According to the National Health Statistics, in 2007 the total number of physician office visits approached one billion. I know that number is so 2007, but imagine how many that would be now that 2014 is almost over. Many of us have visited a physician’s office at least once if not more this year and will probably continue to do so again next year.

Numerous outbreak reports have described transmission of Gram-negative and Gram-positive bacteria, mycobacteria, viruses, and parasites in the ambulatory settings. In many instances, outbreaks and other adverse events were associated with breakdowns in basic infection prevention procedures (e.g., reuse of syringes leading to transmission of bloodborne viruses).

So you see where this is heading…yes..better infection control practice in physician offices. Patients deserve the same level of infection control protection whether they are treated in a hospital or ambulatory care setting, including physician offices. No..there shouldn’t be any difference in infection control practices. It is that simple yet I have seen many nurses practicing in physician offices who either forget this concept or think it doesnt apply to them since most infection control guides are geared towards hospital practice.

The CDC’s “Guide for Infection Prevention in Outpatient Settings: Minimum Expectations for Safe Care” 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

So if there are CDC guidelines for outpatient settings, why is it still an issue? Just a few thoughts on this..

• Absence or lack of infection control policies
• Lack of education and training on basic infection control practices
• No compliance monitoring of the practitioners
• No infrastructure to support an infection control specialist
• Lack of quality measures or reporting mechanism for outbreaks and breaches
• Lack of handwashing provisions in patient/treatment areas

Physician offices and other ambulatory care settings are structured differently than acute care facilities. If the physician office practice is part of a large hospital system or medical groups, infection control education and training are mandatory. Unfortunately, many  are single /private practice offices and don’t have the infection control policies and other resources. In some cases, they simply don’t care because there’s no regulatory agencies to police them, unless they are involved in such outbreaks. Many nurses work alone and become pre-occupied with tasks to get patients out the door, in some cases at the expense of implementing good infection control practices. Sad but true…

All patients deserve the same level of infection control protection whether they are treated in a hospital or ambulatory care setting; what if that patient is your mother/family member or a loved one?

References:

1. Hsiao CJ, Cherry DK, Beatty PC, Rechsteiner EA. National Ambulatory Medical Care Survey: 2007 summary. National health statistics reports; no 27. Hyattsville, MD: National Center for Health Statistics. 2010.
2. Thompson ND, Perz JF, Moorman AC, Holmberg SD. Nonhospital Health Care-Associated Hepatitis B and C Virus Transmission: United States, 1998-2008. Annals of Internal Medicine. 2009;150:33-39.
3. “Guide for Infection Prevention in Outpatient Settings: Minimum Expectations for Safe Care”