Safety records of surgery centers found lacking
■ In the wake of several hepatitis outbreaks, a JAMA study found frequent lapses in infection management.
By Kevin B. O’Reilly — Posted June 28, 2010
Ambulatory surgical centers' safety practices are under scrutiny as a study in the Journal of the American Medical Association found that problems in infection control are common at such centers.
The study came on the heels of a 28-count criminal indictment filed June 4 against Las Vegas gastroenterologist Dipak K. Desai, MD, and two of his endoscopy clinic nurse anesthetists. They were charged in connection with unsafe injection practices that led to a 2008 hepatitis C outbreak infecting 115 patients in southern Nevada.
The felony counts include criminal neglect of patients, racketeering, insurance fraud and "performance of an act of reckless disregard of persons or property." The Clark County indictment says Dr. Desai pressured employees to reuse single-use vials, syringes and needles to save costs.
Dr. Desai, who surrendered his medical license in February, following health problems, pleaded not guilty. His trial is set for March 2011.
The Nevada outbreak, one of at least a half dozen hepatitis B and C outbreaks at hospitals and outpatient clinics in the last three years, led to the JAMA study, which was published June 9. The Centers for Medicare & Medicaid Services paid state surveyors to conduct unannounced, on-site assessments of ambulatory surgical centers' compliance with safety standards.
Sixty-eight ambulatory surgical centers in Maryland, North Carolina and Oklahoma were examined in 2008, and 46 had at least one infection-control lapse, the study said. Twelve centers had lapses in three or more of five infection-control categories, such as injection safety, hand hygiene and equipment reprocessing. Nearly 30% of centers reused single-dose medication vials for more than one patient.
The results "suggest that infection control practices in ASCs might be lacking and were not specific to a given state," the study said. Authors of the paper were not available for interview by this article's deadline.
Nicole Coffin, a spokeswoman for the Centers for Disease Control and Prevention's Division of Healthcare Quality Promotion, said the article shows that physicians must ensure that their nurses and other medical staff are adhering to safe infection-control practices. "Not only do you have to have the right policies in place, but you have to make sure people are following those policies and make sure the staff understands what those policies are," Coffin said.
One and done
In late May, the Safe Injection Practices Coalition released a 10-minute CDC training video as part of the group's One and Only Campaign.
"The overall message -- use one needle, one syringe, only one time -- is the main thrust of the video, and it's done in the hopes of dispelling some of these misperceptions that it's safe to administer medications from single-dose vials to multiple patients," Coffin said.
Organizations representing ambulatory surgical centers objected to the JAMA paper, arguing that it is based on old data, does not look at outcomes and does not compare the clinics' performance with that of hospitals and other health care organizations.
"There's no comparison data, and [the study] doesn't contextualize what's going on," said David Shapiro, MD, chair of the Ambulatory Surgery Center Assn., which represents more than 2,600 surgical centers. "The implication is that they were surveying ambulatory surgical centers because it is the only setting in which infection control is a problem. The data out there suggest that, because of the high-quality patient care we provide in our settings, ASCs are where a patient would go to avoid getting a health care-associated infection."
The ASC Quality Collaboration, launched in 2006, monitors outcomes from more than 650 ambulatory surgical centers. The initiative has found that 80% of ASCs report fewer than 1.5 postsurgical wound infections per 1,000 patients.
Coffin, the CDC spokeswoman, rejected the notion that the agency is singling out ambulatory surgical centers for safety scrutiny. "We expect people to be following our infection-control recommendations in all facilities, whether they are hospitals or ambulatory surgical centers."
Dr. Shapiro said the negative publicity surrounding unsafe injection practices has had an upside. "This has just reminded everyone about the importance of very, very, very basic stuff," he said. "This is physician 101 and nursing 101, and has to do with the basic tenet s of professionalism."