The Centers for Medicare and Medicaid Services (CMS) provides regulatory oversight to over 5,000 ambulatory surgical centers (ASCs) in the United States. Oversight includes inspection of ASCs to assure compliance with health and safety standards. However, inspections have not formally assessed infection control and little is known about infection control practices in ASCs. Recently, CMS collaborated with the Centers for Disease Control and Prevention (CDC) to pilot a new audit tool to assess adherence to infection control as part of the inspection process.
To describe infection control practices in a sample of ASCs.
Inspections using the new audit tool to assess compliance with CMS ASC health and safety standards including specific infection control practices were completed in a convenience sample of ASCs in three states between June-October 2008. Surveyors were trained to use the new tool and instructed to observe at least one procedure during each inspection. Presence of infection control lapses related to hand hygiene, injection and medication safety, equipment reprocessing, environmental cleaning, and handling of blood glucose monitoring equipment were documented. Infection control lapses were stratified by facility type (i.e., single-purpose endoscopy vs. all others) and number of procedures performed per month (i.e., ≤ 200 vs. > 200 procedures).
A total of 68 ASCs was assessed during the pilot; 32 in Maryland, 16 in North Carolina, and 20 in Oklahoma. The ASCs performed a median of 210 (range 3-1260) procedures per month. Thirty-one percent of ASCs were single-purpose endoscopy centers. Two-thirds (68%) of the pilot ASCs had at least one lapse in infection control noted by surveyors; 18% had lapses identified in three or more of the five categories evaluated by surveyors. Proportion of facilities with lapses identified in each category and examples of specific infection control lapses documented are summarized in Table 1. There were no statistically significant associations between presence of a lapse in each infection control category and number of procedures performed per month or facility type.
Results from the pilot suggest that adherence to infection control in this sample of ASCs was suboptimal. As of October 1, 2009, the infection control audit tool became a routine part of all ASC inspections conducted by CMS. Documented lapses are being cited by CMS and facilities are required to correct deficient practices. ASCs are encouraged to review the new audit tool, related requirements, and evidence-based guidelines as part of efforts to ensure adherence to basic infection control and enhance patient safety.