Keeping Patients Safe From Infection in Outpatient Settings

Joseph Perz, DrPH, MA


May 11, 2012

Editorial Collaboration

Medscape &

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Hello. I am Dr. Joseph Perz from the Centers for Disease Control and Prevention (CDC), and I'm here at the Society for Healthcare Epidemiology of America (SHEA) Spring Meeting. I am here to talk to you today about infection control in outpatient settings.

The outpatient setting is an area where attention is definitely needed. The scope of care being provided in outpatient settings is wide, and the complexity and volume of care are increasing. It is important for those of us in the healthcare community, both providers and patients, to consider that we want the care that we receive, as well as that provided to our family members and loved ones, to be safe and to meet basic standards.

A point that is worth considering is that unlike acute care settings, which are subject to accreditation (unusual in the outpatient setting), we are working with an element of trust. For example, only 25% of outpatient ambulatory surgical centers are accredited.

We also lack a standard surveillance approach for healthcare-associated infections in outpatient settings. Much of what we learn comes from outbreaks of infection.[1] Examples of outbreaks that are quite disconcerting are those related to unsafe injection practices. l will give you a few examples.

One outbreak followed administration of influenza vaccines in a Colorado pediatric office. In this office, the responsibility for injecting young children with influenza vaccine was delegated to a medical assistant, and there was a lack of oversight. The assistant was using syringes to give a half-dose for the first dose (thinking that it was the adult formulation and that children would need 2 half-doses), putting the remainder aside in a box labeled "second doses," and then reusing syringes when children came back for the second injection.

I would like to share another example that occurred in a Jacksonville, Florida, hospital. This was recently reported in Annals of Internal Medicine.[2] It involved hepatitis C virus (HCV) transmission from tainted fentanyl syringes. In this case, a radiology technician had access to syringes that had been prefilled with fentanyl. This person injected himself, refilled the syringes with saline, and then patients (who received only the saline) were exposed to his HCV infection.

Yet another example involves insulin pens. These are devices that are commonly used for the convenience of patients to deliver insulin. The pens can be reused, but only for an individual patient. We have to take care that in healthcare settings, these pens are handled very carefully, such that they cannot and will not be reused for a second patient. (See Don't Do It: Sharing Insulin Pens Jeopardizes Patients.)

Another recent example came from a Wisconsin outpatient clinic where insulin pens were reused, resulted in more than 2000 patients requiring notification to seek testing for hepatitis B, HCV, and HIV.

A group of vulnerable patients who really deserve basic protections from healthcare-associated infections are cancer patients. A lot of cancer care is delivered in outpatient settings. A recent outbreak occurred in Mississippi, where it was found that clinicians were reusing syringes for more than 1 patient. This and other errors, including reusing saline bags for multiple patients, resulted in bacterial bloodstream infections.

We have many resources available at the CDC to promote safe outpatient care and to prevent infections, including a summary guide and a checklist, as well as information on safe injections.

The bottom line is that wherever medical care is delivered, patients deserve basic levels of protection from healthcare-associated infections. Thank you.

This has been Joe Perz, for Medscape, CDC, and SHEA.

Web Resources

Basic Infection Control and Prevention Plan for Outpatient Oncology Settings

Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care

Protect Outpatient Oncology Patients From Infections

Don't Do It: Sharing Insulin Pens Jeopardizes Patients


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