According to the Center's for Disease Control (or CDC), doctor offices must do a better job at preventing infections acquired by patients in their offices. The CDC's caution comes on the heels of repeated infection outbreaks uncovered by the Centers for Medicare and Medicaid. As a Chicago medical malpractice lawyer, I am troubled by the outbreak of these infections when the measures that need to be taken to greatly reduce if not prevent them are neither difficult nor complicated. As described below, these infection prevention measures simply require diligence.
There are many types of infections that can develop in the human body. Healthcare associated infections are infections that are not present at the time the patient goes into the hospital or doctor's office. Most infections that become (clinically) evident after 48 hours of hospitalization or an doctor's office visit may be considered hospital or healthcare acquired infections. These infections can be localized to a part of the body or systemic, involving a system of the body.
The deputy director of the CDC, Dr. Michael Bell, says the pattern of infection outbreaks at doctor offices shows there is ample room for improvement. In a press release, Dr. Bell explained "[p]atient's deserve the same basic levels of protection in a hospital or any other healthcare setting." He went on to state the "[f]ailure to follow standard precautions, such as correct injection practices, cannot be tolerated."
According to the CDC, there are a number of measures that should be taken to reduce the risk of infection. These measures include:
1. Ensure that at least one individual with infection prevention training is employed by or regularly available to the facility.
2. Go beyond Occupational Safety and Health Administration (OSHA) requirements for blood-borne pathogen training for infection prevention programs.
3. Develop practice-appropriate written infection-prevention polices and procedures based on evidence-based guidelines, regulations, or standards.
4. Provide job or task specific infection prevention education and training to all healthcare personnel, including volunteers and those employed outside agencies, at orientation and annually or on a regular basis.
5. Follow procedures for the safe handling of potentially contaminated medical equipment and for the use of personal protective equipment (such as gloves, gowns, and face masks).
6. Make sure sufficient and appropriate supplies necessary for adherence to standard precautions available.
7. Regularly audit staff adherence and competency on infection prevention practices.
8. Use the CDC infection prevention checklist.
9. Adhere to local, state, and federal requirements regarding healthcare-associated infection surveillance, reportable diseases, and outbreak reporting.
For medical equipment, the CDC recommends the following measures:
1. Sterilization prior to use for surgical instruments and other tools that enter sterile tissue or the vascular system.
2. Sterilization or at least high-level disinfection for items like endoscopes that contact mucous membranes or breaks in the skin.
3. Clean away debris before disinfection or sterilization.
One example cited by the CDC occurred at an endoscopic clinic in Nevada. Investigators found that medical staff not only contaminated vials of propofol by double-dipping to draw additional doses during procedures but also reused those same vials intended for single dose to other patients. These vials have labels. The labels clearly state they are not to be used for multiple doses or must only be used for single doses. The fact some healthcare providers routinely ignore these safety measures is gross medical malpractice and recklessly endangers the lives of their patients. Unfortunately, the consequences of ignore these infection prevention measures can be deadly. For these reasons, there is no excuse for a doctor's office to consciously ignore the CDC's recommendation or similar recommendations that require a little added effort but which provide a much safer medical environment for their patients.
MedPage Today, Doctor's Office Is Source of Many Infections, July 15, 2011.
Centers for Disease Control, "Guide to infection prevention for outpatient settings: Minimum expectations for safe care" CDC 2011.