Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop A-31, Atlanta, GA 30333, USA.
JAMA. 2010 Jun 9;303(22):2273-9. doi: 10.1001/jama.2010.744.
More than 5000 ambulatory surgical centers (ASCs) in the United States participate in the Medicare program. Little is known about infection control practices in ASCs. The Centers for Medicare & Medicaid Services (CMS) piloted an infection control audit tool in a sample of ASC inspections to assess facility adherence to recommended practices.
To describe infection control practices in a sample of ASCs.
DESIGN, SETTING, AND PARTICIPANTS: All State Survey Agencies were invited to participate. Seven states volunteered; 3 were selected based on geographic dispersion, number of ASCs each state committed to inspect, and relative cost per inspection. A stratified random sample of ASCs was selected from each state. Sample size was based on the number of inspections each state estimated it could complete between June and October 2008. Sixty-eight ASCs were assessed; 32 in Maryland, 16 in North Carolina, and 20 in Oklahoma. Surveyors from CMS, trained in use of the audit tool, assessed compliance with specific infection control practices. Assessments focused on 5 areas of infection control: hand hygiene, injection safety and medication handling, equipment reprocessing, environmental cleaning, and handling of blood glucose monitoring equipment.
Proportion of facilities with lapses in each infection control category.
Overall, 46 of 68 ASCs (67.6%; 95% confidence interval [CI], 55.9%-77.9%) had at least 1 lapse in infection control; 12 of 68 ASCs (17.6%; 95% CI, 9.9%-28.1%) had lapses identified in 3 or more of the 5 infection control categories. Common lapses included using single-dose medication vials for more than 1 patient (18/64; 28.1%; 95% CI, 18.2%-40.0%), failing to adhere to recommended practices regarding reprocessing of equipment (19/67; 28.4%; 95% CI, 18.6%-40.0%), and lapses in handling of blood glucose monitoring equipment (25/54; 46.3%; 95% CI, 33.4%-59.6%).
Among a sample of US ASCs in 3 states, lapses in infection control were common.
美国有超过 5000 家门诊手术中心（ASC）参与了医疗保险计划。但人们对 ASC 的感染控制实践知之甚少。医疗保险和医疗补助服务中心（CMS）在 ASC 检查中试点了感染控制审计工具，以评估设施对推荐实践的遵守情况。
描述样本中 ASC 的感染控制实践。
设计、地点和参与者：邀请所有州调查机构参与。有 7 个州自愿参与；根据地理分布、每个州承诺检查的 ASC 数量以及每次检查的相对成本，选择了 3 个州。从每个州中选择 ASC 的分层随机样本。样本量基于每个州在 2008 年 6 月至 10 月期间估计能够完成的检查数量。对 68 个 ASC 进行了评估；马里兰州 32 个，北卡罗来纳州 16 个，俄克拉荷马州 20 个。CMS 的调查员接受了使用审计工具的培训，评估了对特定感染控制实践的遵守情况。评估重点关注感染控制的 5 个领域：手部卫生、注射安全和药物处理、设备再处理、环境清洁以及血糖监测设备的处理。
每个感染控制类别中出现失误的设施比例。
总体而言，68 个 ASC 中有 46 个（67.6%；95%置信区间[CI]，55.9%-77.9%）至少有 1 次感染控制失误；68 个 ASC 中有 12 个（17.6%；95%CI，9.9%-28.1%）在 5 个感染控制类别中有 3 个或更多类别出现失误。常见的失误包括为不止 1 名患者使用单剂量药物小瓶（64 例中的 18 例，28.1%；95%CI，18.2%-40.0%）、未遵守设备再处理的推荐实践（67 例中的 19 例，28.4%；95%CI，18.6%-40.0%）以及血糖监测设备处理失误（54 例中的 25 例，46.3%；95%CI，33.4%-59.6%）。
在 3 个州的美国 ASC 样本中，感染控制失误很常见。
