Ambulatory Care Program | Duke Infection Control Outreach Network

Preventing infections is a struggle for outpatient clinics and surgery centers everywhere. Achieving this goal becomes more complicated each year as new technologies and procedures are creating new and sometimes unexpected infection prevention problems. Antimicrobial resistance has increased to an alarming level. Staff cutbacks are making it harder for many ambulatory programs to meet increasingly complex infection control regulations. The converging impact of these trends is particularly stressful for ambulatory care programs.

Programs that address infection prevention and improve patient safety are the cornerstones of an increasing number of patient safety, quality of care, cost of care and regulatory imperatives. DICON-affiliated clinics and surgical centers are provided with an array of practical and simple solutions and options to help them. DICON can help outpatient clinics and surgery centers economically and effectively improve quality of their care, enhance patient safety, and minimize costs at a fraction of the cost of “in-house” development of similar solutions and programs.

Over the last several years, there has been a tremendous shift in healthcare from inpatient hospitals to the ambulatory care settings. The ambulatory care settings include hospital-based clinics, nonhospital-based clinics, and ambulatory surgery centers. Our overall goal is to develop a true partnership with ambulatory care programs. Specifically, we want to provide ambulatory care programs with 1) high-quality, practical, timely infection prevention consultative advice and 2) educational resources and data. The explicit goal of this partnership is to provide additional resources for existing strong infection prevention programs. The range and type of services we can provide are summarized below.

Duke Infection Control Outreach Network (DICON) Program of services for Ambulatory Care

Ambulatory program assessment and gap analysis
Infection prevention program policy, risk assessment, plan development for ambulatory practices
Ambulatory infection preventionist orientation & competency training—DICON orientation & competency training includes:
1. Identification of infectious disease processes
2. Surveillance & epidemiologic investigation
3. Preventing/controlling transmission of infectious agents
4. Occupational health
5. Education & research
6. Management & communication
7. Professional development
8. The orientation conforms to the competency domains outlined by the Certification Board of Infection Control and Epidemiology
Assist with development of Clinic Infection Prevention Liaison (CIPL) program
Instruction of the NC .0206 course for outpatient healthcare settings—Topics covered in the course include:
1. Epidemiologic principles of infectious diseases
2. Principles and practice of asepsis
3. Sterilization, disinfection, and sanitation
4. Universal blood and body fluid precautions
5. Safe injection practices
6. Engineering controls to reduce the risk of sharp injuries
7. Disposal of sharps
8. Techniques that reduce the risk of sharp injuries to health care workers
Development of clinic tracking tool with key infection prevention risks
Create comprehensive clinic rounding schedule
Standardized infection prevention tracers tailored to clinic services—Examples of such tracers include, but are not limited to:
1. Primary infection prevention tracer
  1. General environment of care
  2. Safe injection practices
  3. Hand hygiene
  4. Standard & transmission-based precautions
  5. Respiratory hygiene
  6. Low-level disinfection of non-critical items
  7. Communicable disease management
  8. Other key infection prevention topics
2. High-level disinfection (HLD) tracer
  1. Pre-treatment
  2. Device transport
  3. Manual cleaning
  4. High-level disinfection
  5. Drying and storage
  6. Quality control of high-level disinfection solutions and chemicals
  7. Documentation of such reprocessing activities
3. Sterilization tracer
  1. Pre-treatment
  2. Instrument transport
  3. Manual cleaning
  4. Packaging and assembly
  5. Sterilization
  6. Storage
  7. Quality control management for autoclaves and solutions
  8. Documentation of such reprocessing activities
Device reprocessing log standardization—Development of standardized logs include, but are not limited to:
1. Sterilization of critical items
2. Manual high-level disinfection of semi-critical items
3. Automated high-level disinfection of semi-critical items
4. Quality control for high-level disinfectants in use
5. Endocavitary probe reprocessing
Streamline & standardization of enzymatic detergents, high-level disinfectants, and low-level disinfectants based upon instructions for use
Instruction of a cleaning, disinfection, and sterilization course for ambulatory clinics performing device/instrument reprocessing—DICON cleaning, disinfection, and sterilization training includes:
1. Overview of cleaning, disinfection, and sterilization
2. Pre-treatment and transport
3. The reprocessing environment
4. Cleaning
5. High-level disinfection
6. Sterilization
Access to On Line Training Courses—The courses include:
1. Safe Injection Video Modules--Three training videos developed with assistance of a professional production company and professional actors are available. These training modules teach healthcare workers (HCWs) about safe injection practices, how to minimize the risk for cross-transmission of infections, how to confront and correct colleagues when poor injection practices are observed. Based on a series of catastrophic lapses in technique that have resulted in litigation, patient harm, loss of licenses, we believe that there is a clear and compelling need for such training course on safe injection practices.
2. DICON Stopping the Spread Video kit--Six short (4-5 minute) educational video modules on handwashing and infection control were developed with assistance of a professional production company and professional actors. These modules are designed to motivate health care workers to change the unacceptable status quo on handwashing compliance. These modules are ideally suited for orientation of new employees regarding handwashing and infection control and for annual education updates for existing employees.
Other Benefits of DICON Program for Ambulatory Care—Our program includes all the services described above plus these additional benefits:
1. It provides easy, immediate, and convenient access at any time to five trained and experienced physician-epidemiologists and five highly experienced infection preventionists who can respond to minor or major questions or problems related to infection prevention.
2. Monthly newsletters on infection prevention topics newsletters designed to keep infection control professionals, nurses, and physicians up-to-date about technical, timely, and important news regarding infection control topics.
3. Existing frequently asked questions (FAQ) documents plus we will add FAQs for future questions
4. Position statements on controversial infection prevention topics
5. Attendance at our annual DICON Educational Symposium at no additional charge. These symposia are designed to enhance and supplement the educational programs available on our website.