SUB-PROBLEMS INCLUDING LEADING TO IMPAIRMENT AND BEST PRACTICES FOR PHYSICIANS' OFFICES AND MEDICAL CLINICS

(See endnote 56)

In 2007, there were almost 1 billion visits to physician’s offices in the United States. Physician’s offices or medical clinics may be located in a variety of facilities ranging from old houses and remodeled stores to modern medical offices. The older facility may contribute numerous environmental concerns to the safe handling of patients including problems of poor indoor air quality, contaminated surfaces, contaminated waste, lead and asbestos prior use, etc. There may be inadequate room for dirty areas and clean areas as is needed in other types of advanced healthcare facilities. The opportunity for infections increases in the physician’s office or medical clinic because of a variety of factors. There is no central infection control team or individual who is overseeing medical nursing techniques as well as environmental concerns. The disinfection of surfaces and/or sterilization of equipment may not be supervised to ensure a proper job is done. The waiting room becomes a problem because sick people as well as those who are healthy but still vulnerable and getting blood work or other procedures done, may be sitting together. This is especially a problem in pediatric practices where there are so many sick children and on the other hand well babies who are in for routine examinations and vaccinations. Injection practices within offices may also be a problem, particularly reinsertion of used needles into multiple dose vials or containers of solution. The personnel at the facility may be both paid professionals and also unpaid volunteers who may expose patients to a variety of diseases or become infected by contaminated materials, medical supplies and equipment, environmental surfaces, or air problems. Clerical and housekeeping personnel may also become exposed to infectious agents.

Best Practices for Physician’s Office or Medical Clinic

• • Develop and maintain an infection control program as well as an occupational health and safety program. Assign one knowledgeable person to be in charge.
• • Develop written infection prevention policies and procedures as well as the occupational health and safety policies and procedures appropriate for the practice.

• • Train all employees in the previous policies and procedures during new employment orientation and periodic brief reviews.
• • Follow all necessary reporting requirements on healthcare-acquired infections and occupational health and safety rules and regulations from all local, state, and federal agencies.
• • Use appropriate hand-washing techniques as discussed under acute hospitals.
• • Use appropriate personal protective equipment as discussed under acute hospitals.
• • Utilize safe injection practices as discussed under acute hospitals.
• • Use appropriate cleaning and disinfection of surfaces and cleaning, disinfection, and/or sterilization of medical equipment as discussed under acute hospitals.
• • Use and teach patients appropriate respiratory hygiene for coughs and sneezes and how to dispose of the tissues without contaminating others.