In response to a question from a former ER nurse who now works for a physician office providing infusion services, I came upon this guide from the CDC. The question is why should infection control practices in a physician’s office differ from those in the hospital? In particular, this nurse was appalled that the physician office did not use safety IV catheters and connectors, reusing syringes and observed that the nurse she was replacing was not wearing gloves to start IVs. (loud gasp here)
I think we all know the answer…NO..there shouldn’t be any difference in infection control practices. It is that simple yet I have seen many nurses practicing in physician’s offices who either forget this concept or think it doesnt apply to them since most infection control guides are geared towards hospital practice.
Now the CDC has released the “Guide for Infection Prevention in Outpatient Settings: Minimum Expectations for Safe Care”. This is a summary guide of infection prevention recommendations for outpatient (ambulatory care) settings. The recommendations included in this document are not new but rather reflect existing evidence-based guidelines produced by the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee. This summary guide is based primarily upon elements of Standard Precautions and represents the minimum infection prevention expectations for safe care in ambulatory care settings.
Key recommendations for safe injection practices in ambulatory care settings:
1. Use aseptic technique when preparing and administering medications
2. Cleanse the access diaphragms of medication vials with 70% alcohol before inserting a device into the vial
3. Never administer medications from the same syringe to multiple patients, even if the needle is changed or the injection is administered through an intervening length of intravenous tubing
4. Do not reuse a syringe to enter a medication vial or solution
5. Do not administer medications from single-dose or single-use vials, ampoules, or bags or bottles of intravenous solution to more than one patient
6. Do not use fluid infusion or administration sets (e.g., intravenous tubing) for more than one patient
7. Dedicate multidose vials to a single patient whenever possible. If multidose vials will be used for more than one patient, they should be restricted to a centralized medication area and should not enter the immediate patient treatment area (e.g., operating room, patient room/cubicle)
8. Dispose of used syringes and needles at the point of use in a sharps container that is closable, puncture-resistant, and leak-proof.
9. Adhere to federal and state requirements for protection of HCP from exposure to bloodborne pathogens
Ambulatory care is defined as care provided in facilities where patients do not remain overnight e.g., hospital-based outpatient clinics, non-hospital based clinics and physician offices, urgent care centers, ambulatory surgical centers, public health clinics, imaging centers, oncology clinics, ambulatory behavioral health and substance abuse clinics, physical therapy and rehabilitation centers
The CDC states that the recommendations described in the document represent the absolute minimum infection prevention expectations for safe care in outpatient (ambulatory care) settings. This guidance is not all-encompassing. Facilities and HCP are encouraged to refer to the original source documents, which provide more detailed guidance and references for the information included in this