A study published in the Journal of the American Medical Association concludes that infection mistakes are common at U.S. outpatient surgical centers, where procedures such as colonoscopies take place. The research suggests that millions of patients may be at risk of contagion.
More than half of 68 Maryland, North Carolina and Oklahoma day-surgery centers in the study were cited for inadequate procedures, such as lack of hand washing and failure to disinfect blood-glucose meters. Several million patients annually may be exposed to infection at the more than 5,000 centers in the U.S.
The study considers the risks at outpatient centers, as compared to hospitals. About 1.7 million infections occur annually at hospitals, leading to about 100,000 deaths for in-patients, according to an April report by the Agency for Healthcare Research and Quality. The most-common infections at hospitals are of the urinary tract, surgical sites or the bloodstream, the earlier research found.
But more than six million procedures are performed each year at ambulatory surgical centers, whose numbers have soared in the past decade, the researchers said. The number of outpatient-surgery facilities certified by Medicare, the federal health program for the elderly and disabled, jumped 50 percent from 2001 and to 2008, reaching more than 5,000.
The sites studied were chosen at random and the states volunteered to be part of the research. Representatives from the Centers for Medicare and Medicaid Services trained state inspectors on how to assess compliance in five areas: hand hygiene, injection safety and medication handling, equipment reprocessing, environmental cleaning, and handling of blood- glucose-monitoring equipment.
The inspections occurred in 2008. The researchers found that 46, or 68 percent, of the centers had at least one lapse in infection control, and 18 percent had deficiencies in three or more of the five infection-control categories. Twelve centers had errors in hand hygiene, 18 had problems related to using single-dose medicines for more than one person, and 19 didn't follow recommendations regarding the cleaning, disinfection or repair of surgical equipment.
The percentage of inspections with problems related to infection control was more than six-fold higher than the number reported to Medicare nationally from October 2006 through September 2007, the researchers said. As of May, 2009, Medicare updated health and safety standards for the centers, requiring them to maintain infection- control programs based on national guidelines. Medicare is currently in the process of inspecting one-third of the centers.
How it works:
