One of the news updates I read this morning had this headline: “NJ: 29 hepatitis cases tied to one doctor’s office”. I have seen similar headlines in the past, but this one happened in a physician based oncology clinic where chemotherapy is administered each day. As an infusion nurse and one who administers infusions and chemotherapy in an outpatient infusion center, this headline got my full attention. In addition, as a nurse consultant, this headline made me think of the several physicians’ offices providing infusion services that I have had the opportunity to visit and evaluate. While the physician’s offices I have visited do not infuse chemotherapy, they offer infusion services to patients receiving biologic therapy for immune mediated disorders. One common observation is the unsafe and poor infection control practices and lack of basic infection control policies. I am not implying that the healthcare providers in physician’s offices do not know basic infection control principles. They do, however, they believe that nosocomial infections only occurs in hospitals and the incidence of transmission of infections in physician’s offices are significantly low, as a result, infection control practices are overlooked. Many of these practices do not have written policies or staff training programs on infection control. Often, these offices ignore federal and state safety regulations because they are a small practice. There are increasing evidence of cases of Hepatitis outbreaks, HIV transmission, as well as other infections such as tuberculosis and measles in many outpatient settings since 1998 resulting from unsafe and poor infection control practices. This is now a patient safety issue as well as liability risks for the physician.
There are recommendations for infection control in physician’s offices from the American Academy of Pediatrics Committee on Infectious Diseases and Committee on Practice and Ambulatory Medicine. Although the recommendations speak to pediatric offices, the basic infection control principles / standard precautions outlined can apply to all other office based practices.
Key highlights of the recommendations are:
• Barrier Precautions to prevent skin and mucous membrane exposure
• Handling of Sharps and Contaminated waste
• Cleaning and disinfection of surfaces and equipment
• Aseptic technique for invasive procedures
For offices providing infusion services, follow the Infusion Nursing Standards of Practice. Each office should define in written policies their infection control practices and educate their staff on these policies. To keep all this in perspective, at the end of my office evaluation, I always ask this question….will you bring your mother or loved one to this office? Patient safety is everyone’s responsibility regardless of where care is provided. Let us not forget, as nurses, we have a responsibility to make choices that will improve patient care, because it is simply the right thing to do.