Ahead of Print -Health Care–Associated Infection Outbreak Investigations in Outpatient Settings, Los Angeles County, California, USA, 2000−2012 - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC
Volume 21, Number 8—August 2015
Health Care–Associated Infection Outbreak Investigations in Outpatient Settings, Los Angeles County, California, USA, 2000−2012
Health care services are increasingly delivered in outpatient settings rather than inpatient, acute-care settings. Nationwide, nearly 1.2 billion outpatient visits occur per year (1). Outpatient facilities encompass a broad array of facilities, such as primary care clinics, ambulatory surgery centers, pain clinics, oncology clinics, imaging facilities, dialysis centers, urgent care centers, and other specialized facilities. The types of procedures performed in outpatient settings are also diverse and include myriad procedures, from podiatry and nail clipping to advanced surgeries (e.g., joint replacements).
Procedures performed in outpatient settings are often invasive and carry risks of infection. Many of these procedures were previously performed in hospitals in which infection control practices are subject to regular oversight and regulation (2). Despite the increase in ambulatory care, there has not been a corresponding increase in infection control oversight in outpatient settings, and data are insufficient on the rates of infections resulting from procedures performed in outpatient settings (3).
At the same time, the amount of literature reporting a need for infection control oversight in outpatient settings is increasing. For example, during 2001–2011, there were >18 outbreaks of viral hepatitis associated with unsafe injection practices in outpatient settings, such as physician offices or ambulatory surgery centers (4). In addition, in an infection control audit conducted by the Centers for Medicare and Medicaid Services (CMS) in 2008, a total of 46 (68%) of 68 ambulatory surgery centers surveyed had >1 lapse in infection control; 12 (18%) had lapses identified in>3 of 5 infection control categories (5). CMS now requires adherence to its infection control surveyor worksheet for participation in CMS by ambulatory surgery centers (6). However, many outpatient settings opt out of participation in CMS or are not licensed by state health departments and are thus not held to the standardized infection control standards.
We recognized the infection control concerns associated with outpatient settings. Therefore, the Los Angeles County Department of Public Health (LACDPH) conducted an analysis to characterize health care–associated infection (HAI) outbreak investigations in Los Angeles County outpatient settings.
Ms. OYong is an epidemiology analyst at the Los Angeles County Department of Public Health. Her primary research interests are communicable disease epidemiology and health care–associated infections.
We thank Rachel Civen, L’Tanya English, Susan Hathaway, Moon Kim, Laurene Mascola, Joseph Perz, Clara Tyson, and the Acute Communicable Disease Control Program of the LACDPH for assistance in this analysis.
- Perz J. Infection prevention, surveillance, and oversight for ambulatory care settings. In: Abstracts of IDWeek. San Diego, October 16–21, 2012. Abstract no. 66 [cited 2015 May 11]. https://idsa.confex.com/idsa/2012/webprogram/POSTER.html
- The Joint Commission on Accreditation of Healthcare Organizations. 2014 hospital accreditation standards. Oakbrook Terrace (IL): The Commission; 2014.
- United States Government Accountability Office. Health-care-associated Infections: HHS action needed to obtain nationally representative data on risks in ambulatory surgical centers. Report to congressional requesters, subcommittee on health, committee on energy and commerce, House of Representatives; 2009. GAO-09-213.
- United States Government Accountability Office. Patient safety: HHS has taken steps to address unsafe injection practices, but more action is needed. Report to the ranking member, subcommittee on health, committee on energy and commerce, House of Representatives; 2012. GAO-12-712.
- Schaefer MK, Jhung M, Dahl M, Schillie S, Simpson C, Llata E, Infection control assessment of ambulatory surgical centers. JAMA. 2010;303:2273–9.
- Center for Medicare and Medicaid Services. Ambulatory surgical center infection control surveyor worksheet. Updated 2013 Dec 12 [cited 2014 Feb 14]. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107_exhibit_351.pdf
- California Health and Safety Code. Title 17. Section 2501. Investigation of a reported case, unusual disease, or outbreak of disease, 2008 [cited 2015 May 13]. https://govt.westlaw.com/calregs/Document/IC7766820D60511DE88AEDDE29ED1DC0A?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)
- Medicare Learning Network. Centers for Medicare and Medicaid Services. Ambulatory surgical center fee schedule. Updated Jan 13 [cited 2013 May 31]. http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/AmbSurgCtrFeepymtfctsht508-09.pdf
- Bancroft E. Outbreak of Enterobacter cloacae blood stream infections in a hemodialysis center—Los Angeles, 2001. Presented at: 13th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; 2003 Apr 5–8; Arlington, Virginia, USA.
- Centers for Disease Control and Prevention. Transmission of hepatitis B virus among persons undergoing blood glucose monitoring in long-term–care facilities—Mississippi, North Carolina, and Los Angeles County, California, 2003–2004. MMWR Morb Mortal Wkly Rep. 2005;54:220–3.
- Wise ME, Marquez P, Sharapov U, Hathaway S, Katz K, Tolan S, Outbreak of acute hepatitis B virus infections associated with podiatric care at a psychiatric long-term care facility. Am J Infect Control. 2012;40:16–21.
- Kim MJ, Mascola L. Mycobacterium chelonae wound infection after liposuction. Emerg Infect Dis. 2010;16:1173–5 and.
- Centers for Disease Control and Prevention. Notes from the field: multi-state outbreak of postprocedural fungal endophthalmitis associated with a single compounding pharmacy—United States, March–April 2012. MMWR Morb Mortal Wkly Rep. 2012;61:310–1 .
- Harbarth S, Sax H, Gastmeier P. The preventable proportion of nosocomial infections: an overview of published reports. J Hosp Infect.2003;54:258–66 .
- Goodman RA, Solomon SL. Transmission of infectious diseases in outpatient health care settings. JAMA. 1991;265:2377–81.
- Siegel JD, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings [cited 2013 Mar 20]. http://www.cdc.gov/hicpac/pdf/isolation/isolation2007.pdf
- Macedo de Oliveira A, White KL, Leschinsky DP, Beecham BD, Vogt TM, Moolenaar RL, An outbreak of hepatitis C virus infections among outpatients at a hematology/oncology clinic. Ann Intern Med. 2005;142:898–902.
- Owens PL, Barrett ML, Raetzman S, Maggard-Gibbons M, Steiner CA. Surgical site infections following ambulatory surgery procedures. JAMA.2014;311:709–16.
- Centers for Disease Control and Prevention. Guide to infection prevention in outpatient settings: minimum expectations for safe care. Atlanta: The Centers; 2011. CS217710.
Suggested citation for this article: OYong K, Coelho L, Bancroft E, Terashita D. Health care–associated infection outbreak investigations in outpatient settings, Los Angeles County, California, USA, 2000−2012. Emerg Infect Dis. 2015 Aug [date cited]. http://dx.doi.org/10.3201/eid2108.141251