OrthoCarolina outlines how structured oversight, staff training, and supplier partnerships reduce variability and risk.
As outpatient orthopedic care continues to grow across the Southeast, OrthoCarolina is emphasizing rigorous infection prevention protocols to support more than 1 million patient visits annually.
Founded in 1922, the independent academic orthopedic practice has built a reputation not only for musculoskeletal care, but also for clinical quality and safety across its more than 300 practitioners in North and South Carolina. In a recent interview with Repertoire Magazine, three clinical leaders outlined how standardized protocols, staff education and workflow design underpin infection prevention efforts across the organization’s outpatient facilities.
Infection prevention “part of the culture”
At the core of OrthoCarolina’s approach is a culture built around standard precautions, according to Karen Berry, RN, Manager of Office-Based Surgery & Clinical Operations.
“In today’s healthcare, the requirement for standard precautions is part of the culture in our outpatient facilities,” Berry said. “Elements begin with our primary infection-prevention defense, handwashing, with either an alcohol-based sanitizer or soap and water. Team members and practitioners are provided with personal protective equipment such as gowns, masks and gloves to protect themselves as well as our patients.”
Berry noted that infection prevention extends beyond individual behaviors to include environmental and engineering controls. “Engineering controls are in place in all our outpatient facilities that include containers for sharps and safety needles to promote safe injection practices. Continuous cleaning and disinfection occur in exam rooms, waiting rooms, procedure rooms and equipment,” she said.
Education and oversight also play a central role. “All team members receive ongoing education with written infection prevention policies and participate in biannual audits that are built on regulatory requirements,” Berry said. “Site visits are frequented by oversight leadership at all outpatient facilities. Internal committees guide safe practices, policies, and plans for the evaluation of safer products.”
In procedural settings, sterilization protocols are closely monitored. Berry added, “For our procedural areas, instruments are cleaned and sterilized according to manufacturer instructions. Chemical and biological indicators are used to monitor and validate sterilizer performance. Safety data sheets are maintained for all chemicals and other products within the clinical areas.”
Despite the breadth of services provided, OrthoCarolina leaders say infection risks are consistent with typical outpatient environments. Liz Maselli, PA-C, MBA, Vice President of Clinic Operations, explained that the elective nature of orthopedic procedures can actually help reduce risk.
“Orthopedic procedures in the outpatient setting are elective cases. This allows us time to optimize our patients prior to their procedure. Thus, our risk for infection is quite low,” Maselli said. “With that being said, there are no unique infection risks for our facilities. We carry the standard risk as with any outpatient facility.”
Still, maintaining consistency across diverse clinic layouts presents challenges – particularly in workflow design. Kathleen Wilkins, RN, Clinical Resource & Quality Specialist, said human factors play a critical role in ensuring compliance.
“The physical environment can be challenging in the outpatient setting because spaces are often not specifically designed for all procedures,” Wilkins said. “We have had to standardize workflow design to make infection prevention steps easier to implement throughout our clinics.”
She pointed to practical measures such as visual cues and structured processes. “We follow best practices by maintaining standardized, clearly defined workflows. Examples include establishing boundaries with splash guards; using visual cues such as signage for ‘Dirty,’ ‘Clean,’ and ‘Sterile’; and posting signs when the office-based surgery (OBS)/procedure room is in use.”
Technology and simplification strategies also support consistency. “We also maintain electronic quality assurance logs for autoclave maintenance, instrument cleaning, sterilization, and spore testing,” Wilkins said. “In addition, we simplify decision points in sterile processing to help team members make the right decisions quickly and consistently.”
Instrument reprocessing remains a key focus area, particularly in outpatient settings where space constraints and staff turnover can introduce variability. Berry highlighted these as common industry challenges.
“One of the most common challenges is the physical spacing and layout of outpatient clinics when maintaining a dirty-to-clean workflow for disinfection and sterilization, as well as providing adequate space for sterile storage of supplies and instruments,” she said.
To address these issues, OrthoCarolina emphasizes clear separation of clean and contaminated areas, along with ongoing staff education. “Although each outpatient clinic has a different layout, dirty and clean areas are clearly labeled, and in some cases separated with splash guards to prevent chemicals or fluids from reaching clean instruments,” Berry said.
She also underscored the importance of training and compliance monitoring. “Team members receive education during orientation and annually thereafter, along with real-time updates when leadership conducts onsite oversight. Competency training includes all steps of the disinfection and sterilization process, proper use of personal protective equipment, and instruction on chemical products, equipment, and surgical instruments.”
Detailed processes govern every step of instrument handling, from post-procedure transport to sterilization validation. “After a procedure is completed, instruments are placed in a closed, labeled container and transferred to the designated dirty area for cleaning,” Berry said. “Biological indicators are monitored weekly, and chemical indicators are included in each pouch or instrument pan. Sterilizers are maintained according to manufacturer guidelines.”
Setting – and keeping – a standard
Maintaining consistent infection prevention standards across a large outpatient network requires more than policies – it demands structure, accountability, and a deeply embedded culture of safety. Leaders at OrthoCarolina say their approach combines centralized oversight, standardized training, and strong supplier partnerships to ensure consistency across every site.
Maselli emphasized that routine oversight is foundational to maintaining alignment across locations.
“OrthoCarolina has an oversight team that performs routine in-person observations and audits to observe all clinical areas, including our office-based surgeries,” Maselli said. “This allows us to ensure all proper protocols and policies are being followed at every site.”
In addition to operational audits, physician leadership plays a direct role in shaping and reinforcing standards.
“We also have an OBS oversight committee, which consists of a small group of our orthopedic surgeons who regularly utilize our OBS,” she said. “These surgeons review our policies, protocols, and procedures that are executed at every clinic. This ensures that there is oversight of which procedures are performed in our OBS.”
Standardization extends to staff roles and training as well. “We also have standardized the training for OBS roles, such as sterile processing experts who run our autoclaves across every site,” Maselli added, underscoring the importance of consistency in high-risk processes.
Beyond structure and oversight, OrthoCarolina leaders say building a culture of infection prevention is critical – especially among team members who may not specialize in perioperative care. Wilkins pointed to education as the starting point.
“A strong infection prevention culture outside perioperative specialties requires education, clear expectations and accountability,” she said. “This culture should begin with new hire onboarding and include experiential learning in the clinical lab.”
Training programs are both comprehensive and continuous. “All team members involved in autoclave use and sterilization processes for office-based surgery must receive initial training on proper autoclave operation and sterilization procedures, followed by annual education and competency reviews thereafter,” she said.
To reinforce understanding, OrthoCarolina has developed internal education modules that go beyond basic instruction. “The education modules are detailed with an explanation of the ‘why’ behind the things we do,” Wilkins said. “Competency quizzes follow each module with a minimum passing score of 80%.”
The organization also ensures on-the-ground expertise is readily available. “A clinic-wide program was created to have an on-site sterilization processing expert (SPE) for the autoclave process,” Wilkins explained. “These SPEs serve as resources for staff and support hands-on training when needed.”
Standardized workflows and checklists further support consistency in daily operations. Wilkins noted that clearly defined processes guide everything from hand hygiene and safe injection practices to instrument transport. “Workflows have been designed to provide clear, repeatable routines for team members, including ‘clean-to-dirty’ sequences for instrument processing, environmental cleaning, room turnover checklists, and transport protocols,” she said.
Accountability is reinforced through ongoing monitoring and feedback. “Scheduled and unannounced visits are conducted to audit workflows, ensure established processes are followed, and provide remedial training when needed,” Wilkins said. “Successes are recognized, and actionable feedback is shared with team members and managers.”
While internal processes are critical, Maselli noted that external partners also play an important role in infection prevention outcomes.
“The best way for suppliers and distributors to make a big difference in helping maintain our infection prevention standards is to continue to create high-quality products that can withstand the sterilization process, such as the autoclave,” she said. “This will allow healthcare providers to decrease the contamination of equipment.”
She added that consistency and quality from suppliers directly impact patient safety. “Suppliers and distributors that maintain high-quality standards and continual improvement processes will also allow us to have a decreased risk of contamination, thus lowering our infection rate.”
OrthoCarolina’s experience shows that effective infection prevention in outpatient care is not the result of any single protocol, but of a disciplined, organization‑wide commitment to consistency, education, and accountability. By pairing standardized workflows with hands‑on training, routine audits, and clearly defined roles, the organization ensures that “standard precautions are part of the culture” and that every clinic, regardless of size or layout, can reliably deliver safe, high‑quality care. Their emphasis on continuous improvement, from sterilization validation to supplier partnerships, reflects a system designed not just to meet regulatory expectations but to exceed them. As outpatient volumes continue to grow, OrthoCarolina’s model demonstrates how a unified, culture‑driven approach can reduce variability, strengthen staff confidence, and ultimately safeguard patients across an expanding network.