Study: Lax infection control at surgery centers

[June 09, 2010]  CHICAGO (AP) -- A new federal study finds many same-day surgery centers -- where patients get such things as foot operations and pain injections -- have serious problems with infection control.

Failure to wash hands, wear gloves and clean blood glucose meters were among the reported breaches. Clinics reused devices meant for one person or dipped into single-dose medicine vials for multiple patients.

The findings, appearing in Wednesday's Journal of the American Medical Association, suggest lax infection practices may pervade the nation's more than 5,000 outpatient centers, experts said.

"These are basic fundamentals of infection control, things like cleaning your hands, cleaning surfaces in patient care areas," said lead author Dr. Melissa Schaefer of the Centers for Disease Control and Prevention. "It's all surprising and somewhat disappointing."

The study was prompted by a hepatitis C outbreak in Las Vegas believed to be caused by unsafe injection practices at two now-closed clinics.

It's the first report from a push to more vigorously inspect U.S. outpatient centers, a growing segment of the health care system that annually performs more than 6 million procedures and collects $3 billion from Medicare. Procedures performed at such centers include exams of the esophagus, colonoscopies and plastic surgery.

U.S. Health and Human Services Secretary Kathleen Sebelius said in a statement that her department is expanding its hospital infection control action plan to include ambulatory surgical centers and dialysis centers.

In the study, state inspectors visited 68 centers in Maryland, North Carolina and Oklahoma. They used a new audit tool focusing on infection control. At each site, inspectors followed at least one patient through an entire stay. Inspections weren't announced ahead of time, but staff were notified once inspectors arrived.

The new study found 67 percent of the centers had at least one lapse in infection control and 57 percent were cited for deficiencies. The study didn't look at whether any of the lapses actually led to infections in patients.

"These people knew they were under observation, had the opportunity to be on their best behavior and yet these lapses were still identified, some of which potentially are very dangerous and have been warned against explicitly," said Dr. Philip Barie of Weill Cornell Medical College in New York. Barie was not involved in the study but wrote an accompanying editorial in the journal.

A few centers in the study hadn't been inspected in 12 years. State agencies have the main responsibility for making sure centers comply with federal standards, but states often fall behind.

In the Nevada outbreak, officials notified 63,000 patients that they might have been exposed to blood-borne diseases. Nine cases of hepatitis C were linked to the clinics; more than 100 other cases also may be related.

States now are required to use the new audit tool to inspect centers participating in Medicare. Of surveys using the tool so far, 61 percent of centers have been cited for an infection control deficiency.

The new findings will cause centers to "redouble our efforts to improve patient care," said Dr. David Shapiro of the Ambulatory Surgery Center Association, a trade group. "Any incident is one too many."

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Online:

JAMA: http://jama.ama-assn.org/

[Associated Press; By CARLA K. JOHNSON]

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