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

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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

Synopsis

Health Care–Associated Infection Outbreak Investigations in Outpatient Settings, Los Angeles County, California, USA, 2000−2012

On This Page

• Databases and Study Population
• Measures
• Characterization of Outbreak Investigations
• Public Health Response
• Infection Control Breaches
• Suspected Sources of Outbreaks
• Oversight of Settings and Infection Control
• Conclusions
• Suggested Citation

Tables

• Table 1
• Table 2
• Table 3
• Table 4

Downloads

• RIS[TXT - 2 KB]

Kelsey OYong , Laura Coelho, Elizabeth Bancroft, Dawn Terashita, and Kelsey OYong

Author affiliations: Los Angeles County Department of Public Health, Los Angeles, California, USA (K. OYong, D. Terashita); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (L. Coelho); Independent Consultant, Los Angeles (E. Bancroft)

Suggested citation for this article

Abstract

Health care services are increasingly delivered in outpatient settings. However, infection control oversight in outpatient settings to ensure patient safety has not improved and literature quantifying reported health care–associated infection outbreaks in outpatient settings is scarce. The objective of this analysis was to characterize investigations of suspected and confirmed outbreaks in outpatient settings in Los Angeles County, California, USA, reported during 2000–2012, by using internal logs; publications; records; and correspondence of outbreak investigations by characteristics of the setting, number, and type of infection control breaches found during investigations, outcomes of cases, and public health responses. Twenty-eight investigations met the inclusion criteria. Investigations occurred frequently, in diverse settings, and required substantial public health resources. Most outpatient settings investigated had >1 infection control breach. Lapses in infection control were suspected to be the outbreak source for 16 of the reviewed investigations.

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.

Acknowledgment

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.

References

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2. The Joint Commission on Accreditation of Healthcare Organizations. 2014 hospital accreditation standards. Oakbrook Terrace (IL): The Commission; 2014.
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4. 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.
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7. 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)
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Tables

• Table 1. Attributes of 28 selected health care–associated infection outbreaks in outpatient settings, Los Angeles County, California, USA, 2000–2012
• Table 2. Distribution of selected health care–associated infection outbreaks in outpatient settings, by hospital affiliation and setting type, Los Angeles County, California, USA, 2000–2012
• Table 3. Public health response during outbreak investigations, Los Angeles County, California, USA, 2000–2012
• Table 4. Infection control breaches noted in outbreak investigations, Los Angeles County, California, USA, 2000–2012

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

DOI: 10.3201/eid2108.141251