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Women’s College Hospital experts adapt infection control best practice guidelines for outpatient setting

August 15

Jessica NgInfection control experts at Women’s College Hospital (WCH) suggest new recommendations for monitoring infections, isolation practices and personal protective equipment use, environmental cleaning and hand hygiene will help curb the spread of infectious diseases in an outpatient setting.

The team of experts, led by manager of infection prevention and control at WCH, Jessica Ng, and including Jane Mosley and Michael Gardam adapted four key infection prevention and control (IP&C) best practice guidelines. The findings, published in the American Journal of Infection Control, led to a less rigid and more pragmatic approach to IP&C guidelines in an outpatient setting. 

“Women’s College Hospital transitioned from an acute to ambulatory care hospital in 2006 but we found that many of the inpatient practices relating to IP&C were still being used today,” said Jessica Ng, lead author. “Unlike inpatient settings, the status of patients who carry infectious diseases resistant to antibiotics is largely unknown in standalone ambulatory care settings because patients visit and leave the hospital within a day, long before lab results could become available.”

Therefore in 2011, the team evaluated and modified the IP&C best practice guidelines to suit the outpatient setting at WCH. They found:

  • Monitoring Infections: WCH was placing a strong focus on tracking infection rates and screening patients.
  • Isolation practices and personal protective equipment use: Hospital staff were placing excessive emphasis on hand hygiene and personal protective equipment use for patients with infectious diseases resistant to antibiotics. For all other patients infection control practices were often lax.
  • Environmental cleaning: Similar to isolation practices, staff paid more attention to environmental cleaning when patients were previously identified with an infectious disease. 
  • Hand hygiene: Infection control staff were monitoring healthcare providers but entering the exam room with the healthcare provider and the patient. This often led to workflow and privacy concerns.

“Because the majority of the current IP&C guidelines relate to inpatient settings, our focus was to review, evaluate and modify these guidelines to better fit the outpatient setting at WCH,” added Ng.

The changes/modifications that were made to the guidelines include:

  • Monitoring infections: Because it is difficult to attribute a patient infection to a healthcare encounter in an outpatient setting, infection rates are no longer formally tracked and reported publicly. Instead, efforts have been focused on IP&C practices within our hospital, such as promoting good respiratory etiquette and improving compliance with measures designed to prevent the spread of disease.
  • Isolation practices and personal protective equipment use: Stronger emphasis on the use of IPAC practices such as hand hygiene and use of personal protective equipment for all patients at all times, regardless of their infectious status.
  • Environmental cleaning: Focusing on routinely cleaning patient equipment between uses with a thorough end-of-day cleaning in exam rooms, despite the infectious status of patients seen in those rooms.
  • Hand hygiene: Engaging patients to be observers for hand hygiene practices. This has minimized workflow and privacy concerns and increased opportunities for patient engagement and education.

“We hope that the initial modification of these four guidelines will lead to further development of IP&C best practices for outpatient settings,” said Ng.


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