APIC Offers Tips for Reducing Infection Risk in Outpatient Clinics
According to CDC, outpatient surgery now accounts for nearly two-thirds of all surgery visits. The settings for these freestanding health care centers often are more convenient and the turnaround time quicker than at a hospital, and, according to the Association for Professionals in Infection Control and Epidemiology, most patients who have outpatient surgery recover fine. However, because surgical wound infections can occur when germs from the skin or the environment enter the incision made during the operation and infection control issues such as unsafe injection practices and the re-use of syringes have been reported at some ambulatory care clinics, APIC has issued a set of tips that can be used by prospective patients and providers alike.
Consumers can arm themselves by asking questions before undergoing a surgical procedure or receiving care at an ambulatory facility. Among the topics APIC recommends asking about are:
- Antibiotics: Giving antibiotics before some surgeries can help to prevent an infection. Find out if and when you will receive antibiotics. As a general rule, a single dose of antibiotics should be given one hour prior to surgery. If more than one dose is given it should be discontinued in 24 hours.
- Site preparation: Discuss strategies for infection prevention with your health care team prior to surgery. Follow your doctor's instructions to shower or cleanse your surgical site with a special product (e.g., chlorhexidine) before arriving for surgery or other invasive procedures to remove bacteria from your skin. Ask your surgeon what product he or she uses to clean the skin before he or she makes the first cut. These prep solutions are most effective when they contain two active ingredients, one of which should be alcohol. Ask your surgeon how he or she preps the surgical site--for example, does he or she clip rather than shave the hair? You should not shave the area where you are having surgery. Shaving with a razor irritates the skin and therefore increases the likelihood of infection.
- Warmth: Recent studies have shown that keeping patients warm during and after surgery may improve outcomes. Ask if maintaining normal body temperature will be an issue during your procedure, and, if so, how you will be kept warm before, during, and after surgery.
- Glucose control: Maintaining blood glucose (sugar) control during and for two days after surgery may reduce the risk of complications and improve your outcome. Ask the surgeon if glucose control is an issue for your procedure and, in particular, if you have diabetes, find out how your blood sugar levels will be managed during and after surgery.
- Smoking cessation: If you are a smoker, consider a smoking cessation program. This will reduce your chances of developing an infection after surgery and will increase your body’s ability to heal.
- Hand hygiene: Hand hygiene is the most effective way of preventing the spread of infection. The chances of developing an infection can be significantly reduced if health care staff cleanse their hands before and after examining patients. Please ask health care staff who come to examine you if they have washed their hands or used the alcohol hand rub. Do not feel embarrassed or awkward when requesting this information as they welcome your help in keeping you safe. As a patient, you should also practice good hand hygiene after using the bathroom, before eating, after shaking hands, after blowing your nose, and before and after touching the bandage on your surgical incision. This applies to visitors and care providers at home as well.
- Protective gear: Personal protective equipment such as gowns, head cover, masks, gloves, and goggles are worn by health care workers to reduce the transmission of microorganisms (germs) that could cause infection. Be sure to ask if health care workers, including the surgeons, wear protective apparel when performing sterile procedures.
- Safe injection practices: In 2008, more than 60,000 people were notified of their risk of hepatitis C due to reuse of syringes at a Nevada endoscopy clinic. There have also been reports of reuse of finger stick devices and insulin injection devices meant for individual use. Reused syringes can transport tiny fragments of a patient’s blood to the next medication vial, potentially infecting other patients. Syringes and needles must be used one time only. Before receiving an injection, ask if the needle and syringe have been newly opened for you. Inquire if the center uses single-dose vials of medication or multi-dose vials with strict controls. If they use multi-dose vials, ask if they unwrap a new syringe and needle for each dose of medication. If you will receive intravenous fluids, ask that they do not use the bag for other patients or set up the intravenous tubing until they are ready to administer to you.
After the surgery, APIC recommends making sure you understand what to expect during recovery, both at the facility and at home. Ask who will be responsible for your care after you are discharged and who to contact with questions. If you have a wound, make sure you receive instructions for wound care. Contact your doctor right away if, after you leave the center, you develop one or more of the following symptoms of infection:
- the skin around your wound gets red and/or sore, or it feels hot and swollen
- your wound has a green or yellow colored discharge (pus)
- you feel generally unwell or feverish, or you have a temperature
APIC notes that while most procedures go smoothly, it is important to find out how the facility is prepared to handle a potential emergency. For instance, are personnel certified in CPR? Ask what would happen if you developed complications and required emergency care. In addition, some states require ambulatory care facilities to have a license to perform certain procedures. Ask if the procedure you are having is required to be done at a licensed facility and if this center has such a license.
For the complete report, "Reduce Your Risk of Infection Before an Ambulatory Procedure," click here.