What are You Learning From Your Infection Control Rounds?
By Deborah Mack, RN, CASC, CAIP
As I prepare ASCs for survey readiness (e.g., Centers for Medicare & Medicaid Services (CMS), Accreditation Association for Ambulatory Health Care, The Joint Commission), I continue to witness problems with infection control breaches. Most of the issues concern hand hygiene, injection safety, environmental cleaning and proper disinfecting of endoscopes.
Hand hygiene should not just be a topic for a quality assurance and performance improvement (QAPI) study. Random observations of all staff and credentialed providers should be an ongoing part of your ASC’s quality program. I often ask about hand hygiene and a clinical director will say, “We did a QAPI study on that last year.” I recommend completing at least 10 observations monthly and reporting your findings.
If you identify a specific population not using proper hand hygiene, focus on that area for education. For example, scrub techs or anesthesia providers may not be washing their hands after they take their gloves off.
Even though injection safety has been discussed at length in the media and CMS has focused on the issue for several years, there continues to be deficiencies. I recently witnessed an anesthesiologist carrying an emesis basin full of pre-drawn syringes from room to room. In another instance, the rubber septum was not being wiped with alcohol prior to inserting the needle.
Last, but not least, multi-dose vials are still found in anesthesia carts, open and not dated. The most common is Labetalol, which does not come in a multi-dose vial.
I recommend checking anesthesia carts at the end of every day. All staff should be part of infection control monitoring and not be afraid of notifying leadership if they observe a breach in safe medication practice.
I sometimes arrive at facilities and, during my walkthrough, find a clinical director complaining about poor housekeeping service. When asked how often the clinical director watches the housekeeping staff clean the facility, the typical response: “Never.”
I recommend the ASC’s infection control practitioner (ICP) monitor the cleaning service, even if it is late in the evening, at least annually and whenever there is a concern.
Housekeeping should be provided with a comprehensive daily/weekly/monthly cleaning checklist. When evaluating your janitorial cleaning service, ask for documentation on its current infection control training. If you are using your own staff to terminally clean, ensure there is a current competency for each employee that includes an understanding of the proper use of all cleaning solutions. There are quite a few solutions that must be diluted, so they will need to know the dilution ratio.
For some facilities performing endoscopy cases, there remain issues with cleaning the endoscopes properly and proper transporting of the scopes after the case to the decontamination room. Endoscopes must be pre-cleaned at the bedside. There are specific cleaning instructions for use for each type of endoscope. The endoscopes must be covered and transported correctly and with a biohazard sign to the decontamination room.
Staff sometimes lack current competencies concerning the cleaning process and use of the automatic endoscope processor. There should also be documentation of quality controls related to the chemicals used according to the manufacturer’s recommendations.
Value of Rounding
As the ICP, you should be rounding at least quarterly or monthly if you work in a busy center. If you are not yet an infection control and prevention expert, take the opportunity to spend time in your operating rooms, sterile processing and endoscopy suite to learn best practices from your staff.
It takes constant diligence and continuing education and training of staff to maintain a safe environment for your patients. To have an effective infection control program, collect your data and provide this information to your QAPI committee. This committee can provide support and help strategize on how to improve performance and outcomes.
Deborah Mack, RN, CASC, CAIP, is founder of Quality and Risk Solutions (QRS) in Littleton, Colorado. Write her at firstname.lastname@example.org.