Why ASCs Have Lower Infection Rates Than Hospitals

Ambulatory surgery centers (ASCs) have transformed the outpatient surgery landscape since the first modern facility opened in 1970. These facilities have become increasingly popular sites for outpatient procedures in recent years due to exceptional surgical care quality, lower costs, and specialized focus. However, significantly lower rates of healthcare-associated infections, compared to hospital outpatient surgery departments (HOPDs), are an additional factor driving the growth of ASCs.

Post-Op Infection Rates: A Key Quality Indicator

Post-operative surgical site infections (SSIs) are a crucial measure hospitals and ASCs track to benchmark quality. The Centers for Disease Control and Prevention (CDC) define an SSI as an infection related to an operative procedure that occurs at or near the surgical incision within 30 days of the procedure, or 90 days if prosthetic material has been implanted. These infections can be superficial or life-threatening, damaging organs and tissues deep under the skin.

While antibiotics may treat these surgical site infections (SSIs), they can lead to higher patient morbidity, costs, and significantly longer recovery times. They are also a leading cause of hospital readmissions.

According to research, ASCs maintain lower SSI rates than hospitals following outpatient surgery. One analysis by the California Ambulatory Surgery Association, involving over one million ASC surgeries, found that:

ASC SSI rates were six times lower than hospital outpatient departments
Only one infection occurred per 1,000 ASC surgical cases
Even higher-risk specialty ASCs kept SSI rates under 0.7%

CDC estimates for SSIs in ASCs are slightly lower. While the CDC estimates that hospitals have an infection rate of around 1%, they find that the infection rate of ASC is about 0.1%.

Why is this the case? Here are three potential reasons for ASCs’ incredibly low infection rates:

Specialization

ASCs focus on performing same-day, elective surgical procedures, unlike hospitals that handle a wide range of complex medical conditions. Each facility has a specialized focus, whether ophthalmology, gastroenterology, orthopedics, or dermatology.

This specialized focus allows ASCs to only perform specific types of low-risk surgeries such as hernia repairs, spine laminectomies, orthopedic procedures, and more, depending on the specialty (or specialties) of the ASC. This limited scope of procedures simplifies the infection control process.

Strict Screening

ASCs also minimize infectious exposures by first screening the patients admitted to their centers. They typically refer medically complex cases, higher-risk individuals, and those needing overnight care to hospital surgical units.

This selective filtering gives ASCs a patient population of low-risk cases undergoing quick outpatient procedures as opposed to higher acuity procedures. As a result, ASC patients typically have more limited exposure to potential infection sources – unlike hospital inpatients. Finally, this focused business model allows ASCs to tailor their facilities, protocols, and quality benchmarks around predictable and minimally invasive procedures.

Sterilization Procedures

The physical environment of ASCs is specially designed to prevent infections. Most ASCs install advanced air purifiers, sterilize surgical instrument sets for each new case, and implement strict sanitization protocols between all procedures. Some ASCs also contain specialized procedure suites for “clean” surgeries that show no signs of inflammation and do not involve the respiratory, gastrointestinal, or genitourinary tracts.

Conclusion

It’s important to note that current benchmarks analyzing infection rates in ASCs versus hospitals rely primarily on estimates, assumptions, and extrapolations. Drawing definitive conclusions is difficult without a national standardized database dedicated to this purpose. However, while imperfect, the data presently available consistently shows a vast difference in infection rates.

This significant gap highlights that while hospitals must balance infection prevention across numerous wards while treating complex cases and patients with comorbidities, ASCs can shift the majority of their focus to maximizing patient safety.

SCA Health recognizes infection control as a cornerstone of exceptional outpatient surgical care. That’s why we provide an experienced clinical quality team to assist our facilities in not only meeting cleanliness requirements, but exceeding them. Click here to learn more about SCA Health and our available resources.