What can we learn from the US on Infection Prevention in outpatient settings?


The USA’s Centre for Disease Control and Prevention (CDC) has issued a new concise guide and checklist on infection control. The aim of the guide and its recommendations is to protect patients by informing clinicians of minimal expectations of safe care, with a particular focus on healthcare that is provided in outpatient-type settings.

There is a concern in the US that compliance with standard infection prevention practices is often poorer in outpatient facilities, which include endoscopyclinics, surgical centres, primary care locations, pain management clinics, urgent care centres, public health clinics, imaging centres, oncology clinics, outpatient behavioural health and substance abuse clinics, physical therapy and rehabilitation centres, and also hospital-based outpatient departments and clinics.

“Patients deserve the same basic levels of protection in a hospital or any other health care setting,” said Michael Bell, deputy director of CDC’s Division of Healthcare Quality Promotion, in a news release. “Failure to follow standard precautions, such as correct injection practices, cannot be tolerated. Repeated outbreaks resulting from unsafe practices, along with breaches of infection control noted in ambulatory surgical centres during inspections by the Centres for Medicare and Medicaid, indicate the need for better infection prevention across our entire health care system, including outpatient settings.”

In the United States, clinicians at outpatient facilities currently perform more than 75% of all surgical procedures. Between 1995 and 2007, the average number of outpatient visits to physician offices was 3 per person per year, resulting in a total of nearly 1 billion physician office visits by 2007.

Because a significant proportion of outpatients come from vulnerable patient populations, it is essential that clinicians offer care under conditions that minimize the risk for healthcare-associated infections (HAIs).

On the basis of currently available, evidence-based CDC guidelines mostly used by hospitals but applicable to a variety of healthcare settings, the easy-reference guide uses Standard Precautions as the foundation to prevent transmission of infectious agents during patient care in all healthcare settings. Accompanying materials include an Infection Prevention Checklist for Outpatient Settings and supporting materials.

One of the leading recommendations in the new guide is that all outpatient practices should designate 1 or more individuals specifically trained in infection control to be on staff or regularly available. The infection control leader(s) should play an important role in developing a written policy to prevent and contain infection and should regularly communicate with the other healthcare providers regarding specifically identified issues or concerns.

Other Recommendations

Other recommendations for outpatient facilities and practices include the following:

  • Infection prevention and occupational health programs should be developed, implemented, and maintained.
  • Written infection prevention policies and procedures, based on evidence-based guidelines, regulations, or standards, should be developed to address services provided by each facility.
  • All healthcare personnel, including those employed by outside agencies and available by contract or on a volunteer basis to the facility, should receive job- or task-specific infection prevention education and training focusing on principles of both healthcare provider safety and patient safety.
  • Sufficient and appropriate supplies needed to comply with standard precautions should always be available. These precautions should include hand hygiene, use of personal protective equipment, safe injection practices, respiratory precautions, cough etiquette, and environmental cleaning and maintenance of reusable medical equipment according to the maker’s instructions.
  • Staff’s compliance with infection prevention practices should be monitored regularly with audits and competency evaluations.
  • To evaluate infection control practices, facilities should use CDC’s infection prevention checklist for outpatient settings.
  • Facilities should comply with local, state, and federal requirements regarding HAI surveillance, reportable diseases, and outbreak reporting.
  • Healthcare personnel should always follow procedures to ensure safe handling of medical equipment that may be contaminated.
  • Healthcare personnel should always follow safe medical injection practices.

Additional resources, including the guide, checklist, continuing medical education course, CDC and external commentary about the guide, clinician and patient education materials, a CDC Safe Surgery feature, and other supporting materials are available in the guidelines.