentially contagious patients to wait (e.g., an exam room or a “sick child waiting area” at a pediatrician’s office).

Cleaning, Disinfection, and Sterilization
Appropriate cleaning, disinfection, sterilization, and storage of clean and contaminated equipment is important in limiting infections related to reusable patient care equipment. Clearly written policies and procedures should be in place for cleaning, disinfecting, sterilizing, and storage of clean and contaminated instruments in your practice.

Education is a critical element of an effective infection prevention and control plan. Staff members should be properly trained on the policies and procedures you establish. This involves training new employees immediately after they are hired, as well as ongoing education for everyone in your practice, including required annual training that addresses OSHA’s Bloodborne Pathogen Standard and tuberculosis. Staff members should be periodically monitored to ensure they are following the appropriate infection prevention and control practices. The safety of healthcare personnel and patients should be the focus of the education, with emphasis on job-specific and task-specific needs. Education and competency checks should be documented and repeated as appropriate or needed for the specific job classifications that are at risk of exposure to bloodborne pathogens and tuberculosis.

Reducing the risk of infection is an essential part of providing quality care in the outpatient setting, especially as more patients choose to receive treatment in such an environment. With established policies and procedures for prevention and attention to staff training regarding those expectations and guidelines, your practice can help ensure that patient visits are as healthy and free from additional illness as possible.
No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances. 

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