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Poor Hygiene a Danger at Outpatient Surgery Centers

CDC study finds 1 in 5 doesn't practice proper hand washing, for example

TUESDAY, June 8 (HealthDay News) -- Ambulatory surgical centers -- places where you can have certain surgeries and go home just hours later -- may need to improve their infection-control practices to safeguard patients, researchers warn.

A U.S. Centers for Disease Control and Prevention (CDC) study that sampled ambulatory surgical centers in three states found that 68 percent of those centers had at least one lapse in infection control, and 18 percent had lapses in three or more out of five infection-control categories, according to the study.

"The CDC, along with the Centers for Medicare & Medicaid and state survey agencies, did a pilot study looking at ambulatory surgical centers. About two-thirds had at least one lapse in infection control practices," said study author Dr. Melissa Schaefer, a medical officer at the CDC in Atlanta.

During the past several decades, more and more surgical procedures are being performed in ambulatory surgical centers instead of hospitals. These centers offer patients a wide range of same-day surgeries, specializing in dental procedures, plastic surgeries, orthopedic procedures or other operations.

Between 2001 and 2008, there was more than a 50 increase in the number of Medicare-certified ambulatory surgical centers in the United States, according to the study, which is published in the June 9 issue of the Journal of the American Medical Association (JAMA).

More than 6 million surgical procedures were performed in such centers in 2007, the study authors noted.

However, an outbreak of hepatitis C and unsafe injection practices found at one licensed ambulatory surgical center in Las Vegas highlighted the need to assess the infection-control practices at such centers. The center in question "had not undergone a full inspection by state surveyors in seven years," the researchers explained.

In their study, the CDC first asked state survey agencies if they'd be willing to participate. Seven states volunteered and three were selected, mostly due to location, according to Schaefer. The three states included in the study were Maryland, North Carolina and Oklahoma.

Sixty-eight ambulatory surgical centers were evaluated by auditors from the Centers for Medicare & Medicaid Services (CMS). Of those centers, almost 68 percent had at least one lapse in infection control.

Almost 20 percent had a lapse in proper hand washing or the use of protective gloves. Just over 28 percent displayed deficiencies in medication handling -- most commonly, using a single-dose vial of medication for more than one patient.

More than 46 percent of the centers inappropriately handled equipment used for blood sugar monitoring, and more than 28 percent failed to follow the recommended infection-control processes for reprocessing used surgical equipment, according to the investigators.

"These institutions need to rededicate their efforts to making sure that their infection-control practices incorporate best practices, and the tolerance for less has to be zero," said the author of an accompanying editorial in the same issue of JAMA, Dr. Philip S. Barie, editor in chief of the journal Surgical Infections, and a professor of surgery and public health at Weill Cornell Medical College in New York City.

To that end, Schaefer said the CDC is offering an infection-control audit tool to surgical centers, and suggested that facilities shouldn't wait to be inspected, but they should proactively conduct their own audits of their infection-control practices.

Neither expert could say with any certainty why these lapses were occurring, but Barie said it was particularly troubling that the problems occurred even though these centers were aware they were being evaluated. "People knew they were being observed, so there was every opportunity for them to modify their behavior," noted Barie.

Responding to the study, organizations representing the ambulatory surgery center (ASC) industry issued a news release on Tuesday.

"The industry takes this report seriously, and since the release of the findings from the pilot study in 2009, we have worked with CMS, accrediting bodies, state ASC associations, medical and nursing professional organizations and leaders in quality measurement to address concerns quickly and effectively," Andrew Hayek, chair of the Ambulatory Surgery Center Advocacy Committee and president and CEO of Surgical Care Affiliates, said in the statement.

"The industry has implemented voluntary reporting standards," he added, "and has called on CMS to implement a system for nationwide quality reporting for ASCs and for the entire health-care delivery system using comparable data so patients are able to make informed decisions about where to receive their health care."

Ambulatory surgical centers aren't the only places with infection concerns, however. According to a different study in the same issue of JAMA, a large teaching hospital in Madrid, Spain has experienced an outbreak of the superbug, methicillin-resistant Staphylococcus aureus (MRSA) that is resistant to yet another line of antibiotics.

The study reports on 12 critically ill patients who were found to be infected with the first reported cases of linezolid-resistant Staphylococcus aureus. Linezolid is an antibiotic and one of the few options left to effectively treat MRSA, according to background information in the study.

With reduced use of linezolid and infection-control measures, the hospital was able to stop the spread of this new infection, according to the study. One patient who was infected died due to the infection, however.

More information

Hand washing, though simple, is one of the most effective ways to control all kinds of infections. Read more from the U.S. Centers for Disease Control and Prevention on the right way to wash your hands.

SOURCES: Melissa K. Schaefer, M.D., medical officer, U.S. Centers for Disease Control and Prevention, Atlanta; Philip S. Barie, M.D., M.B.A., professor of surgery and public health, Weill Cornell Medical College, New York City, and editor in chief, Surgical Infections;June 8, 2010, news release, Ambulatory Surgery Center Association; June 9, 2010, Journal of the American Medical Association

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