According to the Centers for Disease Control and Prevention (CDC), the trend in healthcare services has shifted significantly from inpatient hospital settings to ambulatory and community-based settings.1 In 2007, almost a billion visits were made to office-based physician practices.2
Ambulatory care is provided in outpatient settings where patients do not stay overnight, such as office-based physician practices. The CDC describes ambulatory care as:
“Hospital-based outpatient clinics, nonhospital-based clinics and physician offices, ambulatory surgical centers, and many other specialized settings.”3
With the transition from acute care to outpatient settings, the CDC published guidelines for ambulatory care settings in 2011 entitled, “Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care.” They also provided a corresponding Infection Prevention Checklist for Outpatient Settings.
Infection Control Recommendations for Physician and Outpatient Settings:
Infection control protocol within physician offices and clinics should mirror the same standards as a hospital, taking into consideration the type of service that is provided.
- Administration should provide fiscal and human resources, including equipment and supplies to maintain proper infection prevention.
- The practice should have at least one individual on staff that is trained in infection prevention or is regularly available to the practice.
- This individual should be involved in developing and implementing policies for infection prevention according to evidence-based guidelines, regulations, or standards.
- Infection prevention policies should be re-assessed on a regular basis.
Standard Precautions are the minimum infection prevention practices that apply to all patient care in any setting. Each of these points should be fully addressed when policies and procedures for infection control protocol are developed. They include:
- Hand hygiene
- Use of Personal Protective Equipment (PPE)
- Safe injection practices
- Safe handling of potentially contaminated equipment or surfaces
- Respiratory hygiene
CIVCO Medical Solutions specializes in the field of high-level disinfection, which falls under the fourth precaution (safe equipment handling). When medical equipment is designed to be reusable, disinfection or sterilization after each use is absolutely critical. Equipment must be cleaned according to the manufacturer’s instructions and according to evidence-based guidelines.
The Spaulding Classification System determines the level of disinfection or sterilization required for reusable medical devices. Regulatory agencies, like the CDC, refer to this system.
|Critical||Object enters sterile tissue||Surgical Instruments||Sterilization|
|Semi-critical||Object contacts mucous membranes or non-intact skin||Endocavity Probes, Endoscopes||High-level Disinfection|
|Non-critical||Object contacts intact skin||Blood Pressure Cuffs||Low or Mid-level Disinfection|
GUS Disinfection Soak Stations are designed to high-level disinfect endocavity ultrasound probes or endoscopes – devices that are classified as semi-critical. Some statistics related to these instruments:
- Imaging services ordered or provided by a physician’s office in 2007 – 144 million
- Endoscope services ordered or provided by a physician’s office in 2007 – 16 million4
Medical practices historically lacked the resources for infection control protocols or staff. In an interview with AAFP News Now, Jonathan Temte, M.D., Ph.D., a member of the CDC’s Advisory Committee on Immunization Practices, said that implementing the guidelines should not present a major financial undertaking because they represent the minimum in infection control expectations. “They are very reasonable, very feasible and very affordable. We don’t want to expose patients to any risks or infections that are easily avoidable.”
Legislation has now brought infection control standards into ambulatory care settings. In the past, hospitals were the only healthcare entities required to follow stringent health and safety guidelines. The Accreditation Association of Ambulatory Health Care (AAAHC) lists the state laws and regulations for ambulatory care settings.
1, 3 Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. CDC, 2011.
2, 4 Physician Office Visits according to the National Center for Health Statistics: http://www.cdc.gov/nchs/ahcd/ahcd_reports.htm