Health. Care. | An Educational Blog

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.

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.

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 general public has never been more aware of handwashing, thanks to the COVID pandemic. We all got a glimpse into the world of the healthcare worker as we washed our hands or used hand sanitizer every time we left a store or got home. Healthcare workers live this life daily, with protocols set to remind them to take every handwashing opportunity in an effort to protect patients (and themselves) from disease. In today's post, we will explore how the pandemic impacted hand washing, called hand hygiene, during the pandemic and beyond. Did the pandemic increase or decrease hand hygiene?

So much of the success of infection control and prevention teams is the establishment of routines that promote best practices: Easy-to-access hand hygiene stations, checklists, terminal cleaning protocols, and a built environment that supports a lower bioburden all work together to help reduce transmission of pathogens. Disruptions to those routines open gaps where opportunistic microorganisms can sneak in and wreak havoc. While some of those disruptions can be avoided, there is a predictable, massive disruption facing all healthcare facilities: Renovation and construction projects. Today's post will explore some of the threats introduced by construction projects and what the facility can do to minimize HAIs.

The Centers for Disease Control and Prevention (CDC) recently released a report addressing the impact COVID-19 has had on antimicrobial resistance. While other reports have covered the incidence of hospital-associated infections during COVID, this report focused on the prevalence of drug-resistant strains of the pathogens causing the HAIs. The report reveals that the top drug-resistant pathogens are transmitted via contaminated surfaces, which become reservoirs for these strains that elude our most powerful treatments. In today's post, we will share their findings and their implications for infection prevention.

Exploration of the Golden Age of Microbiology would not be complete without a look at how its discoveries impacted hospitals and medical care. Today’s post takes us into the 1800s hospital, where the “good old surgical stink” was just as familiar as the blood-stained aprons worn (with some pride) by doctors. In fact, that “stink” was what led one pioneering microbiologist to make a very helpful connection.

You go to a professional conference and learn about an exciting new medical innovation. You think it might work at your facility, so you go ahead and authorize its purchase and are ready to go. Then you wake up from your daydream and remember all the steps required to get that exciting new innovation into your facility - if that is even possible. With a sigh, you move on to your next session, thinking, how can we fast-track those medical innovations that could really make a difference in patient outcomes? What would that take? In today's post, we'll look at some of the things your facility can expect if they want to fast-track a medical innovation, and some ideas to make that process successful.