Infection Prevention in the Outpatient Physician Clinic

Abstract

Infection prevention (IP) must be a priority in all healthcare settings. Compared to hospitals, ambulatory care settings have traditionally lacked infrastructure, resources, and guidelines to support infection prevention and surveillance activities. Healthcare delivery has moved from the in-patient acute facilities to outpatient surgery centers, skilled nursing facilities, outpatient dialysis units, outpatient infusion units, assisted living facilities, and office-based procedural settings. In 2010, there were approximately 100.7 million outpatient department visits in the United States. Federal oversight of the outpatient setting has been delegated to each state or local authority leaving offices prone to enormous variations in clinical and safety practices, especially in infection prevention. Furthermore, the mechanisms of reporting infection prevention are disjointed and infection control surveillance is absent. The Center for Disease Control reports the lack of standardized practices related to infection control includes variations in: aseptic technique, hand washing, sterilization, environmental cleaning, parental medication administration, medical equipment, and proper protective equipment, all of which have led to variations in clinical and safety practices. Ultimately, the lack of standardized infection control practices affects patient care. The development and implementation of IP policies and procedures need to be based on evidence-based guidelines, regulations, or standards. Can the implementation of evidence-based guidelines and educational interventions for clinic staff improve IP outcomes? During a 12-month period, survey and observational data focused on IP knowledge and practices were collected from a healthcare system’s 27 newly acquired clinics. Using the Center for Disease Control and Prevention Guide to Infection Prevention in Outpatient Settings: Minimal Expectations for Safe Care as a guide; each clinic underwent an unscheduled assessment of current IP practices, followed by employees completing a set of IP education modules, which was later followed by another unscheduled post education assessment of IP practices. Five IP education modules were developed, delivered, and evaluated, and an IP champion was established at each clinic. Descriptive statistics were analyzed. Out of the 27 newly acquired physician clinics; four clinics were not analyzed due to missing data. Results from the remaining 23 clinics found that, 15 clinics (66%) improved 1.70%- 16.95%, six clinics (26%) stayed the same with an initial/post module inspection score ranging from 89.83% - 98.31%, one clinic’s (4%) score dropped 3.39%, and one clinic (4%) scored 100% on the pre and post module inspection. Sustainability of these findings was supported when four months later, zero IP deficiencies were found by an external credentialing agency. Infection control guidelines and educational interventions can improve IP practice outcomes as was demonstrated by improved IP inspection scores. These efforts are critical to prevent healthcare associated infections. Yearly IP education, bi-annual surveillance inspections and clinic IP champions are essential to maintain adherence to guidelines.