I know that this title seems like I am tying in a number of fairly diverse topics but hear me out on this one. I was browsing through USA Today while sitting in an airplane last week and came across a story whose title read “Safety Breaches at Surgery Centers”. That, in and of itself was interesting enough to me but upon reading the story I learned that “A federal study finds many same day surgery centers – where patients get such things as foot operations (my emphasis added) and pain injections – have serious problems with infection control.”
This short piece in the paper was reporting on the results reported in a study published in the June 9, 2010 issue of the Journal of the American Medical Association by Schaefer MK, et al entitled “Infection Control Assessment of Ambulatory Surgical Centers.” Ambulatory surgical centers in 3 states were assessed specifically looking at hand hygiene, injection safety and medication handling, equipment reprocessing, environmental cleaning and handling of blood glucose monitoring equipment. Despite the centers knowing that they were being observed 67.6% had at least one lapse. Also of interest was the breakdown on numbers and types of procedures. Almost a full 1/3 of all of the procedures performed at these surgi-centers were classified as “Podiatry”. I did not find where the study differentiated lapses in infection control by types of procedure and, unlike the USA Today piece, the JAMA article did not specifically single out “foot operations”.
The reason for me reporting on this study, besides the public relations nightmare from the USA Today piece, is that I know many podiatric physicians have financial interest in an ambulatory surgical center. All I can do is plead with you to maintain the absolute highest level of vigilance in your infection control practices. This WILL come back and “bite” you if you do not. After a report like this in a journal like JAMA you know that more regulations are not far behind!
Along the same vein, I sit on my hospital’s Infection Prevention and Control Committee. At our most recent meeting the RN Infection Control Coordinator passed out an article which was a position paper from the Association for Professionals in Infection Control and Epidemiology (APIC) on safe injection practices: Dolan SA, et al. APIC position paper: Safe injection, infusion and medication vial practices in health care. Am J Infect Control 2010, 38:167-72. Why I found this particularly pertinent to what we do in lower extremity practice is that it discusses the use of multi-dose medication vials. I have personally reviewed a few mal-practice cases of docs being sued for allegedly causing infection by using these vials. Apparently, there is some controversy about how long one of these vials can be used. The United States Pharmacopeia (USP) requires that a multi dose vial must be disposed of 28 days after the initial stopper penetration unless the Product Insert states otherwise. The Centers for Disease Control and Prevention (CDC), however, takes the stance that the bottle can be used until the manufacturers’ expiration date or if there are concerns about its sterility.
Taking these different opinions into account the APIC Guidelines suggests “…adhering to strict aseptic technique when accessing the vial, using a new sterile needle and a new sterile syringe for every access, removing all access devices from the vial, storing the vial in a clean protected location according to the manufacturer’s directions and ensuring that any vial whose sterility may be compromised is immediately discarded.” I rather like one of their other comments and suggest to you that, although not economically viable, and not currently “standard of care”, may be the best advice to protect your patient and yourself…”Use multi-dose medication vials for a single patient whenever possible…Infection transmission risk is reduced when multi-dose vials are dedicated to a single patient”.