By Crissy Benze, MSN, BSN, RN
Progressive Surgical Solutions
As busy Clinical Directors and Infection Control Coordinators, constant attention is required to ensure our ambulatory surgery center (ASC) policies and procedures for infection control (IC) are kept up-to-date.
Though IC is incorporated into ASCs required Quality Assessment and Performance Improvement (QAPI) programs for Medicare, and we work to ensure that all ambulatory care staff remain compliant, there are still some commonly overlooked elements of IC programs.
First and foremost is to ensure that ALL ambulatory care medical and facility staff members understand the concept of Standard Precautions, which are designed to reduce the risk of transmission from both recognized and unrecognized sources of infection. Standard Precautions apply to all patients regardless of their diagnosis or suspected infection status. The basic rule of thumb is to consider all your patients as ‘infected’ and treat them with the highest level of precaution.
Standard Precautions include the following:
- hand hygiene
- personal protective equipment (PPE)
- safe injection practices
- personnel safety
- patient placement
- patient care equipment
- care of the environment
Staging the OR
With Standard Precautions practices in mind, there should be only minimal supplies actually kept in the operating room (OR). Any supplies maintained in the OR should be stored in cabinets and drawers or covered carts. Supplies for subsequent patients should be kept covered and not exposed until the time of surgery.
Timing must be just as precise with regard to cleaning. As a general rule, ORs must be cleaned between each surgical patient, but the cleaning should not start until the previous patient and soiled instruments leave the room. The next patient should not enter the OR until it is cleaned, per facility protocol.
Finally, we must adhere to specific traffic patterns in the surgical suite. The ASC’s space planning and layout was created with these traffic patterns in mind. There are three designated areas, defined by the activities performed in each one:
- unrestricted areas
Restricted areas include ORs and other procedural areas in which operative or other invasive procedures are performed. Medical and facility staff in restricted areas must wear appropriate surgical attire, including hair covering. Masks must be worn and the doors should be opened minimally when sterile supplies are open.
It is easy sometimes to be focused on the big elements of our facility IC programs, but it is so important to not forget the less obvious protections. This can mean the difference between a positive patient outcome and a post-op infection. Hand hygiene, PPE, safe injection practices, traffic patterns, and more are all key elements!
A great place to keep abreast of the latest developments impacting ambulatory care Infection Control and Prevention issues is The Joint Commission’s Healthcare Acquired Infections Portal.