APIC conference updates: Ambulatory care

By: November 19th, 2009 Email This Post Print This Post

More updates from APICs “Healthcare-associated infections: A changing legal and regulatory landscape. For the previous two updates, click here for part 1, and here for part 2.

This session might be of particular interest to the OSHA Healthcare Advisor audience since it focused specifically on HAI prevention in ambulatory surgery centers (ASC).

The first to present was Dr. Joseph Perz, the prevention team leader for the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention in Atlanta, Georgia. He’s worked extensively with safe injection practices, which have been a problem in recent years among ASCs. Some of his major points:

  • This sector has grown enormously over the since 1996 with a 240% increase since in ASCs, a 72% increase in dialysis centers, and approximately 1.2 billion outpatient visits per year.
  • Perz spoke about the incidents in the past decade including the oncology unit in Nebraska that infected 99 patients with hepatitis C by reusing syringes during flush procedures, and the infamous Nevada endoscopy infection control breach in which 40,00 patients were notified of possible hepatitis C, hepatitis B, and HIV infections.
  • Perz spoke candidly about the infection prevention ignorance in these cases. “The idea of removing the needle from the syringe is interesting,” Perz said with a bit of disbelief, noting that there are studies that date back a number of years that show this procedure transmits  infection.
  • He also condemned the practice of using a dirty syringe to draw more propofol from a bag, which was the standard of care for the Nevada endoscopy clinic. “In the end what’s the savings, 17 cents per syringe?” he said.
  • Perz used restaurants as an analogy. When you go out to eat anywhere in the country you can be reasonably sure you are protected from infected food, but currently we don’t have that for most of healthcare.
  • Perz acknowledged the need for basic infection control education. He also commented in the Q&A portion that they are increasingly seeing demands for criminal prosecution and liability for facilities that don’t comply with basic infection control procedures.

The second speaker was Angela Brice-Smith, RN, BSN, MPA, the deputy director of the survey & certification group at CMS. Brice-Smith focused on CMS efforts to address IC deficiencies in ASCs.

  • Brice-Smith also recognized this was one of the fastest growing areas of healthcare, which was part of the reason CMS decided to focus on it. Roughly 3,300 ASCs participated in Medicare in 2001, compared to 5,200 today.
  • She explained that CMS conducted surveys in 2008 in Nevada and found that 64% of ASCs had condition-level problems, and five were terminated because of IC deficiencies.
  • CMS than wanted to know if this was a state anomaly. It wasn’t, and a pilot study in Maryland, North Carolina, and Oklahoma told them 85% of ASCs inspected had deficient practices, 19% of which were serious.
  • Brice-Smith cited reuse of vials for anesthesia, unlabeled syringes, improper sterilization of surgical instruments, and disinfection and sterilization as major deficiencies.
  • Because of these numbers CMS received funding from HHS to increase surveys and develop new IC survey tools with the CDC.
  • CMS has also found IC problems with nursing homes and dialysis centers, and that its “safe to say more initiatives are coming,” in regards to these settings.

The last presenter was Chesley Richards, MD, MPH, the deputy director of the Division of Healthcare Quality Promotion in the National Center for Infectious Diseases at the CDC. He focused mainly on pay for performance initiatives to promote prevention measures.

  • He noted that obviously if you incentivize performance there needs to be significant funding.
  • The studies the CDC has done so far show that pay for performance initiatives don’t decrease infections all that much more than public reporting.
  • Some of the pay for performance options included: relative rank, relative rank with penalties, target attainment, target attainment plus improvement, percentage improvement. However, he still wasn’t sure which method would work best.
  • Richards reiterated the point Dr. Peter Pronovost made in his opening remarks that IPs will be challenged to get clinicians more involved and hold them accountable.
  • Richards also said the because the infection prevention department generates and owns infection data, that group will have tremendous responsibility if a pay for performance format came into play. “It puts a lot of pressure on the validity of those numbers… the CEO may not be happy with what you are presenting and you have to stand by it,” Richards said.

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