Hostname: page-component-857557d7f7-fn92c Total loading time: 0 Render date: 2025-12-08T23:26:58.968Z Has data issue: false hasContentIssue false
  • English
  • Français

Infection Control in the Outpatient Setting

Published online by Cambridge University Press:  02 January 2015

Loreen A. Herwaldt ,
Shanon D. Smith  and
Cheryl D. Carter
Loreen A. Herwaldt
Affiliation:
Department of Internal Medicine, Iowa City, Iowa University of Iowa College of Medicine, and the University of Iowa Hospitals and Clinics, Iowa City, Iowa
Shanon D. Smith
Affiliation:
Department of Internal Medicine, Iowa City, Iowa
Cheryl D. Carter
Affiliation:
University of Iowa College of Medicine, and the University of Iowa Hospitals and Clinics, Iowa City, Iowa
Get access Rights & Permissions [Opens in a new window]

Abstract

This article discusses aspects of ambulatory care that increase the difficulty of practicing infection control in this setting or that require infection control staff to use different methods than they would use in the inpatient setting. The article reviews basic infection control precautions that apply to the outpatient setting in general and specific precautions that apply to dialysis centers and physical therapy programs. The article also describes outbreaks that have occurred in the outpatient setting, defines the deficiencies in infection control practice that caused the outbreaks, and discusses methods to prevent transmission of pathogens in the outpatient setting.

Information

Type
Practical Healthcare Epidemiology
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 1 , January 1998 , pp. 41 - 74
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

References

1. Lamkin, L. Outpatient oncology settings: a variety of services. Seminars in Oncology Nursing 1994;10:227, 229–235.Google Scholar
2. Perl, TM, Stevens, D, Roy, M-C, Herwaldt, LA, Lemke, J. Are current surveillance activities keeping pace with changing clinical practices? Infect Control Hosp Epidemiol 1996;17(suppl):p22. Abstract 39.Google Scholar
3. Meier, PA. Infection control issues in same-day surgery. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 3rd ed. Philadelphia, PA: Williams & Wilkins; 1997:262–282.Google Scholar
4. Department of Labor, Occupational Safety and Health Administration. 29 CFR Part 1920.1030, Occupational exposure to bloodborne pathogens, final rule. Federal Register 12 6, 1991;56:64, 004-64, 182.Google Scholar
5. Centers for Disease Control and Prevention. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health care facilities, 1994. MMWR 1994;43:1–133.Google Scholar
6. Joint Commission on Accreditation of Healthcare Organizations. Leadership standard. In: Comprehensive Accreditation Manual for Hospital: The Official Handbook. Oakbrook Terrace, IL: JCAHO; 1996:LD–1–LD-52.Google Scholar
7. Wade, BH. Outpatient/out of hospital care issues. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 3rd ed. Philadelphia, PA: Williams & Wilkins; 1997:243–259.Google Scholar
8. Smith, PW, Roccaforte, JS. Epidemiology and prevention of infections in home health care. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia, PA: Williams & Wilkins; 1996:1171–1176.Google Scholar
9. Molinari, JA. Dental office. In: Olmsted, RN, ed. APIC Infection Control and Applied Epidemiology: Principles and Practice, Part I Section C, Practice Settings. St Louis, MO: Mosby-Year Book, Inc; 1996:88–1–88-20.Google Scholar
10. Kelen, GD, Hansen, KN, Green, GB, Tang, N, Ganguli, C. Determinants of emergency department procedure- and condition-specific Universal (barrier) Precaution requirements for optimal provider protection. Ann Emerg Med 1995;25:743–750 Google Scholar
11. Kelen, GD, Green, GB, Purcell, RH, et al. Hepatitis B and hepatitis C in emergency department patients. N Engl J Med 1992;326:1399–1404.Google Scholar
12. Kelen, GD, Green, GB, Hexter, DA, et al. Substantial improvement in compliance with Universal Precautions in an emergency department following institution of policy. Arch Intern Med 1991;151:2051–2056.Google Scholar
13. Thurn, J, Willenbring, K, Crossley, K. Needlestick injuries and needle disposai in Minnesota physicians' offices. Am J Med 1989;86:575–579.Google Scholar
14. Miller, KE, Krol, RA, Losh, DP. Universal Precautions in the family physician's office. J Fam Pract 1992;35:163–168.Google Scholar
15. Kent, GP, Brondum, J, Keenlyside, RA, LaFazia, LM, Scott, HD. A large outbreak of acupuncture-associated hepatitis B. Am J Epidemiol 1988;127:591–598.Google Scholar
16. Stryker, WS, Gunn, RA, Francis, DP. Outbreak of hepatitis B associated with acupuncture. J Fam Pract 1986; 22:155-8.Google Scholar
17. Canter, J, Mackey, K, Good, LS, et al. An outbreak of hepatitis B associated with jet injections in a weight reduction clinic. Arch Intern Med 1990;150:1923–1927.Google Scholar
18. Alter, MJ, Ahtone, J, Maynard, JE. Hepatitis B virus transmission associated with a multiple-dose vial in a hemodialysis unit. Ann Intern Med 1983;99:330–333.Google Scholar
19. Danzig, LE, Tormey, MP, Sinha, SD, et al. Common source transmission of hepatitis B virus infection in a hemodialysis unit. Infect Control Hosp Epidemiol 1995;16(suppl):p19. Abstract 24.Google Scholar
20. Rosenberg, J, Gilliss, DL, Moyer, L, Vugia, D. A double outbreak of hepatitis B in a dialysis center. Infect Control Hosp Epidemiol 1995;16(suppl):p19. Abstract 23.Google Scholar
21. Hlady, WG, Hopkins, RS, Ogilby, TE, Allen, ST. Patient-to-patient transmission of hepatitis B in a dermatology practice. Am J Public Health 1993;83:1689–1693.Google Scholar
22. Drescher, J, Wagner, D, Haverich, A, et al. Nosocomial hepatitis B virus infections in cardiac transplant recipients transmitted during transve-nous endomyocardial biopsy. J Hosp Infect 1994;26:81–92.Google Scholar
23. Reingold, AL, Kane, MA, Murphy, BL, Checko, P, Francis, DP, Maynard, JE. Transmission of hepatitis B by an oral surgeon. J Infect Dis 1982;145:262–268.Google Scholar
24. Ciesielski, C, Marianos, D, Ou, CY, et al. Transmission of human immunodeficiency virus in a dental practice. Ann Intern Med 1992;116:798–805.Google Scholar
25. Velandia, M, Fridkin, SK, Cardenas, V, et al. Transmission of HIV in dialysis centre. Lancet 1995;345:1417–1422.Google Scholar
26. Chant, K, Lowe, D, Rubin, G, et al. Patient-to-patient transmission of HIV in private surgical consultating rooms. Lancet 1993;342:1548–1549. Letter.Google Scholar
27. Haley, CE, McDonald, RC, Rossi, L, Jones, WD, Haley, RW, Luby, JP. Tuberculosis epidemic among hospital personnel. Infect Control Hosp Epidemiol 1989:10:204–210.Google Scholar
28. Centers for Disease Control. Mycobacterium tuberculosis transmission in a health clinic—Florida, 1988. MMWR 1989;38:256–258, 263-264.Google Scholar
29. Calder, RA, Duclos, P, Wilder, MH, Pryor, VL, Scheel, WJ. Mycobacterium tuberculosis transmission in a health clinic. Bulletin of the ’International Union Against Tuberculosis and Lung Disease 1991;66:103–106.Google Scholar
30. Fischl, MA, Uttamchandani, RB, Daikos, GL, et al. An outbreak of tuberculosis caused by multiple-drug-resistant tubercle bacilli among patients with HIV infection. Ann Intern Med 1992;117:177–183.Google Scholar
31. Couldwell, DL, Dore, GJ, Harkness, JL, et al. Nosocomial outbreak of tuberculosis in an outpatient HIV treatment room. AIDS 1996;10:521–525.Google Scholar
32. Moore, M, the Investigative Team. Evaluation of transmission of tuberculosis in a pediatric setting—Pennsylvania. Presented at the 46th Annual Epidemic Intelligence Service Conference; 04 14-18, 1997; Atlanta, GA; p 53.Google Scholar
33. Agerton, TB, Valway, S, Gore, B, Poszik, C, Onorato, I. Transmission of multidrug-resistant tuberculosis via bronchoscopy. Presented at the 46th Annual Epidemic Intelligence Service Conference; 04 14-18, 1997; Atlanta, GA; p 54.Google Scholar
34. Griffith, DE, Hardeman, JL, Zhang, Y, Wallace, RJ, Mazurek, GH. Tuberculosis outbreak among healthcare workers in a community hospital. Am J Respir Crit Care Med 1995;152:808–811.Google Scholar
35. Sokolove, PE, Mackey, D, Wiles, J, Lewis, RJ. Exposure of emergency department personnel to tuberculosis: PPD testing during an epidemic in the community. Ann Emerg Med 1994;24:418–421.Google Scholar
36. Sepkowitz, KA. AIDS, tuberculosis, and the health care worker. Clin Infect Dis 1995;20:232–242.Google Scholar
37. Moran, GJ, McCabe, F, Morgan, MT, Talan, DA. Delayed recognition and infection control for tuberculosis patients in the emergency department. Ann Emerg Med 1995;26:290–295.Google Scholar
38. Moran, GJ, Fuchs, MA, Jarvis, WR, Talan, DA. Tuberculosis infection-control practices in United States emergency departments. Ann Emerg Med 1995;26:283–289.Google Scholar
39. Davis, RM, Orenstein, WA, Frank, JA, et al. Transmission of measles in medical settings: 1980 through 1984. JAMA 1986;255:1295–1298.Google Scholar
40. Istre, GR, McKee, PA, West, GR, et al. Measles spread in medical settings: an important focus of disease transmission? Pediatrics 1987;79:356–358.Google Scholar
41. Centers for Disease Control. Measles—Washington, 1990. MMWR 1990;39:473–476.Google Scholar
42. Bloch, AB, Orenstein, WA, Ewing, WM, et al. Measles outbreak in a pediatric practice: airborne transmission in an office setting. Pediatrics 1985;75:676–683.Google Scholar
43. Centers for Disease Control. Measles—Hawaii. MMWR 1984;33:702, 707–711.Google Scholar
44. Miranda, AC, Falcao, JM, Dias, JA. Measles transmission in health facilities during outbreaks. Int J Epidemiol 1994;23:843–848.Google Scholar
45. Measles among children of migrant workers—Florida. MMWR 1983;32:471-472, 477–478.Google Scholar
46. Remington, PL, Hall, WN, Davis, IH, Herald, A, Gunn, RA. Airborne transmission of measles in a physician's office. JAMA 1985;253:1574–1577.Google Scholar
47. Krause, PJ, Gross, PA, Barrett, TL, et al. Quality standard for assurance of measles immunity among health care workers. Clin Infect Dis 1994;18:431–436.Google Scholar
48. Gladstone, JL, Millian, SJ. Rubella exposure in an obstetric clinic. Obstet Gynecol 1981;57:182–186.Google Scholar
49. Fliegel, PE, Weinstein, WM. Rubella outbreak in a prenatal clinic: management and prevention. Am J Infect Control 1982;10:29–33.Google Scholar
50. Exposure of patients to rubella by medical personnel—California. MMWR 1978;27:123.Google Scholar
51. Pellitteri, OJ, Fried, JJ. Epidemic keratoconjunctivitis report of a small office outbreak. Am J Ophthalmol 1950;33:1596–1599.Google Scholar
52. Thygeson, P. Office and dispensary transmissions of epidemic kerato- conjunctivitis. Am J Ophthalmol 1957;43:98–101.Google Scholar
53. Dawson, C, Darrell, R. Infections due to adenovirus type 8 in the United States, I: an outbreak of epidemic keratoconjunctivitis originating in a physician's office. N Engl J Med 1963;68:1031–1034.Google Scholar
54. D'Angelo, LJ, Hierholzer, JC, Holman, RC, Smith, JD. Epidemic kerato-conjunctivitis caused by adenovirus type 8: epidemiologic and laboratory aspects of a large outbreak. Am J Epidemiol 1981;113:44–49.Google Scholar
55. Keenlyside, RA, Hierholzer, JC, D'Angelo, LJ. Keratoconjunctivitis associated with adenovirus type 37: an extended outbreak in an ophthalmologist's office. J Infect Dis 1983;147:191–198.Google Scholar
56. Buehler, JW, Finton, RJ, Goodman, RA, et al. Epidemic keratoconjunctivitis: report of an outbreak in an ophthalmology practice and recommendations for prevention. Infect Control 1984;5:390–394.Google Scholar
57. Craven, ER, Butler, SL, McCulley, JP, Luby, JP. Applanation tonometer tip sterilization for adenovirus type 8. Ophthalmology 1987;94:1538–1540.Google Scholar
58. Koo, D, Bouvier, B, Wesley, M, Courtright, P, Reingold, A. Epidemic kera-toconjunctivitis in a university medical center ophthalmology clinic; need for re-evaluation of the design and disinfection of instruments. Infect Control Hosp Epidemiol 1989;10:547–552.Google Scholar
59. Epidemic keratoconjunctivitis in an ophthalmology clinic—California. MMWR 1990;39:598–601.Google Scholar
60. Warren, D, Nelson, KE, Farrar, JA, et al. A large outbreak of epidemic ker-atoconjunctivitis: problems in controlling nosocomial spread. J Infect Dis 1989;160:938–943.Google Scholar
61. Colon, LE. Keratoconjunctivitis due to adenovirus type 8: report on a large outbreak. Annals ofOphthalmology 1991;23:63–65.Google Scholar
62. Jernigan, JA, Lowry, BS, Hayden, FG, et al. Adenovirus type 8 epidemic keratoconjunctivitis in an eye clinic: risk factors and control. J Infect Dis 1993;167:1307–1313.Google Scholar
63. Smith, D, Gottsch, J, Froggatt, J, Dwyer, D, Karanfil, L, Groves, C. Performance improvement process to control epidemic keratoconjunctivitis transmission. Infect Control Hosp Epidemiol 1996;17(suppl):p 36. Abstract S52.Google Scholar
64. American Academy of Ophthalmology. Updated recommendations for Ophthalmic Practice in Relation to the Human Immunodeficiency Virus and Other Infectious Agents. San Francisco, CA: AAO; 1992.Google Scholar
65. Dailey, JR, Parnes, RE, Aminlari, A. Glutaraldehyde keratopathy. Am J Ophthal 1993;115:256–258.Google Scholar
66. Christie, CDC, Marx, ML, Marchant, CD, Reising, SF. The 1993 epidemic of pertussis in Cincinnati. Resurgence of disease in a highly immunized population of children. N Engl J Med 1994;331:16–21.Google Scholar
67. Hardy, IRB, Strebel, PM, Wharton, M, Orenstein, WA. The 1993 pertussis epidemic in Cincinnati. N Engl JMed 1994;331:1455–1455.Google Scholar
68. American Society for Gastrointestinal Endoscopy. Infection control during gastrointestinal endoscopy: guidelines for clinical application. Gastrointest Endosc 1988;34(suppl):37S–40S.Google Scholar
69. Members of the American Society for Gastrointestinal Endoscopy Ad Hoc Committee on Disinfection. Position statement. Reprocessing of flexible gastrointestinal endoscopes. Gastrointest Endosc 1996;43:540–546.Google Scholar
70. Rutala, WA. APIC guideline for selection and use of disinfectants. Am J Infect Control 1996;24:313–342.Google Scholar
71. Spach, DH, Silverstein, FE, Stamm, WE. Transmission of infection by gastrointestinal endoscopy and bronchoscopy. Ann Intern Med 1993;118:117–128.Google Scholar
72. Ayliffe, GA. Nosocomial infections associated with endoscopy. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia, PA: Williams & Wilkins; 1996:680–693.Google Scholar
73. Weber, DJ, Rutala, WA. Nosocomial infections associated with respiratory therapy. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia, PA: Williams & Wilkins; 1996:748–758.Google Scholar
74. Muscarella, LF. Advantages and limitations of automatic flexible endoscope reprocessors. Am J Infect Control 1996;24:304–309.Google Scholar
75. Reynolds, CD, Rhinehart, E, Dreyer, P, Goldmann, DA. Variability in reprocessing policies and procedures for flexible fiberoptic endoscopes in Massachusetts hospitals. Am J Infect Control 1992;20:283–290.Google Scholar
76. Foss, D, Monagan, D. A national survey of physicians' and nurses' attitudes toward endoscope cleaning and the potential for cross-infection. Gastroenterology Nursing 1992;15:59–65.Google Scholar
77. Beecham, JH III, Cohen, ML, Parkin, WE. Salmonella typhimurium: transmission by fiberoptic upper gastrointestinal endoscopy. JAMA 1979;241:1013–1015.Google Scholar
78. Dwyer, DM, Klein, EG, Istre, GR, Robinson, MG, Neumann, DA, McCoy, GA. Salmonella newport infections transmitted by fiberoptic colonoscopy. Gastrointest Endosc 1987;33:84–87.Google Scholar
79. Struelens, MJ, Rost, F, Deplano, A, et al. Pseudomonas aeruginosa and Enterobacteriaceae bacteremia after biliary endoscopy: an outbreak investigation using DNA macrorestriction analysis. Am J Med 1993;95:489–498.Google Scholar
80. Classen, DC, Jacobson, JA, Burke, JP, Jacobson, JT, Evans, RS. Serious Pseudomonas infections associated with endoscopic retrograde cholangiopancreatography. Am J Med 1988;84:590–596.Google Scholar
81. Low, DE, Micflikier, AB, Kennedy, JK, Stiver, HG. Infectious complications of endoscopic retrograde cholangiopancreatography: a prospective assessment. Arch Intern Med 1980;140:1076–1077.Google Scholar
82. Earnshaw, JJ, Clark, AW, Thom, BT. Outbreak of Pseudomonas aeruginosa following endoscopic retrograde cholangiopancreatography. J Hosp Infect 1985;6:95–97.Google Scholar
83. Langenberg, W, Rauws, EAJ, Oudbier, JH, Tytgat, GNJ. Patient-to-patient transmission of Campylobacter pylori infection by fiberoptic gastroduo-denoscopy and biopsy. J Infect Dis 1990;161:507–511.Google Scholar
84. Akamatsu, T, Tabata, K, Hironga, M, Kawakami, H, Uyeda, M. Transmission of Helicobacter pylori infection via flexible fiberoptic endoscopy. Am J Infect Control 1996;24:396–401.Google Scholar
85. Birnie, GG, Quigley, EM, Clements, GB, Follet, EAC, Watkinson, G. Endoscopic transmission of hepatitis B virus. Gut 1983;24:171–174.Google Scholar
86. Singh, S, Singh, N, Kochhar, R, Mehta, SK, Talwar, P. Contamination of an endoscope due to Trichosporon beigelii . J Hosp Infect 1989;14:49–53.Google Scholar
87. Wheeler, PW, Lancaster, D, Kaiser, AB. Bronchopulmonary cross-colonization and infection related to mycobacterial contamination of suction valves of bronchoscopes. J Infect Dis 1989;159:954–985.Google Scholar
88. Wang, H-C, Liaw, Y-S, Yang, P-C, Kuo, S-H, Luh, K-T. A pseudoepidemic of Mycobacterium chelonae infection caused by contamination of a fibreoptic bronchoscope suction channel. Eur Respir J 1995;8:1259–1262.Google Scholar
89. Nye, K, Shadha, DK, Hodgkin, P, Bradley, C, Hancox, J, Wise, R. Mycobacterium chelonei isolation from broncho-alveolar lavage fluid and its practical implications. J Hosp Infect 1990;16:257–261.Google Scholar
90. Pappas, SA, Schaaff, DM, DiCostanzo, MB, King, FW Jr, Sharp, JT. Contamination of flexible fiberoptic bronchoscopes. Am Rev Respir Dis 1983;127:391–392. Letter.Google Scholar
91. Steere, AC, Corrales, J, von Graevenitz, A. A cluster of Mycobacterium gor-donae isolates from bronchoscopy specimens. Am Rev Respir Dis 1979;120:214–416.Google Scholar
92. Kolmos, HJ, Lerche, A, Kristoffersen, K, Rosdahl, VT. Pseudo-outbreak of Pseudomonas aeruginosa in HIV-infected patients undergoing fiberoptic bronchoscopy. Scand J Infect Dis 1994;26:653–657.Google Scholar
93. Umphrey, J, Raad, I, Tarrand, J, Hill, LA. Bronchoscopes as a contamination source of Pseudomonas putida . Infect Control Hosp Epidemiol 1996;17(suppl):p 42. Abstract M2.Google Scholar
94. Hoffmann, KK, Weber, DJ, Rutala, WA. Pseudo-outbreak of Rhodotorula rubra in patients undergoing fiberoptic bronchoscopy. Am J Infect Control 1989;17:99. Abstract.Google Scholar
95. Reeves, DS, Brown, NM. Mycobacterial contamination of fibreoptic bronchoscopes. J Hosp Infect 1995;30(suppl):531–536.Google Scholar
96. Van Gossum, A, Loriers, M, Serruys, E, Cremer, M. Methods of disinfecting endoscopic material: results of an international survey. Endoscopy 1989;21:247–250.Google Scholar
97. Kaczmarek, RG, Moore, RM, McCrohan, J, et al. Multi-state investigation of the actual disinfection/sterilization of endoscopes in health care facilities. Am J Med 1992;92:257–261.Google Scholar
98. Axon, ATR, Cockel, R, Banks, J, Deverill, CEA, Newmann, C. Disinfection in upper-digestive-tract endoscopy in Britain. Lancet 1981;1:1093–1094 Google Scholar
99. Rutala, WA, Clontz, EP, Weber, DJ, Hoffmann, KK. Disinfection practices for endoscopes and other semicritical items. Infect Control Hosp Epidemiol 1991;12:282–288.Google Scholar
100. Gorse, GJ, Messner, RL. Infection control practices in gastrointestinal endoscopy in the United States: a national survey. Infect Control Hosp Epidemiol 1991;12:289–296.Google Scholar
101. Favero, MS. Strategies for disinfection and sterilization of endoscopes: the gap between basic principles and actual practice. Infect Control Hosp Epidemiol 1991;12:279–281.Google Scholar
102. Rutala, WA. Disinfection, sterilization, and waste disposal. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 3rd ed. Philadelphia, PA: Williams & Wilkins; 1997:539–593.Google Scholar
103. Alfa, MJ, DeGagne, P, Olson, N, Puchalski, T. Comparison of ion plasma, vaporized hydrogen peroxide, and 100% ethylene oxide sterilizers to the 12/88 ethylene oxide gas sterilizer. Infect Control Hosp Epidemiol 1996;17:92–100.Google Scholar
104. Rutala, WA, Weber, DJ. Low-temperature sterilization technologies: do we need to redefine “sterilization”? Infect Control Hosp Epidemiol 1996;17:87–91.Google Scholar
105. Food and Drug Administration. Compliance policy guide 7124.16. 9/24/87. Available from FDA Kansas City Regional Office.Google Scholar
106. Greene, VW. Reuse of disposable devices. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia, PA: Williams & Wilkins; 1996:946–954.Google Scholar
107. Association for the Advancement of Medical Instrumentation. AAMI— Good Hospital Practice: Flash Sterilization—Steam Sterilization of Patient Care Items for Immediate Use (ST37). Arlington, VA: AAMI Steam Sterilization Hospital Practices Working Group, AAMI Sterilization Standards Committee; 1996.Google Scholar
108. Association for the Advancement of Medical Instrumentation. AAMI— Good Hospital Practice: Guidelines for the Selection and Use of-Reusable Rigid Sterilization Container Systems (ST33). Arlington, VA: AAMI Steam Sterilization Hospital Practices Working Group of the Thermal Sterilization Subcommittee, AAMI Sterilization Standards Committee; 1996.Google Scholar
109. Longfield, R, Longfield, J, Smith, LP, Hyams, KC, Strohmer, ME. Multidose medication vial sterility: an in-use study and a review of the literature. Infect Control 1984;5:165–169.Google Scholar
110. Melnyk, PS, Shevchuk, YM, Conly, JM, Richardson, CJ. Contamination study of multiple-dose vials. Ann Pharmacother 1993;27:274–277.Google Scholar
111. Hospital Infection Control Practices Advisory Committee, Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995;16:105–113.Google Scholar
112. Morrison, AJ Jr. Infection control in the outpatient setting. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. 2nd ed. Philadelphia, PA: Williams & Wilkins; 1993:89–92.Google Scholar
113. Reinhardt, PA, Gordon, JG, Alvarado, CJ. Medical waste management. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia, PA: Williams & Wilkins; 1996:1099–1108.Google Scholar
114. Favero, MS, Alter, MJ, Bland, LE. Nosocomial infections associated with hemodialysis. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia, PA: Williams & Wilkins; 1996:693–714.Google Scholar
115. Alter, MJ, Favero, MS, Moyer, LA, Bland, LA. National surveillance of dialysis-associated diseases in the United States, 1989. Transactions American Society for Artificial Internal Organs 1991;37:97–109.Google Scholar
116. Band, JD. Nosocomial infections associated with peritoneal dialysis. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia, PA: Williams & Wilkins; 1996:714–725.Google Scholar
117. Garcia-Houchins, S. Dialysis. In: Olmsted, RN, ed. APIC Infection Control and Applied Epidemiology: Principles and Practice, Part I Section C, Practice Settings. St Louis, MO: Mosby-Year Book, Inc; 1996:89–1–89-15.Google Scholar
118. Niu, MT, Alter, JM, Kristensen, C, Margolis, HS. Outbreak of hemodialysis-associated non-A, non-B hepatitis and correlation with antibody to hepatitis C virus. Am J Kidney Dis 1992;19:345–352.Google Scholar
119. Yu, VL, Goetz, A, Wagener, M, Smith, PB, et al. Staphylococcus aureus nasal carriage and infection in patients on hemodialysis: efficacy of antibiotic prophylaxis. N Engl J Med 1986;315:91–96.Google Scholar
120. Luzar, MA, Coles, GA, Faller, B, et al. Staphylococcus aureus nasal carriage and infection in patients on continuous ambulatory peritoneal dialysis. N Engl J Med 1990;322:505–509.Google Scholar
121. Ena, J, Boelaert, JR, Boyken, L, Van Landuyt, HW, Godard, CA, Herwaldt, LA. Epidemiology of Staphylococcus aureus infections in patients on hemodialysis. Infect Control Hosp Epidemiol 1994;15;78–81.Google Scholar
122. Pignatari, A, Pfaller, M, Hollis, R, Sesso, R, Leme, I, Herwaldt, L. Staphylo-coccus aureus colonization and infection in patients on continuous ambulatory peritoneal dialysis. J Clin Microbiol 1990;28:1898–1902.Google Scholar
123. Boelaert, JR, Van Landuyt, HW, Godard, CA, et al. Nasal mupirocin ointment decreases the incidence of Staphylococcus aureus bacteraemias in haemodialysis patients. Nephrol Dial Transplant 1993;8:235–239.Google Scholar
124. The Mupirocin Study Group. Nasal mupirocin prevents Staphylococcus aureus exit-site infection during peritoneal dialysis. J Am Soc Nephrol 1996;7:2403–2408.Google Scholar
125. Dryden, MS, McCann, M, Phillips, I. Housewife peritonitis: conjugal transfer of a pathogen. J Hosp Infect 1991;17:69–70. Letter.Google Scholar
126. Herwaldt, LA, Boyken, LD, Coffman, S. Epidemiology of S aureus nasal carriage in patients on continuous ambulatory peritoneal dialysis who were in a multicenter trial of mupirocin. Presented at the 36th Interscience Conference on Antimicrobial Agents and Chemotherapy; 09 15-18, 1996; New Orleans, LA; p 233. Abstract J78.Google Scholar
127. Temple, RS. Physical medicine and rehabilitation/occupational therapy/speech. In: Olmsted, RN, ed. APIC Infection Control and Applied Epidemiology: Principles and Practice, Part I Section D, Support Services and Facilities Management. St Louis, MO: Mosby-Year Book, Inc; 1996:114–1–114-5.Google Scholar
128. Linnemann, CC. Nosocomial infections associated with physical therapy, including hydrotherapy. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia, PA: Williams & Wilkins: 1996:725–730.Google Scholar
129. Goodman, RA, Solomon, Sl. Transmission of infectious diseases in outpatient health care settings. JAMA 1991;265:2377–2381.Google Scholar
130. Zuber, TJ, Geddie, JE. Occupational safety and health administration regulations for the physician's office. J Fam Pract 1993;36:540–550.Google Scholar
131. Favero, MS, Sadovsky, R. Office infection control, OSHA, and you. Patient Care 1993;27:117–121.Google Scholar
132. Inman, PM, Beck, A, Brown, AE, Stanford, JL. Outbreak of injection abscesses due to Mycobacterium abscessus . Arch Dermatol 1969;100:141–147.Google Scholar
133. Borghans, JGA, Stanford, JL. Mycobacterium chelonei in abscesses after injection of diphtheria-pertussis-tetanus-polio vaccine. Am Rev Respir Dis 1973;107:1–8.Google Scholar
134. Jackson, PG, Keen, H, Noble, CJ, Simmons, NA. Injection abscesses in a diabetic due to Mycobacterium chelonei var abscessus . BMJ 1980;281:1105–1106.Google Scholar
135. Newman, PE, Goodman, RA, Waring, GO III, et al. A cluster of cases of Mycobacterium chelonei keratitis associated with outpatient office procedures. Am J Ophthalmol 1984;97:344–348.Google Scholar
136. Lowry, PW, Jarvis, WR, Oberle, AD, et al. Mycobacterium chelonae causing otitis media in an ear-nose-and-throat practice. New Engl J Med 1988;319:978–982.Google Scholar
137. Wenger, JD, Spika, JS, Smithwick, RW, et al. Outbreak of Mycobacterium chelonae infection associated with use of jet injectors. JAMA 1990;264:373–376.Google Scholar
138. Weems, JJ Jr, Usry, G, Schwab, U. Infection due to rapidly-growing mycobacteria associated with ultrasound directed prostrate biopsy. Infect Control Hosp Epidemiol 1996;17(suppl):p 50. Abstract M67.Google Scholar
139. Centers for Disease Control and Prevention. Infection with Mycobac-terium abscessus associated with intramuscular injection of adrenal cortex extract—Colorado and Wyoming, 1995-1996. MMWR 1996; 45:713–715.Google Scholar
140. Kothari, T, Reyes, MP, Brooks, N, Brown, WJ, Lerner, AM. Pseudomonas cepacia septic arthritis due to intra-articular injections of methylpred- nisolone. Can Med Assoc J 1977;116:1230–1232. Letter.Google Scholar
141. Huang, A, Stamler, D, Edelstein, P, Skalina, D, Brennan, PJ. Isolation of Pseudomonas pickettii in a sinus clinic. Program of the Third Annual Meeting of the Society for Hospital Epidemiology of America; 04 1820, 1993; Chicago, IL; p A29. Abstract M18.Google Scholar
142. Pegues, DA, Carson, LA, Anderson, Rl, et al. Outbreak of Pseudomonas cepacia bacteremia in oncology patients. Clin Infect Dis 1993;16:407–411.Google Scholar
143. Climo, M, Pastor, A, Wong, E. Outbreak of P aeruginosa infections related to contaminated urodynamic testing equipment. Infect Control Hosp Epidemiol 1996;17(suppl):p 48. Abstract M58.Google Scholar
144. Arsan, AK, Adisen, A, Duman, S, Aslan, B, Kocak, I. Acute endophthalmitis outbreak after cataract surgery. J Cataract Refract Surg 1996;22:1116–1120.Google Scholar
145. Ginsburg, CM, Henle, G, Henle, W. An outbreak of infectious mononu-cleosis among the personnel of an outpatient clinic. Am J Epidemiol 1976;104:571–575.Google Scholar
146. Istre, GR, Kreiss, K, Hopkins, RS, et al. An outbreak of amebiasis spread by colonic irrigation at a chiropractic clinic. N Engl J Med 1982;307:339–342.Google Scholar
147. Greaves, WL, Hinman, AR, Facklam, RR, Allman, KC, Barrett, CL, Stetler, HC. Streptococcal abscesses following diphtheria-tetanus toxoid-per-tussis vaccination. Pediatr Infect Dis J 1982;1:388–390.Google Scholar
148. Kantor, RJ, Carson, LA, Graham, DR, Petersen, NJ, Favero, MS. Outbreak of pyrogenic reactions at a dialysis center: association with infusion of heparinized saline solution. Am J Med 1983;74:449–456.Google Scholar
149. Stetler, HC, Garbe, PL, Dwyer, DM, et al. Outbreaks of group A streptococcal abscesses following diphtheria-tetanus toxoid-pertussis vaccination. Pediatrics 1985;75:299–303.Google Scholar
150. Rutala, WA, Weber, DJ, Thomann, CA. Outbreak of wound infections following outpatient podiatric surgery due to contaminated bone drills. Foot Ankle Int 1987;7:350–354.Google Scholar
151. Nakashima, AK, McCarthy, MA, Martone, MJ, Anderson, RL. Epidemic septic arthritis caused by Serratia marcescens and associated with a benzalkonium chloride antiseptic. J Clin Microbiol 1987;25:1014–1018.Google Scholar
152. O'Mahony, MC, Stanwell-Smith, RE, Tillett, HE, et al. The Stafford outbreak of legionnaires' disease. Epidemiol Infect 1990;104:361–380.Google Scholar
153. Gordon, SM, Drachman, J, Bland, LA, Reid, MH, Favero, M, Jarvis, WR. Epidemic hypotension in a dialysis center caused by sodium azide. Kidney Int 1990;37:110–115.Google Scholar
154. Longfield, RN, Wortham, WG, Fletcher, LL, Nauscheutz, WF. Clustered bacteremias in a hemodialysis unit: cross-contamination of blood tubing from ultrafiltrate waste. Infect Control Hosp Epidemiol 1992;13:160–164.Google Scholar
155. Flaherty, JP, Garcia-Houchins, S, Chudy, R, Arnow, PM. An outbreak of gram-negative bacteremia traced to contaminated O-rings and reprocessed dialyzers. Ann Intern Med 1993;119:1072–1078.Google Scholar
156. Beck-Sague, CM, Jarvis, WR, Bland, LA, Arduino, MJ, Aguero, SM, Verosic, G. Outbreak of gram-negative bacteremia and pyrogenic reactions in a hemodialysis center. Am J Nephrol 1990;10:397–403.Google Scholar
157. Fridkin, SK, Kremer, FB, Bland, LA, Padhye, A, McNeil, MM, Jarvis, W. Acremonium kiliense endophthalmitis that occurred after cataract extraction in an ambulatory surgical center and was traced to an environmental source. Clin Infect Dis 1996;22:222–227.Google Scholar
158. Hopkins, DP, Cicirello, H, Dievendorf, G, Kondracki, S, Morse, D. An outbreak of culture-negative peritonitis in dialysis patients—New York. Presented at the 46th Annual Epidemic Intelligence Service Conference; 04 14-18, 1997; Atlanta, GA; p 40.Google Scholar

Other Resources

1. The American Society of Gastrointestinal Endoscopy (ASGE) and the Society of Gastroenterology Nurses and Associates. Reprocessing of Flexible Gastrointestinal Endoscopes. A white paper publication, 12 1995. This document may be accessed through the ASGE home page http://www.asge.org/. Select position papers, then select this title. Original copies may be obtained by writing to ASGE or by calling 508-5268330.Google Scholar
2. The American Academy of Ophthalmology's Updated Recommendations for Ophthalmic Practice in Relation to the Human Immunodeficiency Virus and Other Infectious Agents may be obtained from that society at 655 Beach St, PO Box 7424, San Francisco, CA 94120-7424; telephone, 415- 561-8500; fax, 415-561-8533; web site, www.eyenet.org/.Google Scholar
3. Heroux, DL. Ambulatory care. In: Olmsted, RN, ed. APIC Infection Control and Applied Epidemiology: Principles and Practice, Part I Section C, Practice Settings. St Louis, MO: Mosby-Year Book, Inc; 1996:83–1–83-15.Google Scholar
4. Heroux, D, Garris, J, Nahan, J, Vivolo, P. Ambulatory Care Infection Control Manual. © 1993, Group Health Cooperative, Group Health Cooperative of Puget Sound, 1809 Seventh Ave, Suite 1003, Seattle, WA 98101. Publishing coordination and production by Laing Communications Inc., Redmond, Washington.Google Scholar
5. ECRI Special Report. Reuse of Single-Use Medical Devices. 1997, ECRI 5200 Butler Pike, Plymouth Meeting, PA 19462; telephone 610-825-6000; fax, 610-834-1275; e-mail .Google Scholar
6. The Reuse of Single-Use Medical Devices. 1996, Canadian Healthcare Association, CHA Press, 17 York St, Suite 100, Ottawa, Ontario K1N 9J6, Canada.Google Scholar
7. Association for the Advancement of Medical Instrumentation, 3330 Washington Blvd, Suite 400, Arlington, VA 22201-4598.Google Scholar
8. Centers for Disease Control. (CDC). Guidelines for preventing the transmission of tuberculosis in health-care settings, with special focus on HIV-related issues. MMWR 1990;39.Google Scholar
9. Core Curriculum On Tuberculosis. What The Clinician Should Know. 3rd ed. CDC, National Center for Prevention Services, Division of Tuberculosis Elimination, US Department of Health and Human Services, Atlanta GA; 1994.Google Scholar
10. Diosegy, AJ, Lord, MC. What physicians need to know about OSHA: how to avoid tough new penalties. North Carolina Medical Journal 1993;54:251–254.Google Scholar
11. Department of Labor, Occupational Safety and Health Administration. Proposed rulemaking on occupational exposure to tuberculosis. 29 CFR Part 1910. Federal Register 10 17, 1997;62:54160–54308.Google Scholar