Special problems associated with reprocessing instruments in outpatient care facilities.

Abstract

In the United States, more patients obtain health care in specialty clinics, ambulatory surgery centers, and physicians’ offices than in hospitals. In 2008, there were 1.2 billion ambulatory care visits in the United States, including physicians’ offices, outpatient hospitals, and emergency departments. Nearly 61% of those visits were to primary care physicians’ offices.1 Although many outbreaks of infection associated with instrument processing in outpatient care facilities go unreported, reported outbreaks occur with frequency. In 2003, Srinivasan et al2 reported an outbreak of Pseudomonas aeruginosa associated with bronchoscopes in an outpatient setting, apparently caused by loose biopsy ports on the bronchoscopes. Thirty-nine patients were infected. Sixty-seven percent of these 39 patients were infected with P aeruginosa. In 2012, a commentary by Weber and Rutala3 that looked back at bronchoscopies from the 12-year period between 2000 and 2012 found 25 outbreaks and pseudo-outbreaks in the literature. The outbreaks described in their commentary resulted in 82 infections and 4 deaths. Notably, single use, disposable bronchoscopes are available. In 2013, Kovaleva et al4 reported on transmission of infections via endoscopy and found, of the 98 outbreaks assessed, 1,113 patients were contaminated and 249 patients were infected. Kovaleva et al4 noted that if deficiencies related to cleaning, disinfection, automated endoscope reprocessors (AERs), contaminatedwater, and drying were eliminated, approximately 85% of outbreaks would be eliminated as shown in Table 1. Neither the work byWeber and Rutala3 nor Kovaleva et al4 distinguish between outbreaks associated with inpatient and outpatient facilities. This paper looks at 2 problems associated with instrument processing practices at a large university teaching hospital’s outpatient facilities: 1.) physical space problems and 2.) training and education problems related specifically to high-level disinfection (HLD) practices and attempts to offer solutions or at least improvements to these two problems. PROBLEM 1: PHYSICAL SPACE