Strategies for reducing infection risks associated with "Intravascular Devices" should include the following:

• Site selection
• Tunneled catheter or ports used when possible due to lower rates of infection then non-tunneled catheters.
• TPN catheters used only for TPN and not accessed for other procedures.
• Insertion of intravascular devices should be by experienced and trained staff only.
• The dressing may be transparent or gauze; for long term IV devices instruct family on inspecting for signs of infection, tenderness or drainage.
• Use good or maximum aseptic technique for insertion of IV devices.
• Avoid antibiotic ointments at insertion site; danger of fungal infections, (on long term catheters) or an increase in resistance of bacteria.
• Catheter material may affect infection rate; choose catheters mad of Teflon®, antimicrobial impregnated catheters or polyurethane have shown lower rates of infection.
• Rotate sites of insertion especially for patients who require short peripheral venous catheters for repeated or intermediate therapy.

I have had several questions about mops and mopping, reusable verses disposable. Detergent solutions can become contaminated during use. The trend toward use of pre-moistened disposable mop heads rather than buckets of solution has resolved some of the issues. As far as environmental cleaning is concerned, mopping must be done daily with a clean mop head and germicidal detergent in the mop water as part of the terminal cleaning. Mopping must also be done between cases even if the floor looks clean. Airborne contamination as well as droplet contamination of the floor occurs during every surgery. Have you ever had to get down on the floor to look for something? If you have then you know what I'm talking about: tidbits of suture, dust and debris of all kinds. Whether you use a reusable mop head or a disposable mop heap really does not matter. If, however, you use the reusable type, change the mop head after each use. Also change the mop water after each use as the water and the detergent become contaminated.

We have recent experience with 2 ASC's who have gone to great lengths to assure multiple patient use of single use propofol vials meets stringent standards. Great research and care were applied while policies and procedures were developed and followed. Both centers engaged the assistance of their Medical Directors in the process. However, survey findings assured both facilities that such procedures were not in keeping with CDC and pharmacy codes and are not acceptable. Looks like the activities of Dr. Desai in southern Nevada has paved the way for new enforcement of single use vials for single patients only!

Although not an ambulatory surgery center, the John Cochran VA Hospital in St. Louis began sending letters to 1,812 patients advising them that they may have been exposed to viruses: hepatitis and HIV. This was the result of the technicians washing the dental surgical instruments themselves prior to sterilization. They thought that they were doing the right thing.
The techs were quoted as saying that they were trying to protect the delicate instruments by doing the cleaning by hand but instead they were breaking their sterilization protocol.
Another example as to why you should have a review of your sterile processing procedures and make sure everyone at your center is following protocol. This is an excellent time/reminder to invite your vendor in for a brush-up in-service training.

August 5, 2010 @ 4:00pm Central Time
By attending this webinar, you will be able to:

• Describe the necessary components of an Infection Control Program for your ASC.
• Describe the proper handling of pharmaceuticals for the prevention of infection.
• Describe the elements of a sanitary environment necessary for the proper management of an ASC.
• Obtain the CMS surveyor 'tool' checklist - utilized for on-site surveys.
• Ability to reconnect with Cathy & Robert for later questions.