Ambulatory care: It’s as bad as we thought

January 12th, 2015

A staggering succession of hepatitis outbreaks has steeled the general perception that infection prevention programs in ambulatory care settings leave a lot to be desired.

Inspections by the Occupational Safety and Health Administration (OSHA) confirm these fears, even as the number of surgeries performed in ambulatory care centers (ASCs) continues to rise. In the past four years, OSHA has increased inspections in these settings, fining ASCs and physician offices for violations of its Bloodborne Pathogen Standard. In fact, such violations make up the majority of OSHA medical facility citations in recent years, according to a two-part series of articles published in the journal of the Association for Operating Room Nurses (AORN).

The authors found that the most frequent causes of bloodborne pathogen violations were outdated or nonexistent exposure control plans, poor documentation, the failure to use safety devices and the lack of free training during working hours. The violations that merited the largest fines dealt with failure to immediately remove personal protective equipment (PPE) penetrated with body fluids; failure to use safety devices; and the failure to provide workers with a free Hepatitis B vaccination and follow up.

“Compliance with the Bloodborne Pathogen Standard may seem complex; however, it is the key to providing a safe workplace for both the health care employee and patient,” writes Pamela Dembski Hart, BS, MT(ASCP), CHSP, principal of Healthcare Accreditation Resources of Boston, in the two-part series, “Complying With the Bloodborne Pathogen Standard: Protecting Health Care Workers and Patients,” and “Compliance: the Key to Bloodborne Pathogen Safety.”

OSHA adopted the mandatory Bloodborne Pathogen Standard approximately 20 years ago in order to protect health care workers from exposure to blood, body fluids and infectious material. In the last decade more than 130,000 U.S. patients served at ASCs were notified of potential exposure to HBV, HCV and HIV due to unsafe injection practices and lapses in infection control. Facilities should develop and exposure control plans that determine safety risks and describe work practice controls, Hart recommends. ASC managers should solicit input from all employees to prevent needle sticks and sharps contamination and identify employees’ exposure risks.