Infection prevention is a major focus of the ASC industry today. Although many patients are choosing the efficiency and quality of ambulatory security centers over other options, doubts linger over whether the precautions used are keeping them safe from infection. High-profile cases like the death of comedian Joan Rivers in 2014 (which arose from therapeutic complications following an outpatient procedure at a free-standing surgical center) have raised concerns that ASCs may not be as prepared to deal with the issue of infection prevention as they believe they are.
However, it’s difficult to determine the efficacy of infection prevention at ASCs because there is surprisingly little data on the subject. Unlike hospitals, outpatient surgical centers are not officially required to track infections associated with care procedures, and even though many do, there are no federal mechanisms in place to aggregate key data and use it to identify large-scale issues that are trending across the industry. At the moment, circumstances place the burden of addressing infection prevention squarely on individual ASCs. And if those ASCs want to continue to enjoy their current popularity, it’s not a burden they can afford to shrug off.
A recent article from the Association of periOperative Registered Nurses highlights the following five key reasons why every ASC needs to make infection prevention a top priority.
The stakes are higher due to more complex procedures.
Historically, ASCs tended to offer fairly straightforward procedures to relatively healthy patients, thus greatly minimizing the risk of infection. But today, more and more ASCs have expanded the scope of their offerings, performing more complex procedures like colon and gynecological surgeries. But these specialized procedures come with new and different risk factors that may pose a greater challenge for ASCs than for hospitals, which are more accustomed to dealing with a broader range of patient conditions.
New instrumentation comes with new challenges.
Not only are the procedures themselves posing new potential infection risks, so too is the complex instrumentation required by such procedures. While the development of intricate and more sophisticated instrumentation has made it possible to perform many surgical procedures more quickly and efficiently and with minimal invasion—indeed, this is one of the factors that has allowed complex procedures to move from a hospital to an outpatient setting in the first place—it can be more challenging, regardless of setting, to ensure that such instrumentation is properly cleaned, disinfected, and sterilized. Robotic instruments, for example, are particularly difficult; the journal Infection Control & Hospital Epidemiology recently published a study illustrating the challenges of properly processing robotic instruments to prevent infection transmission.
Regulators are increasing scrutiny.
Throughout the health care industry, including the ASC sector, regulatory agencies are focusing much more closely on infection prevention. While ASCs are still exempt from having a certified infection prevention professional on the premises, according to regulations established by the Centers for Medicare & Medicaid Services, all ASCs must have an appropriate infection prevention program in place that complies with certain standards and requirements and is overseen by a designated ASC staff member. Accreditors and their surveyors pay close attention to these programs to ensure that ASCs are taking compliance seriously.
Infections come with financial ramifications.
Preventing infections is primarily a patient safety issue for ASCs, but increasingly, it’s becoming a financial issue as well. As the health care system continues its shift towards value-based care, Medicare reimbursement for ASCs is becoming more closely linked to outcomes. This means that treatment for avoidable healthcare-associated infections, such as surgical site infections, may no longer qualify for reimbursement.
Individuals responsible for infection prevention need time and training.
A final reason why ASCs need to make infection prevention a priority is that it takes time and training to ensure that it’s being handled properly. Developments in surgical procedures, instrumentation, technology, and infection prevention products are happening at a rapid rate, and ASC staff members who are tasked with implementing infection prevention initiatives need dedicated time and support to stay abreast of these developments. This means that infection prevention also needs to be considered from a staffing perspective. In other words, for an infection prevention program to be as credible and effective as possible, ASCs must determine whether they have people with the appropriate expertise already on staff, and if so, whether those people have the capacity to take on infection prevention duties or need to be assigned to different roles.
Fortunately, ASCs that are struggling with the question of how to address infection prevention have resources to turn to. The ASC Quality Collaboration, an industry association formed in 2006, is dedicated to supporting health care quality and safety throughout the ASC industry. As part of their work, they offer a number of toolkits on different aspects of infection prevention, along with many other health and safety resources.