Who's in charge of infection prevention at your facility? If you work at an ASC or HOPD, chances are whoever it is has a lot more than infection prevention on her plate. That alone makes the job extremely challenging. And when you add in the never-ending stream of new standards, new findings and new regulations, well, it can be downright overwhelming. Phenelle Segal, RN, CIC, FAPIC, president of Infection Control Consulting Services in Delray Beach, Fla., has been on the front lines of infection control for years. In a lively show-and-tell presentation, she'll present some extreme examples of the kinds of things that can go wrong, and, more importantly, explain what it takes to make sure things go right.

The challenge for outpatient facilities. ASCs and HOPDs are required to have an infection-control program that follows nationally recognized guidelines and is directed by a qualified, licensed healthcare professional. But unlike hospitals, which are required to have one or more full-time infection-control specialists, the people designated to be in charge at ASCs and HOPDs almost always have other jobs to do, as well. It could be a staff nurse, a scrub tech or any other member of the surgical team. They not only have limited experience in infection control, they also have to wear multiple hats. It's very daunting. Administrators need to make sure their infection-control coordinators are well supported — that they have the time and resources they need.

Phenelle Segal, RN, CIC, FAPIC

Develops infection prevention and control plans, risk assessments, corrective action plans, and policies and procedures for surgery centers, hospitals, medical groups and long-term care.

Conducts onsite visits to assess "best practices," and reports on findings and recommendations.

Stakeholder/ member of HHS Federal Steering Committee for the elimination of healthcare-associated infections.

Strict standards. The job is only going to get tougher. CMS, surveyors and accreditation organizations are now insisting — and checking — that the people in charge of infection prevention have had specific training. And many are refusing to accept webinars as adequate. They want the learning to take place at in-person workshops, presentations or one-on-one training.

New challenges? I predict that in the near future, antimicrobial stewardship program development will be included as a new measure by CMS and that accreditation organizations will follow suit. It's already mandatory in hospitals, and it will be soon in nursing homes, too. That means that on top of all their other demands, ASCs and HOPDs are going to have to examine their provider antibiotic prescribing habits and make sure they're consistent with evolving guidelines.

Seen it all. I hear over and over, "We've always done it this way and we've never been told that it's wrong." Some of the things I've seen are eye-opening, like storing IV bags and sterile solution bottles uncovered directly below scrub sinks. Or running portable dehumidifiers in operating rooms while procedures are going on. Those are extreme, but there are also many very common errors, such as drawing up injectables early in the morning that are to be used for the entire day. OSM