Infection Control in Ambulatory Settings Is Focus of New CDC Guide

FP Expert Calls Recommendations 'Reasonable, Feasible, Affordable'

August 05, 2011 06:20 pm David Mitchell
[Stock photo of medical personnel washing hands]

Health care delivery increasingly is moving from inpatient to ambulatory care settings, says the CDC, and efforts to combat infections in outpatient facilities need to keep pace with that shift. Compared with inpatient acute-care settings, infrastructure and resources dedicated to infection control in ambulatory settings, such as hospital-based outpatient clinics, nonhospital-based clinics and physician offices, are lacking.

In an effort to close that gap, the CDC has released a document that summarizes its existing evidence-based recommendations for infection control in one concise guide for ambulatory care settings -- including physicians' offices and clinics.

Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care( covers recommendations for issues such as health care-associated infection surveillance and reporting, hand hygiene, cough etiquette, personal protective equipment, injection safety, and the proper cleaning and disinfection of both environmental surfaces and medical equipment.

"It's a straightforward, quick read that is easily understood," family physician Jonathan Temte, M.D., Ph.D., a member of the CDC's Advisory Committee on Immunization Practices, or ACIP, told AAFP News Now. "Even if someone doesn't want to read the whole thing -- which is only 17 pages -- the key recommendations give you everything in a nutshell. It's worthwhile for anyone in a medical home to go through this to see where they are and make the necessary improvements where they can."

The CDC also released a companion checklist( that allows practices to

Story Highlights

  • A new CDC document summarizes the agency's existing evidence-based recommendations for infection control.
  • The guide covers recommendations for health care-associated infection surveillance and reporting, hand hygiene, cough etiquette, personal protective equipment, injection safety, staff education, and cleaning and disinfection of environmental surfaces and medical equipment.
  • ensure that a facility has appropriate infection prevention policies and procedures in place, as well as adequate supplies to allow health care personnel to provide safe care; and
  • systematically assess personnel adherence to correct infection prevention practices.

In addition to recommendations for specific issues, such as hand hygiene, the guide sets "big picture" goals, such as developing and maintaining an infection prevention program with written policies and procedures appropriate for the services provided by the facility. The guide recommends ensuring that at least one person with training in infection prevention is employed by, or available to, the facility.

The guide also offers the following educational recommendations:

  • provide job- or task-specific training to all health care personnel, including those employed by outside agencies, contract workers and volunteers;
  • training should cover principles of safety for both health care personnel and patients;
  • training should be provided during orientation and repeated regularly; and
  • competencies should be documented.

Temte, a professor in the department of family medicine at the University of Wisconsin School of Medicine and Public Health, Madison, suggested that teaching facilities would benefit from providing the guide to medical students and residents.

He also noted that implementing the recommendations should not be a significant financial burden for family medicine practices. The CDC emphasized that the guide's recommendations reflect the "absolute minimum in infection prevention expectations."

"The bottom line is that this is a succinct set of common sense guidelines," said Temte. "They are very reasonable, very feasible and very affordable. We don't want to expose patients to any risks or infections that are easily avoidable."