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METHODS: We reviewed the LAC Department of Public Health (DPH) Disease Control Outbreak Log database, LAC DPH Special Studies Reports, and personal correspondence with LAC DPH employees for HAI outbreaks in ACSs that occurred from January 2000 through November 2012. ACSs were defined as distinct entities, hospital-based or non-hospital-based, that operate exclusively on an outpatient basis for patients who do not require hospitalization and who are expected to stay less than 24 hours. Suspected and confirmed outbreaks were classified by type of setting, agent, duration of investigation, case count, hospitalizations, deaths, infection control breaches, and public health response.
RESULTS: Twenty-seven investigations of suspected or confirmed outbreaks were related to HAIs in ACSs from January 2000 through November 2012. Of these, 7 occurred in hospital-based ACSs, 19 in non-hospital-based ACSs, and 1 in multiple ACSs. Settings included dialysis centers (6), private physician offices (6), contracted home health agencies (5), plastic surgery offices (3), ambulatory surgery centers (3), hospital-associated clinics (2), an oncology office (1), a pain clinic (1), and a medical spa (1). One investigation occurred in two settings. The types of agents included bacterial (14), viral (6), fungal (3), ectoparasitic (1), and other (3). For the 27 investigations reviewed, the total case count was 151 (median: 3; mean: 6; range: 0-36). The total number of confirmed cases was 127; fifty-seven were hospitalized and 5 died. Infection control issues identified included breaches in hand hygiene, proper glove use, single-use medication policies, equipment processing and sterilization, and documentation of medication dosage and lot numbers. Investigation duration ranged from 7 to 144 days (median: 35; mean: 42). LAC DPH performed site visits, medical record reviews, epidemiologic studies, specimen collection, laboratory analysis, patient interviews and notification, and consultations. Investigations involved cross-cutting collaboration with LAC Environmental Health Division, the LAC Public Health Laboratory, and other programs.
CONCLUSIONS: HAI outbreaks in ACSs occur frequently, in diverse settings, and require substantial public health resources. The reviewed outbreaks resulted in considerable morbidity and mortality, as more than one-third of affected patients were hospitalized. Infection control standards and appropriate event reporting should be promoted, enhanced, and enforced in ACSs to ensure patient safety.