Ill. surgery clinics cited over infection control

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The five-second rule appears to be alive and well in Illinois same-day surgery centers, where medical staff were observed picking up items that had fallen to the floor and behaving as if they weren’t contaminated by germs, according to state inspection re

CHICAGO (AP) — The five-second rule appears to be alive and well in Illinois same-day surgery centers, where medical staff were observed picking up items that had fallen to the floor and behaving as if they weren’t contaminated by germs, according to state inspection reports. The reports, obtained by The Associated Press through the Freedom of Information Act, detail numerous instances where inspectors saw nurses and other medical staff retrieving dropped materials and then tainting sanitary areas, including in operating rooms. But that wasn’t the only problem. Some of the outpatient clinics — where procedures include cosmetic surgeries, colonoscopies and laser eye treatments — cleaned and reused devices that were meant for one person. Doctors were lax about tying their masks before entering surgery. And surgical nurses wore earrings and necklaces banned by clinic policy because jewelry can carry germs into the operating room. Unsafe clinic practices are a growing concern because of hepatitis C outbreaks in other states linked to reuse of syringes and medication vials. Same-day surgery centers, which can handle some procedures more cheaply than hospitals, are a growing segment of the health care system. No disease outbreaks have been linked to Illinois clinics, but there’s no way to tell how many patients, if any, suffered infections because of the problems seen by inspectors. Of 29 Illinois surgery centers inspected during the past year, 22 — or nearly 76 percent — were cited for infection-control problems, a statistic that underscores a problem that has long gone undetected because the state inspected so infrequently. The number "points to a serious problem that must be addressed to ensure that patients are kept safe from these preventable infections," said Michael McCauley, a spokesman for Consumers Union’s Safe Patient Project. The group supports mandatory, public reporting of infection rates at the centers, so patients can easily see a clinic’s track record. The Illinois citations led to repeat inspections in the worst cases, officials said, and all lapses now have been addressed. But dozens of the state’s more than 100 clinics have yet to be inspected with a new sharper-eyed approach. Previously, inspectors from the Illinois Department of Public Health visited the centers about every seven years. But the state last year began more vigorous and frequent inspections of outpatient surgery centers, following directives from national health officials. The state now plans to inspect a third of Illinois centers each year, said Karen Senger, a supervisor in the Health Department’s Division of Health Care Facilities and Programs. The crackdown resulted from a hepatitis C outbreak in Las Vegas believed to be caused by unsafe injection practices at two now-closed clinics. There have been no similar outbreaks in Illinois. "This was a result of things that happened in other states," said Bill Bell, acting deputy director for the Office of Health Care Regulation in the Illinois Department of Public Health. Even so, some of the incidents cited in Illinois inspection reports could have led to problems, Bell said. For example: —At a Chicago-area surgery center, a staffer picked up paper that fell to the floor "with her bare hands, and without performing hand antisepsis, she donned gloves and started an intravenous site to (a patient’s) left arm," according to the inspector’s report. —In a Springfield operating room, a nurse picked debris off the floor, put the items in the trash and, without washing her hands, returned to duty. —In a Decatur operating room, a surgical instrument was dropped on the floor, picked up and placed on a clean table, then not removed during cleaning after the surgery ended. —A package of suture (surgical needle and thread) fell to the floor, was picked up and placed on dressing cart by a staffer at an upscale clinic near Chicago’s Michigan Avenue. —Inspectors discovered that a Chicago surgery center was using a converted commercial dishwasher to sanitize surgical instruments, with no evidence that it was hot enough to kill pathogens. Patients generally are sedated or unconscious during many of the procedures performed at outpatient surgery centers, so they don’t see infection-control lapses going on around them. "It disturbs me greatly to hear this," said Kim Pongpaet, 37, of Chicago, who had exploratory surgery last year at the 900 North Michigan Surgical Center in Chicago, which was cited for failing to train all staff in infection control and for breaches including the dropped suture package. "I’m disgusted." The lapses for which the center was cited did not occur during Pongpaet’s surgery, and she didn’t suffer any infection problems. The center did not respond to AP messages seeking comment. Mary Goldsher, interim chief executive of DuPage Medical Group, said the state’s inspection of DMG Surgical Center in Lombard, which found the center failed to maintain an active infection control program, led to the formation of a committee "whose sole responsibility is carrying out the Infection Control Policy and Program to ensure our patients continue to receive high quality medical care." The state’s effort is meant to raise standards in the centers to more closely mirror what’s expected of hospitals, which have had stricter oversight, state officials said. Earlier this year, U.S. Health and Human Services Secretary Kathleen Sebelius announced her department is expanding its hospital infection control action plan to include ambulatory surgical centers and dialysis centers. Same-day surgery centers annually perform more than 6 million procedures and collect $3 billion from Medicare. Previously, Illinois inspectors toured centers and interviewed staff, but rarely spent much time in operating rooms or watched surgeries. Inspectors now follow at least one patient through an entire stay at each clinic. So they’re seeing things they wouldn’t have seen before, Bell said, including what happens in operating rooms. Pongpaet was glad to hear state regulators are paying closer attention. "It’s appalling. I’m glad to hear someone’s looking into it," she said. Copyright 2010 The Associated Press.

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