Read Article: Keeping Patients Safe from Infection in Outpatient Settings Joseph
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Read Article: Keeping Patients Safe from Infection in Outpatient Settings Joseph Perz, DrPH, MA, May 11, 2012.
Hello. I am Dr. Joseph Perz from the Centers for Disease Control and Prevention (CDC), and I'm here at the Society for Healthcare Epidemiology of America (SHEA) Spring Meeting. I am here to talk to you today about infection control in outpatient settings.
The outpatient setting is an area where attention is definitely needed. The scope of care being provided in outpatient settings is wide, and the complexity and volume of care are increasing. It is important for those of us in the healthcare community, both providers and patients, to consider that we want the care that we receive, as well as that provided to our family members and loved ones, to be safe and to meet basic standards.
A point that is worth considering is that unlike acute care settings, which are subject to accreditation (unusual in the outpatient setting), we are working with an element of trust. For example, only 25% of outpatient ambulatory surgical centers are accredited.
We also lack a standard surveillance approach for healthcare-associated infections in outpatient settings. Much of what we learn comes from outbreaks of infection.[1] Examples of outbreaks that are quite disconcerting are those related to unsafe injection practices. l will give you a few examples.
One outbreak followed administration of influenza vaccines in a Colorado pediatric office. In this office, the responsibility for injecting young children with influenza vaccine was delegated to a medical assistant, and there was a lack of oversight. The assistant was using syringes to give a half-dose for the first dose (thinking that it was the adult formulation and that children would need 2 half-doses), putting the remainder aside in a box labeled "second doses," and then reusing syringes when children came back for the second injection.
I would like to share another example that occurred in a Jacksonville, Florida, hospital. This was recently reported in Annals of Internal Medicine.[2] It involved hepatitis C virus (HCV) transmission from tainted fentanyl syringes. In this case, a radiology technician had access to syringes that had been prefilled with fentanyl. This person injected himself, refilled the syringes with saline, and then patients (who received only the saline) were exposed to his HCV infection.
Yet another example involves insulin pens. These are devices that are commonly used for the convenience of patients to deliver insulin. The pens can be reused, but only for an individual patient. We have to take care that in healthcare settings, these pens are handled very carefully, such that they cannot and will not be reused for a second patient. (See Don't Do It: Sharing Insulin Pens Jeopardizes Patients.)
Another recent example came from a Wisconsin outpatient clinic where insulin pens were reused, resulted in more than 2000 patients requiring notification to seek testing for hepatitis B, HCV, and HIV.
A group of vulnerable patients who really deserve basic protections from healthcare-associated infections are cancer patients. A lot of cancer care is delivered in outpatient settings. A recent outbreak occurred in Mississippi, where it was found that clinicians were reusing syringes for more than 1 patient. This and other errors, including reusing saline bags for multiple patients, resulted in bacterial bloodstream infections.
We have many resources available at the CDC to promote safe outpatient care and to prevent infections, including a summary guide and a checklist, as well as information on safe injections.
The bottom line is that wherever medical care is delivered, patients deserve basic levels of protection from healthcare-associated infections (Perz, 2012).
**Infection Control in the Ambulatory Setting: We are thinking about Infection Control and risk reduction in Other Venues this week. The Outpatient Setting has unique Infection Prevention challenges and often staffing in the Ambulatory setting does not include a dedicated Infection Preventionist. The Centers for Disease Control has developed guidelines for this setting**
Please answer the following questions:
1. Name three reasons that infection prevention in the Outpatient setting is a challenge.
2. Discuss one outbreaks that Dr. Joseph Perz (CDC) discusses and answer the following questions about each:
What is the issue (what went wrong)?
What is the root cause of the incident?
Was there patient harm; if so, what?
Describe any education for staff that is indicated
How could this incident have been prevented?
3. Name one patient population of vulnerable patients who need protection from healthcare associated infections.
4. What are the key administrative recommendations for Outpatient Settings?
5. What are the objectives of the CDC publication, Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care?
Explanation / Answer
Ans1. The reasons are often staffing in the ambulatory setting does not include a dedicated infection preventionist.
We have also lack of standard surveillance approach for healthcare associated infections in outpatient settings.
It is also very important to educate staff about this how we can prevent from infection.
Ans2.The issue is that insulin pens are used in multiple patient this might be causes come another diseases or infection.
The root cause of the incident is as insulin is delivered inside the cells via insulin pen and this insulin pen can be reused but only to individual patient but not to another patient. So if used the same inshins pens in different person then it causes infection.
Yes offcourse there might be chances of infection like HIV, HCV, Hepatitis B etc.
This incident can be prevented by either properly disposing the insulin pens or using it for same individual.
Ans3.Cancer patient population is one of the vunerable patient s who need protection from healthcare associated infections.
Ans4.The key administrative recommendations for outpatient settings as there are many resources available at the CDC to promote safe outpatient care and to prevent infection inclidinc a summary guide and a checklist as well as information on safe injections.
Ans5.The objectives are as a summary guide and checklist as well as information on safe injections is provided.
The next one is that wherever medical care is delivered, patient deserve basic level of protection from healthcare associated infections.
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