Health. Care. | An Educational Blog

In a widely-circulated interview, President Biden stated that the pandemic was, in effect, over. While not an official statement and also clarified over the next few days, the idea that the worst of the pandemic is over has been echoed by global medical experts. So what now? A return to "normal" in the medical field does not mean no more infections; in fact, it means returning to a world where almost 100,000 people die each year from infections they acquired while receiving medical care - most of which are preventable. There are many similarities between a pandemic and the on-going crisis of hospital-acquired infections, and in today's post, we will explore them. 

This series on outpatient services and infection control can seem rather dismal. Thankfully, most outpatient facilities are safe and only a small percentage of patients experience an HAI. Nonetheless, the breaches in infection control mean that given the right circumstances, severe outbreaks can (and do) take place. The reality can make us feel powerless and confused. Fortunately, there are things that we can do to help.

We recently heard a chilling story: An ER doctor shared that he was treating many of his patients in the waiting room - diagnosing, providing medication, and discharging - not because there was no room in the hospital, but rather because there were not enough nurses. Indeed, there is a significant nursing shortage in the United States. Almost all of us are aware of this professional scarcity thanks to regular news coverage and even personal experience. What many laypeople may not be aware of, however, is that we have been in the midst of a significant nursing shortage not just since COVID-19, but since 2012. In today's post, we will uncover what kind of impact this shortage will have on one of the most critical aspects of hospital care: Infection control and prevention.

So far in our series on infection control in ambulatory care settings, we covered the types of facilities and how they are regulated. One huge topic to cover is the impact of the outpatient setting on the ability to track infections. Today’s post will begin to explore this topic, and our final post will present what we can do, both individually and collectively, to begin to improve infection prevention in these facilities.

No one wants to stay in a hospital any longer than they have to. We all have an innate desire to get back to the comfort of our homes and begin the process of returning to normal activities. Some of us may not realize that there is also a very real, scientific reason for leaving the hospital as soon as possible: The longer a patient is in the hospital, the greater their chances of getting a hospital-associated infection (HAI), and once a patient has an HAI, they tend to stay longer in the hospital. It seems like a lose-lose scenario for everyone involved. It's just in everybody's best interest to reduce HAIs to not increase LOS, and shorten LOS to reduce HAIs. In today's post, we'll see how healthcare facilities are working to accomplish this dual goal.

We don’t know enough about infection in ambulatory care centers. 

Any kind of medical treatment received outside of a hospital admission is considered ambulatory care, or outpatient care. This category of healthcare is growing very quickly; in fact, it is the fastest growing health care market in the US! Outpatient services are growing in popularity for two main reasons. First, they are less expensive than hospitals, which have much higher overhead costs. The second reason is that medical improvements have made outpatient services far more practical. The quality of home health care through technology and nursing services allow patients who would have had to be in a hospital receive the necessary care at home.

Up to 75% of surgical procedures in the US take place in the more than 5,000 outpatient surgical centers. (There was a 300% increase between 1996 and 2006, the last time a survey was made. More on that in our next post.) Add to this the number of scans, tests, dialysis sessions, chemotherapy treatments, and other procedures and you begin to see the vast numbers of individuals receiving medical care at ambulatory care facilities. As more and more of us choose these outpatient services for increasingly complex procedures, it is all the more important to learn about this critical area of health care.

Nursing responsibilities have changed dramatically over the past decades. While some non-medical tasks have been shifted to other workers, additional administrative responsibilities have been added. As a result, nursing is among the top most stressful jobs in our country, made all the more challenging during the pandemic. What happens when nurses feel pressured by time constraints? What can be done to alleviate this pressure? We will look at options in today's post.

In late January of 2016, the CDC issued a health advisory “urging dialysis providers and facilities to assess and improve infection control practices to stop Hepatitis C virus transmission in patients undergoing hemodialysis.” This advisory was released after an increase in Hepatitis C infections, and the preliminary evidence that transmission from patient to patient had taken place in at least 9 clinics. This advisory brought to mind the issue of infection in other outpatient settings and inspired the topic of this series, “Outpatient Services and Infection Prevention.”

The Centers for Medicare and Medicaid Services (CMS) uses a Prospective Payment System (PPS) to provide incentives for healthcare providers to be effective and efficient. Much like health maintenance organizations (HMOs), the PPS provides a flat fee for each service, encouraging providers to stay within efficient financial limits. (In contrast, the older fee-for-service model incentivized over-utilization of services.) Each year, CMS releases changes to the PPS, in their efforts to remain flexible to changing medical needs and feedback from patients and providers. Earlier this month, CMS released the final inpatient rule (all 2,087 pages), including a few important changes.