AORN Journal
Volume 88, Issue 6 , Pages 891-892, December 2008

Targeting Zero: Preventing Infections in Ambulatory Settings

Director of infection control, Downstate Medical Center, Brooklyn, NY

Article Outline

 

Infection preventionists across the nation are fervently implementing a paradigm shift. The shift from controlling the transmission and spread of infections to preventing them—or, to put it more succinctly, from benchmarking to zero tolerance—is aimed at eliminating health care-associated infections (HAIs).

Can all HAIs be eliminated? The simple answer is no. Les Brown, a renowned public speaker, author, and television personality, gives us an apt quotation, however: “Shoot for the moon. Even if you miss, you'll land among the stars.” Increasingly, we are being made aware of institutions that have eliminated some infections (eg, had no central catheter-associated bloodstream infections for periods of up to 18 months1) by endorsing the concept of “zero tolerance” and implementing evidence-based practices. Can zero tolerance for infections work in an ambulatory surgery setting?

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Incidence of Infection 

According to the Centers for Disease Control and Prevention, HAIs account for an estimated 1.7 million infections and 99,000 related deaths each year.2 Of these HAIs, 32% are urinary tract infections, 22% are surgical site infections, 15% are lung infections, and 14% are bloodstream infections.2

All of these categories of infection can and do occur in ambulatory surgery settings. Additionally, more than 60% of elective procedures in the United States are currently performed as outpatient, ambulatory procedures.3 Health experts predict that this percentage will increase to nearly 75% over the next decade.3 Consequently, managers in ambulatory surgery settings should expeditiously embrace the concept of zero tolerance to enhance patient safety and maximize compliance with their fiscal responsibilities.

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Implementing Zero Tolerance 

Implementing zero tolerance in the ambulatory surgery environment begins with recognizing that performing proper hand hygiene, maintaining asepsis, and implementing evidence-based practices is crucial. Managers must ensure that the physical environment has been engineered to accommodate compliance with recommendations for hand hygiene.4 Stations for alcohol-based, waterless hand hygiene products should be available in areas where sinks are not accessible and where contact with patients' nonintact skin or mucous membranes may occur. These products are safe and effective and can be used as long as the hands are not visibly soiled.5

Maintaining asepsis is essential to ensure patient safety and increase the potential for positive outcomes. The likelihood of a bloodstream infection is decreased if aseptic techniques are employed—for example, using a full body drape to create maximal barrier sterility when inserting central catheters.6 The likelihood of a patient developing a urinary tract infection is decreased if personnel wash their hands and don sterile gloves before the procedure and the patient's urinary catheter is inserted using sterile technique.7 The potential for lung infection and surgical site infection is decreased when all personnel use aseptic technique when handling tissue and mucous membranes.8 Managers must ensure that these simple procedures are followed every time. There must be zero tolerance for deviation from standard practices.

Zero tolerance for infection in the ambulatory surgery environment is more than a passing fad. It can easily be implemented by managers through prudent engineering changes and a realization that maintaining aseptic procedures and implementing simple evidence-based practices will likely result in a reduction in HAIs. Infections are indeed preventable in the ambulatory surgery setting.

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References 

  1. Provonost P , Needham D , Berenholtz S , et al.   An intervention to decrease catheter-related bloodstream infections in the ICU . New Engl J Med . 2006;355(26):2725–2732
  2. Centers for Disease Control and Prevention  . Estimates of healthcare-associated infections . http://www.cdc.gov\ncidod\dhqp\hai.html Accessed October 27, 2008.
  3. eMedicineHealth  . Outpatient surgery . http://www.emedicinehealth.com/outpatient_surgery/article_em.htm Accessed October 31, 2008.
  4. Centers for Disease Control and Prevention  . Guideline for hand hygiene in health care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force . MMWR Morb Mortal Wkly Rep . 2002;51(RR-16): http://www.cdc.gov/mmwr/PDF/rr/rr5116.pdf Accessed October 31, 2008.
  5. Allen G . Hand hygiene, an essential process in the OR [Guest Editorial] . AORN J . 2005;82(4):561–562
  6. Centers for Disease Control and Prevention  . Guidelines for the prevention of intravascular catheter-related infections . MMWR Morb Mortal Wkly Rep . 2002;51(RR-10): http://www.cdc.gov/mmwr/PDF/rr/rr5110.pdf Accessed October 31, 2008.
  7. Centers for Disease Control and Prevention  . Guideline for prevention of catheter-associated urinary tract infections . http://www.cdc.gov/ncidod/dhqp/gl_catheter_assoc.html Published February 1981. Accessed October 31, 2008.
  8. Mangram AJ , Horan TC , Pearson ML , Silver LC , Jarvis WR , The Hospital Infection Control Practices Advisory Committee  . Guideline for the prevention of surgical site infection . Infect Control Hosp Epidemiol . 1999;20(4):231–232 http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/SSI.pdf Accessed October 31, 2008.

PII: S0001-2092(08)00770-9

doi:10.1016/j.aorn.2008.11.015

AORN Journal
Volume 88, Issue 6 , Pages 891-892, December 2008

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