The Executive Suite: Rigorous outpatient safety protocols as a best practice for infection control

It’s easy to forget in our pandemic-affected world that mask-wearing in a hospital or doctor’s office has always been a standard practice for infection control. Patient and staff safety in healthcare facilities is continuously a top priority and hospital facilities have strict infection control protocols that aim to protect patients and staff from transmission of airborne, contact, or droplet-transmitted infections. After the widespread shutdowns of 2020 and a seismic shift to telehealth, many in-person office visits have resumed post-pandemic.

Unlike hospitals, doctors’ offices don’t always employ the same rigorous infection control practices, but they should. Results from a wide-ranging pre-COVID-19 study indicate that a significant number of patients exposed to influenza-like illness in a medical office or outpatient setting were more likely than nonexposed patients to revisit with a similar illness within two weeks.

In “Evidence Of Respiratory Infection Transmission Within Physician Offices Could Inform Outpatient Infection Control,” Hannah T. Neprash et. al. examined data from 105 million primary care visits. Published in the August 2021 issue of Health Affairs, the study used athenahealth data from 2016-2017 to reveal that patients who had been exposed during earlier visits were 31.8 percent more likely to make return visits for influenza-like illness (ILI) within 14 days, versus those who were not exposed.

The authors concluded the results demonstrate the potential risks that come with reopening outpatient clinics during the pandemic. Because many, if not most in-office appointments have resumed in 2021, it may be prudent to continue the safety and infection control protocols employed at the height of the pandemic. This could include masking in offices, hospitals, and other healthcare settings and virtual visits as a tool to reduce transmission of infection. Initial virtual triage of patients with low-risk respiratory viral symptoms could remain the method of choice to prevent in-office transmission of these types of illnesses.

A strategy for protection

Maintaining patient safety during an influenza season has been a perennial concern, but there are other common viral illnesses that can be transmitted between patients. Establishing and maintaining rigorous infection control protocols year-round to mitigate transmission risk could go a long way towards lessening transmission in healthcare settings.

Continuing the COVID-19 practice of masking ill patients for an in-person office visit would seem like a prudent solution to decrease the incidence of in-office infection transmission the virus and others. COVID-19 itself may even become an endemic illness, adding to the list of communicable diseases routinely found in outpatient settings and hospitals.

It may also be reasonable to continue the pandemic strategy of requiring ill patients to wait outside the office and escort them directly to an exam room once they’re ready to be seen. This may further serve to decrease the risk of in-office transmission.

As referenced above, telemedicine is another tool that could help prevent in-person transmission.

Last year, many practices evaluated patients with respiratory symptoms virtually, establishing outdoor drive-through testing stations as a follow-up. Continuing this practice could be another strategy to decrease in-office transmission. Beyond safer in-person appointments, the study results have implications for telemedicine reimbursements after the worst of the COVID-19 pandemic recedes. At the height of the pandemic, telemedicine was paid on par with in-office visits, making the investment in telemedicine financially viable for practices. In the future, if telemedicine reimbursement becomes restricted to certain specialties or diagnoses, or reimbursed at a lower rate, many clinicians may decide to forgo virtual appointments in favor of in-office visits despite the increased risk of in-office transmission.

As a matter of public health policy and infection control, telemedicine should remain a financially viable alternative for clinicians.