Infection Control: Shore Up Your Practice's Plan

It’s back to school time which means cold and flu season isn’t too far away. Although a medical practice’s infection control plan consists of much more than preparing for cold and flu, now might be a good time to shore up your practice’s plan. According to the Centers for Disease Control and Prevention (CDC), the transition of healthcare delivery from acute care hospitals to ambulatory care settings, along with ongoing outbreaks and patient notification events, have demonstrated the need for greater understanding and implementation of basic infection prevention guidance. Americans have frequent encounters with outpatient settings. For example, CDC notes that more than three-quarters of all operations in the United States are performed in settings outside the hospital. Vulnerable patient populations rely on frequent and intensive use of outpatient care to maintain or improve their health. It is critical that all of this care be provided under conditions that minimize or eliminate risks of healthcare-associated infections (HAI).

The CDC provides examples of recent outbreaks and patient notification events. These events occurred in a variety of outpatient settings including primary care clinics, pediatric offices, cosmetic surgery centers, pain remediation clinics, imaging facilities, cancer (oncology) clinics, dental clinics, and health fairs. The list serves as a reminder of the serious consequences that can result when healthcare personnel fail to follow basic principles of infection control. Such consequences include: infection transmission to patients, notification of thousands of patients of possible exposure to bloodborne pathogens, referral of providers to licensing boards for disciplinary action, and malpractice suits filed by patients. Some of the most common examples are related to reuse of syringes to access medication vials for more than one individual patient. CDC defines this as “Double Dipping”- a syringe that has been used to inject medication into a patient then reused to enter a medication vial. The syringe is discarded but contents from that vial, which were contaminated through reuse of the used syringe, are then used for subsequent patients, which can lead to transmission of infectious agents. Other frequently noted preventable examples include failure to wear personal protective equipment (PPE), visibly dirty equipment, lack of equipment cleaning or performance checks, failure to follow aseptic technique, and mishandling of medication preparation.

Infection Control Basics

According to the CDC, there are two tiers of recommended precautions to prevent the spread of infections in healthcare settings: Standard Precautions and Transmission-Based Precautions.

Standard precautions are used for all patient care. They are based on the risk assessment and make use of common sense practices and personal protective equipment use that protect healthcare providers from infection, prevent the spread of infection from patient to patient, and prevent the spread from an infected area of a patient to a non-infected area of the same patient. Transmission-based precautions are used in addition to standard precautions for patients with known or suspected infections. These transmission precautions include contact precautions, droplet precautions and airborne precautions.  These precautions involve understanding the viability of infectious agents and the distances they can travel.

To assist healthcare providers with an infection control plan, in September 2016 the CDC updated and published both a checklist and a complete guide to infection prevention for outpatient settings. “The Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care” is  a summary guide of infection prevention recommendations for outpatient (ambulatory care) settings. The recommendations are not new but rather reflect existing evidence-based guidelines produced by the CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). The guide distills existing infection prevention guidance from the CDC and HICPAC, which is based primarily upon elements of Standard Precautions, and represents the minimum infection prevention expectations for safe care in outpatient settings.

By highlighting existing CDC and HICPAC recommendations, the guide has the following objectives: 1) provide basic infection prevention recommendations for outpatient (ambulatory care) settings; 2) reaffirm Standard Precautions as the foundation for preventing transmission of infectious agents during patient care in all healthcare settings; and 3) provide links to full guidelines and source documents, which readers can reference for more detailed background and recommendations. The guide is accompanied by an Infection Prevention for Outpatient Settings Checklist, a tool to help outpatient facilities assess their policies and procedures. In order to prevent patient harm, facilities and healthcare staff members are encouraged to review practices to assure they are in accordance with CDC’s evidence-based guidelines.

The checklist should be used for two purposes:

1. To ensure that the facility has appropriate infection prevention policies and procedures in place and supplies to allow healthcare personnel to provide safe care, and
2. To systematically assess infection prevention practices of individual healthcare personnel.

Healthcare providers are encouraged to download the CDC guide and checklist and to consult the full guidelines (in the Guidelines Library) for additional background, rationale, and evidence behind each recommendation. The Guidelines Library is categorized as follows:

• Basic Infection Prevention and Control
• Antibiotic Resistance
• Device-associated
• Procedure-associated
• Disease/Organism-specific
• Healthcare Worker Guidelines
• Setting-specific Guidelines

These are excellent tools designed to help healthcare providers implement Standard- and Transmission-Based Precautions to prevent infections in the ambulatory and outpatient settings.

Remember, it’s important to protect the healthcare workers in your practice as well. The CDC has recommendations for immunizations, personal protective equipment (PPE), sharps safety and post exposure prophylaxis.

CDC publishes yearly reports to help each state better understand their progress and target areas that need assistance. These include interactive data maps for antibiotic-resistant healthcare associated infections, outpatient antibiotic prescription data and inpatient antibiotic stewardship data. CDC State-based HAI prevention success stories, data, reports and state specific resources are available here.

For additional tools, training and education resources, visit the CDC’s comprehensive Infection Control website.