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ASC QC COVID-19 Survey Confirms Continued Safety in ASCs

Surgery centers had negligible infection rate during the first months of the pandemic

BY SAHELY MUKERJI | DECEMBER 2020

As part of its mission to support the collection and reporting of quality data, the ASC Quality Collaboration (ASC QC) conducted a survey of more than 700 ASCs during the early days of the COVID-19 pandemic when surgeries were limited to urgent and emergent cases. The survey found that ASCs continued to perform essential outpatient surgeries safely during March and April last year with patients facing virtually no heightened risk of contracting the coronavirus either during or following their procedure.

The ASC QC surveyed 709 outpatient surgery centers in eight states—Connecticut, Illinois, Louisiana, Massachusetts, Michigan, New Jersey, New York, Pennsylvania—including three states—New York, New Jersey and Louisiana—that were experiencing high rates of COVID-19 infection in the general population between March 15, 2020, and April 30, 2020. The survey included 84,446 procedures that were performed in the ambulatory settings in that six-week time window. Only 16 of those patients tested positive for COVID-19 within 14 days after their procedure, an infection rate of just .02 percent, and no evidence any of those cases were connected to the patients’ procedures.

The survey also showed that only two of the 16 infected patients required hospitalization, primarily for respiratory issues, and no patients experienced cardiac issues, blood clotting or kidney failure.

“I was surprised that the number was low, and, frankly, lower than what conventional mathematical modeling might have predicted,” says Stuart Simon, MD, ASCA Board member and medical director of United Surgical Partners International, headquartered in Dallas, Texas. “But, if you look at it holistically, I am not surprised because ASCs are a bastion of sterility. We have always employed rigorous handwashing, equipment sterilization, rigorous adherence to aseptic protocols and, historically, not only worn masks, but gloves, cap and gown as well. This is really part of the natural ecosystem of our surgical facilities.”

This survey data confirms that ASCs can continue to perform essential surgeries without putting patients at greater risk of contracting COVID-19, says Ann Shimek, executive director of the ASC QC. “Together with the additional COVID-19 safety measures ASCs have in place today, including heightened preoperative screenings, additional sanitary measures and air filtration protocols, ASCs can maintain a safe, sanitary environment to treat patients, while keeping the health professionals providing their care protected.” “[Editor's note: Shimek passed away soon after this article was written.]

Lee Anne Blackwell, RN, clinical services support for Surgical Care Affiliates in Birmingham, Alabama, supports eight ASCs that participated in the survey. “We have been supporting these ASCs to mitigate the pandemic,” she says. “We have supported implementation of best practices through the guidance from the Centers for Disease Control and Prevention (CDC) and recommendations from other leading authorities, such as the Occupational Safety and Health Administration (OSHA) and the World Health Organization (WHO). We have implemented updated policies, procedures, and protocols based on the expertise from these organizations as well as from the US Food & Drug Administration (FDA) for emergency use authorizations (EUA), the Centers for Medicare & Medicaid Services (CMS), the US surgeon general, amongst other professional societies. We have received continued support from ASCA as we face the changing landscape and impact from this virus.”

Once the pandemic hit, Blackwell and her team focused on educating themselves on understanding the impact of the pandemic in their facilities, communities and across the nation. “As we learned how virulent and highly transmissible the virus was, we realized we needed to implement updated policies and procedures, including specific protocols in order to protect our patients, our employees and our medical staff,” she says. “We have continued to seek guidance from our local, state and federal health authorities as we have had to implement changes in our day-to-day operations.”

Blackwell implemented additional protocols on utilization of personal protective equipment (PPE) and supply utilization. The ASCs learned to have a specific back up plan with PPE procurement, including having a supply contingency plan and a crisis management plan, which involves the reuse and reprocessing of certain PPE. “We looked at what we were using in our setting,” she says. “We already were using PPE, however, we have implemented new protocols on how we use our PPE and how we can sustain sufficient PPE inventory. We also have been guiding patients to wear masks during their visit in the ASC and limiting family and visitors in the facility. We have been working through these changes and challenges and believe we are at a good place with these newer processes regarding the use of PPE.

“We all have had to look ahead and plan for our future needs to protect our patients, our healthcare workers and our environments as we anticipate that this virus may likely be around for a while, ” she says. “We must continue to be ever vigilant to the changing guidance and the evolution of where this pandemic is going.”

COVID-19 testing has evolved over time and has become more widely available, Blackwell says. “Several of our ASCs are able to administer the tests and send these to a lab for analysis,” she says. “We have been able to administer the gold-standard test in several of our centers to detect the SARS-CoV-2 virus, the Real-Time Reverse Transcriptase (RT)-PCR diagnostic test. CDC does not recommend antibody testing to detect an active infection.”

Testing has come a long way since the ASC QC did its survey back in spring 2020. “The low infection rate that was found in the survey predates the imposition of a lot of these new screening and testing measures that ASCs are now making a commonplace part of their healthcare process,” says Bill Prentice, chief executive officer of ASCA. “That makes me think that extraordinarily low infection rate from the survey is probably going to be even lower if we did another survey today, now that we are using enhanced screening and testing mechanisms that probably were not fully in place when that first survey was conducted.”

The ASC QC was formed in 2006, bringing together leaders from both the ASC industry and organizations with a focus on healthcare quality and safety. Today, its efforts are focused on quality measure development, the public reporting of quality data, advancing ASC quality and advocacy.