HHS scaling back to randomonized surveys of injection safety in ASCs

January 12th, 2015

The Department of Health and Human Services (HHS) is scaling back its oversight of needle safety issues in ambulatory care and surgical settings (ASCs), though noting that some 3,200 inspections done in fiscal years 2010 and 2011 “have found that deficient infection control practices are widespread in ASCs,” according to a report by the Government Accountability Office (GAO).

The deficient practices were not specifically described in the report and the HHS referred inquiries back to its written statement included in the GAO report as an appendix. The HHS stated therein that the outpatient settings have been “required to correct these deficient practices,” which were detected in a survey program that began after the 2008 outbreak of hepatitis C virus in a Las Vegas endoscopy clinic. That highly publicized outbreak -- which resulted in nine cases of confirmed HCV transmission to patients and another 100 people that were possibly infected in the now-shuttered clinic – resulted in a partnership between two HHS agencies, the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS). An infection control worksheet was developed that the CMS subsequently used to survey injection safety and other infection control measures in the ambulatory settings, many of which are not accredited by the Joint Commission and have heretofore operated well under the radar.

“CMS stopped collecting individual Worksheets from State Survey Agencies for each ASC survey conducted after FY 2011,” the HHS said in the GAO report. “With over 3,000 Worksheets collected, we believe there is sufficient data to support detailed analysis of ASC infection control practices nationally. CMS was also interested in relieving the State Survey Agencies, which are operating in a resource-constrained environment, of the burden associated with preparing a consolidated Worksheet and submitting it to our contractor after each ASC survey. In its recommendation, GAO has been sensitive to CMS’s concerns about the burden on State Survey Agencies, suggesting that CMS could limit this data collection to a random sample of ASCs, adjusting the sample size, and collecting the data less frequently than every year. Consistent with these GAO suggestions, CMS plans to resume collection of the Infection Control Surveyor Worksheet beginning in FY 2013 for a state-stratified, randomly selected subset of ASCs surveyed in that year, and will repeat this sampling and data collection approximately every three years thereafter.”