Ambulatory care settings provide healthcare on an outpatient basis. That is, patients do not stay overnight in the facility. The term "ambulatory care" encompasses a large variety of healthcare settings that include but are not limited to physician offices, urgent care centers, dialysis facilities, ambulatory surgical centers, cancer clinics, imaging centers, endoscopy clinics, public health clinics, and other types of outpatient clinics.
Special considerations for infection prevention in these settings
- This category covers a wide range of facilities, providing a variety of different medical care services and having a range of licensing requirements, staff training needs, and surveillance procedures.
- The degree to which the infection prevention program is formalized may differ, but for each setting, infection prevention is a high priority. The infection prevention programs range, depending on the type of setting and licensing requirements, from policies established by the facility to accountability defined by the Centers for Medicare and Medicaid Services or another certifying organization.
- Patients play an important role in preventing infections and in identifying any that might be associated with outpatient care. It is important to know the signs and symptoms of infection and contact your provider for follow up if any symptoms develop.
- This is especially true for ambulatory care settings because the signs of an infection may not present until after the patient leaves the facility.
Reporting requirements
- [UPDATED] Virginia Reportable Disease List
- Outlines diseases and conditions (including outbreaks) that are reportable to the local health department by physicians, directors of medical care facilities, and directors of laboratories.
- In January 2012, the Centers for Medicare and Medicaid Services (CMS) began requiring dialysis facilities participating in the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) to report certain infection events to the National Healthcare Safety Network (NHSN), including positive blood culture, I.V. antimicrobial start, and signs of vascular access infection. In January 2015, CMS added summary-level healthcare personnel influenza vaccination coverage rates to the ESRD reporting requirements.
- In October 2014, CMS began requiring ambulatory surgery centers participating in the Ambulatory Surgery Centers Quality Reporting program to report summary-level influenza vaccination data for all healthcare personnel via NHSN.
Resources
General Resources
- CDC outpatient settings website
- Guide to Infection Prevention in Outpatient Settings: Minimum Expectations for Safe Care
- Outbreaks and patient notifications in outpatient settings
- Safe injection practices
- Tips for Preventing Infection Following Surgery – simple tips for patients and family members to follow after surgery and before leaving the healthcare facility to help lower the risk of infection.
- Presentations
- Infection Prevention and Control: Prevention Strategies – an overview of standard precautions, transmission-based precautions, environmental cleaning, safe injection practices, and vaccination. Suitable for use in an ambulatory care setting to teach infection prevention principles to staff.
Ambulatory Surgical Centers
- APIC Infection Control Resource for ASC Employees
- ASC Quality Collaboration – an organization for ambulatory surgical centers focused on measure development, public reporting of quality data, advancing ASC quality, and advocacy.
- ASC tools for infection prevention (ASC TIPs) – includes basic and expanded versions of toolkits that address hand hygiene, safe injection practices, point of care devices, environmental infection prevention, single-use device reprocessing, endoscope reprocessing, and sterilization and high-level disinfection.
- Association of periOperative Registered Nurses (AORN) – professional association that provides educational opportunities to members as well as non-members
- Infection control audit tool used by state surveyors during inspections of CMS-certified ambulatory surgical centers
- Surgical site infections page
Dialysis Facilities
- AHRQ Safety Program for End-Stage Renal Disease Facilities – Toolkit
- CDC Dialysis Infection Prevention Resources
- CMS Dialysis Compare – a searchable database of dialysis providers that permits the user to compare facilities on a variety of quality measures and other facility characteristics.
- National Healthcare Safety Network: Tracking Infections in Outpatient Dialysis Facilities with the National Healthcare Safety Network – includes protocol, training, forms, analysis resources, and support materials.
- CDC Patient Resources
- Recommendations for Preventing Transmission of Infections Among Chronic Hemodialysis Patients, MMWR(2001)
Other Settings
- Dental settings
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- Infection Prevention Guidelines and Recommendations for Dental Settings – includes a checklist used to evaluate compliance of dental-care facilities with best practices surrounding infection prevention.
- CDC website on infection control in dental settings
- Guidelines for Infection Control in Dental Health-Care Settings, 2003
- Outpatient oncology settings
- Preventing Infections in Cancer Patients – tools for patients and caregivers as well as for healthcare providers to help reduce the risk of developing infections during chemotherapy treatment
- Basic Infection Control and Prevention Plan for Outpatient Oncology Settings
- Three Steps Toward Preventing Infections During Cancer Treatment – an evidence-based, interactive online program designed to help assess a cancer patient’s risk for developing both a low white blood cell count during chemotherapy and subsequent infections.
- Preventing Infections in Cancer Patients – tools for patients and caregivers as well as for healthcare providers to help reduce the risk of developing infections during chemotherapy treatment
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Last Updated: July 31, 2023