The CDC investigation also highlighted the special vulnerability of ambulatory care settings, which do not have the same level of infection control infrastructure or licensing requirements as hospitals, Guh says. CDC is trying to work with the Centers for Medicare & Medicaid Services to tighten the link between CMS certification of ambulatory care centers eligible for federal reimbursement, and certain infection control quality criteria.
"Working with CMS, we're also trying to think of ways to provide financial incentives and disincentives to facilities to ensure that appropriate infection control practices are implemented. We're trying to be creative, for example working with partners like malpractice insurers, to engage them in the dialogue." That could lead to requirements that healthcare organizations provide assurance or documentation that their workers are taking necessary infection control courses, she says.
"There's a lack of resources in many of these settings compared to acute care settings," Guh says.
She emphasizes that she does not think the number of patients who will be notified that they were potentially infected will go down in the short term, in fact, she thinks it will increase because of increased awareness.
Better education of healthcare providers not to reuse syringes will result in better detection of those who are unaware of appropriate practices.
"People are going to be more in tune to what they're observing and will be more likely to pick up when there is a potential lapse," Guh says. "And that tends to increase detection of potential outbreaks and associated notification of them."