New Infection Prevention Guidance for Outpatient Settings

Melissa Schaefer, MD

From CDC Expert Commentary

Hello, I'm Dr. Melissa Schaefer, medical officer in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention. I'm pleased to speak with you today as part of the CDC Expert Video Commentary Series on Medscape about a new Infection Prevention Guide for Outpatient Settings just released by the CDC.
Over the last several decades, we have focused our attention on preventing infections in acute care settings and have seen tremendous successes. However, as healthcare continues to transition to settings outside the hospital, we need to extend our efforts and successes to all settings where patients are receiving care. CDC's new Infection Prevention Guide for Outpatient Settings distills existing evidence-based recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee. The recommendations included in this guide represent the minimum expectations for safe care, both for patients and healthcare personnel, in every outpatient setting.
As a clinician myself, I have helped investigate numerous outbreaks in outpatient settings and am concerned that these likely represent the tip of the iceberg with respect to bad practices happening in our healthcare system. For example, as part of an outbreak investigation at an endoscopy clinic in Nevada, providers were noted to reuse syringes to enter vials of propofol to obtain additional doses during a procedure. This practice contaminated the contents of the vials and those single-dose vials, which should have been discarded at the end of the procedures, were then used for subsequent patients. This unsafe practice led to transmission of hepatitis C virus to at least 7 patients on 2 separate days and more than 40,000 patients were notified that they may have been exposed to a blood-borne virus. Events like this continue to surface and cause us great concern at CDC. No patient should be subjected to these kinds of risks, which are completely preventable through adherence to standard precautions.
Although the recommendations contained in this guidance are not new, it provides a clear, concise, evidence-based resource designed specifically for infection prevention in outpatient settings. This new, 16 page document outlines the key policies, procedures, and practices that outpatient settings should have in place in order to deliver safe care.
Recommendations highlighted in the guidance focus on key components of standard precautions, including the following:

1. Good hand hygiene, including use of alcohol-based hand rubs and hand washing with soap and water, is critical to reduce the risk of spreading infections in outpatient settings.
2. Safe injection practices must always be followed. Healthcare personnel should use aseptic techniques when preparing and administering medications, and syringes and needles should not be reused either from patient to patient or to reenter medication vials.
3. Establish and follow procedures for the safe handling of potentially contaminated medical equipment. Reusable medical equipment should be cleaned and reprocessed appropriately prior to use on another patient, and equipment that is labeled for "single patient use" should be appropriately discarded after use.

Healthcare should provide no avenue for the transmission of potentially life-threatening infections. As healthcare professionals, we must recognize our responsibility to implement safe care practices. By working together, we can ensure that safe practices are understood and followed by all. We urge you to use this guidance document to assess the practices in your facility to ensure that patients are receiving the safe care that they expect and deserve.
To review the complete Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care follow the link or see the resources on this page.