Infection control in ambulatory surgery centers

This week's JAMA has a paper on infection control in ambulatory surgery centers. Given the volume of procedures performed in these facilities (>6 million yearly), the recent outbreaks of hepatitis that have been associated with ASCs, and the fact that many are truly freestanding, the topic is important. But all in all, I didn't learn much from this paper. Sixty-eight ASCs in 3 states were surveyed using an audit tool, and at least 1 tracer (following a patient through the continuum of care) was done at each facility. While the tracer methodology is the standard used by The Joint Commission during its on-site audits, can we really infer the quality of care in an organization that cares for thousands of patients yearly on the basis of a handful (at most) patients? Similarly, for all areas of the audit, the assessment was all-or-none with no attempt to quantify anything less than perfect compliance. So with regards to assessing hand hygiene, a single observed noncompliant episode was graded the same as 0% compliance. Most concerning was that in 1 center prefilled syringes and infusion sets were used for more than one patient, though in no centers was there any observed reuse of needles or use of contaminated needles to draw from a medication vial used for more than one patient. It would be interesting to know how the results differ from the same process used to audit hospitals. The author of the paper's editorial seemed to struggle with what to say (understandably), with only 2 paragraphs related to the results of the paper. So in the end we have a study that reflects the audit process that's typical of that used in the real world, but we're left with asking what it all means.