Infection control assessment of ambulatory surgical centers.
BACKGROUND
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.


METHODS
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.


METHODS
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%).


CONCLUSIONS
Among a sample of US ASCs in 3 states, lapses in infection control were common.
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop A-31, Atlanta, GA 30333, USA. mschaefer@cdc.gov
Melissa K
MK
Schaefer
Michael
M
Jhung
Marilyn
M
Dahl
Sarah
S
Schillie
Crystal
C
Simpson
Eloisa
E
Llata
Ruth
R
Link-Gelles
Ronda
R
Sinkowitz-Cochran
Priti
P
Patel
Elizabeth
E
Bolyard
Lynne
L
Sehulster
Arjun
A
Srinivasan
Joseph F
JF
Perz
D000554:Ambulatory Care Facilities / Q000592:standards*; D000556:Ambulatory Surgical Procedures; D017743:Equipment Reuse; D019538:Health Care Surveys; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000592:standards*; D008396:Maryland; D008485:Medical Audit; D006278:Medicare / Q000706:statistics & numerical data; D009657:North Carolina; D009825:Oklahoma; D014481:United States