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Preliminary Communication
June 9, 2010

Infection Control Assessment of Ambulatory Surgical Centers

Author Affiliations

Author Affiliations: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases (proposed) (Drs Schaefer, Jhung, Schillie, Llata, Patel, Sehulster, Srinivasan, and Perz and Mss Link-Gelles, Sinkowitz-Cochran, and Bolyard) and Epidemic Intelligence Service, Office of Workforce Career Development (Drs Schaefer, Schillie, and Llata), Centers for Disease Control and Prevention, Atlanta, Georgia; Survey and Certification Group, Center for Medicaid and State Operations, Centers for Medicare & Medicaid Services, Baltimore, Maryland (Ms Dahl and Dr Simpson).

JAMA. 2010;303(22):2273-2279. doi:10.1001/jama.2010.744

Context More than 5000 ambulatory surgical centers (ASCs) in the United States participate in the Medicare program. Little is known about infection control practices in ASCs. The Centers for Medicare & Medicaid Services (CMS) piloted an infection control audit tool in a sample of ASC inspections to assess facility adherence to recommended practices.

Objective To describe infection control practices in a sample of ASCs.

Design, Setting, and Participants All State Survey Agencies were invited to participate. Seven states volunteered; 3 were selected based on geographic dispersion, number of ASCs each state committed to inspect, and relative cost per inspection. A stratified random sample of ASCs was selected from each state. Sample size was based on the number of inspections each state estimated it could complete between June and October 2008. Sixty-eight ASCs were assessed; 32 in Maryland, 16 in North Carolina, and 20 in Oklahoma. Surveyors from CMS, trained in use of the audit tool, assessed compliance with specific infection control practices. Assessments focused on 5 areas of infection control: hand hygiene, injection safety and medication handling, equipment reprocessing, environmental cleaning, and handling of blood glucose monitoring equipment.

Main Outcome Measures Proportion of facilities with lapses in each infection control category.

Results Overall, 46 of 68 ASCs (67.6%; 95% confidence interval [CI], 55.9%-77.9%) had at least 1 lapse in infection control; 12 of 68 ASCs (17.6%; 95% CI, 9.9%-28.1%) had lapses identified in 3 or more of the 5 infection control categories. Common lapses included using single-dose medication vials for more than 1 patient (18/64; 28.1%; 95% CI, 18.2%-40.0%), failing to adhere to recommended practices regarding reprocessing of equipment (19/67; 28.4%; 95% CI, 18.6%-40.0%), and lapses in handling of blood glucose monitoring equipment (25/54; 46.3%; 95% CI, 33.4%-59.6%).

Conclusion Among a sample of US ASCs in 3 states, lapses in infection control were common.