How Northside Hospital has designed protocols, workflows and communication to protect patients across a growing network of ambulatory sites.
As healthcare continues its steady shift toward outpatient care, infection prevention leaders are adapting strategies to manage risk across a growing network of ambulatory facilities. Procedures that once took place almost exclusively inside hospitals are increasingly being performed in ambulatory surgery centers, physician offices and specialty clinics. While these settings offer efficiency and convenience, they also bring unique challenges for infection prevention teams responsible for protecting patients and staff.
At Northside Hospital, Kaleb Price, MPH, CIC, FAPIC, oversees infection prevention efforts across procedural areas that span both hospital and outpatient environments. As Clinical Manager of the Procedural Infection Prevention Team, Price and his colleagues focus on locations where invasive procedures or anesthesia are performed – ranging from operating rooms to gastrointestinal labs and interventional procedure suites.
“We call our team the Procedural Infection Prevention Team,” Price said. “Procedures is pretty broad, but basically everywhere we might be doing invasive procedures or general anesthesia. So that’s operating rooms, pre-op and post-op areas, interventional radiology, interventional cardiology, and our GI labs where we do a lot of our scopes.”
In these settings, Price’s team is responsible for key infection prevention activities, including surgical site infection prevention, device reprocessing oversight, environmental hygiene practices and evaluating whether facilities are meeting appropriate standards for cleanliness and safety.
Risk assessment drives strategy
Although many of the core infection prevention principles remain the same across care settings, Price said the outpatient environment requires a slightly different approach. Infection prevention teams begin by identifying the most likely risks within a particular setting and then implementing processes, training or products that can reduce those risks.
“In infection prevention we always take things from a risk assessment standpoint,” he said. “We look at what are the most likely risks in this area, and then what sort of interventions or processes or products do we need to put in place to reduce infection risk.”
One key difference between hospital and outpatient environments involves patient acuity and diagnostic clarity. In acute care hospitals, patients often arrive with severe symptoms and are rapidly diagnosed. In outpatient clinics, however, symptoms may be milder or less specific, making early detection of infectious diseases more challenging.
“Patients who come to outpatient clinics often have milder symptoms than they would if they showed up to the emergency room,” Price said. “Usually people who feel really, really sick are going to go to the emergency room. People who have milder symptoms or are earlier in the course of an infection are often going to go to their primary care doctor or an urgent care clinic.”
That dynamic means clinicians must remain vigilant for contagious illnesses even when symptoms are nonspecific. Early signs such as fever, rash or general illness could signal more serious conditions that require isolation precautions or additional testing.
Price noted that outpatient teams must remain alert for highly contagious diseases such as Measles, Tuberculosis or Mpox. Identifying these conditions quickly helps limit potential exposure within clinics that may not have the same physical infrastructure as hospitals for isolating patients.
Communication is critical
Another major difference between inpatient and outpatient infection prevention is simply scale. While infection preventionists may round daily in hospital units, overseeing hundreds of outpatient locations requires a very different operational model.
Northside’s system includes nearly 500 outpatient clinics – far too many to support daily on-site infection prevention coverage.
“You can’t have an infection preventionist on site every day at every one of those,” Price said.
Instead, teams rely heavily on communication and scheduled outreach. Infection prevention leaders conduct routine rounding visits to outpatient sites while also maintaining regular contact through phone calls, email updates, webinars and education sessions.
Communication also extends beyond the health system itself. “We work closely with the Health Department so that we can get reports about epidemiologically significant organisms or infections that are going around in the community,” he said. “Then we communicate that to our clinics.”
Maintaining that steady flow of information ensures frontline staff remain aware of emerging threats and can quickly implement screening protocols or precautionary measures.
Infrastructure and operational challenges
Operational and infrastructure differences also create challenges for infection prevention in outpatient settings. Hospitals typically own and manage their facilities, which allows them to maintain tight control over environmental services, building maintenance and water systems.
Many outpatient facilities, however, operate within leased spaces that may be part of mixed-use buildings containing retail shops, restaurants or offices. That arrangement can complicate infection prevention planning.
“Our ambulatory surgery centers and physician offices often don’t own their own space,” Price said. “So when they’re setting up contracts with building owners and managers, or environmental services who are going to provide cleaning, they have to make sure they really nail down what the expectations are.”
Healthcare facilities often require specialized environmental controls – from enhanced cleaning protocols to monitoring of water systems – because pathogens can spread through contaminated surfaces or infrastructure. If these expectations are not clearly defined in service contracts, clinics may struggle to maintain appropriate infection prevention standards.
Staffing differences also play a role. Hospitals typically maintain dedicated teams focused on infection prevention, antimicrobial stewardship, quality improvement and product evaluation. Outpatient facilities, especially smaller physician practices, may not have personnel assigned to these functions.
“In hospitals we often have dedicated teams to topics like infection prevention or antimicrobial stewardship or quality or product evaluation,” Price said. “In our outpatient clinics, they may not have that person on site to do some of that.”
Standardization across a growing outpatient network
As healthcare continues shifting toward outpatient settings, health systems face a growing challenge: ensuring infection prevention practices remain consistent across dozens – or even hundreds – of facilities.
For large systems like Northside Hospital, which operates hundreds of outpatient locations, standardization is essential to maintaining patient and staff safety. Price said success starts with building clear systemwide policies and reinforcing them through ongoing oversight, education, and operational support.
“We standardize our policies, and that drives the expectation across the system,” he said. “And then the infection prevention team performs routine audits to observe the infection prevention practices at each of our facilities.”
These audits help ensure that frontline staff follow established protocols while also identifying opportunities for additional education and training. The infection prevention team supplements those efforts with regular communication and webinars to keep staff informed about evolving best practices.
Another key element is centralized purchasing. By routing equipment and supply purchases through a single system, Northside’s purchasing department can work closely with infection prevention specialists to monitor product usage and ensure staff have the right tools available.
“Our purchasing department can monitor usage and work with the infection prevention team to make sure the folks who are on the frontline providing care have access to products that are safe and reliable,” Price explained. “And the people in clinics or surgery centers have the training they need – whether that’s how to use the products or, if they’re reusable, how to clean and reprocess them.”
Designing workflows that encourage safer behavior
Beyond policies and equipment, infection prevention also depends on how clinical environments are designed and how staff move through them.
“We always want the safest action for our staff to be easily achieved,” Price said. “Ideally, it’s the easiest way they can do things.”
To achieve that goal, infection prevention teams often observe staff as they work in exam rooms or operating rooms. These observations can reveal simple adjustments that improve compliance with safety protocols.
For example, the placement of hand hygiene products can significantly influence whether staff use them consistently.
“We might go and observe how staff move around an exam room while they’re providing care,” Price said. “If we see where they spend most of their time, that might be where we need to put the hand hygiene products.”
If hand sanitizer is placed in an inconvenient location – such as across the room or behind equipment – staff may be less likely to use it. Moving dispensers closer to the point of care can dramatically increase compliance.
Similarly, the team evaluates where sharps containers are located and how equipment is arranged within the workspace.
Small changes can have a big impact.
“Maybe your sharps container isn’t quite in the right place, or your hand hygiene products are on the wrong wall,” Price said. “If we just move them from the left side of the room to the right side, staff may use them much more often.”
Technology can also help reduce risk. Whenever possible, Northside looks for devices with built-in safety features, such as needles or scalpels with automatic safety mechanisms that engage after use.
“That’s one less thing staff have to think about,” Price said. “We protect them without anyone having to actually do anything.”
By combining standardized policies, centralized resources, and thoughtful workflow design, large health systems can help ensure infection prevention practices remain strong – even as care increasingly moves outside the hospital walls.
Opportunities for suppliers and distributors
As outpatient care continues to expand, suppliers and distributors can play an increasingly important role in supporting infection prevention efforts. Price noted that many ambulatory facilities rely on outside expertise and trusted partners to help evaluate products, maintain compliance and implement best practices.
Education is particularly valuable. Training resources, product guidance and workflow support can help clinics ensure staff understand how to properly use infection prevention tools – from disinfectants and personal protective equipment to device reprocessing systems.
Suppliers can also assist facilities in selecting products that align with the specific risks associated with outpatient care. For example, portable infection prevention technologies, simplified reprocessing solutions and easy-to-implement environmental cleaning tools may be particularly useful in clinics that lack large support teams.
When it comes to supporting outpatient clinic facilities, clear and timely communication from suppliers and distributors can make all the difference. “If they can communicate any changes or problems to us as soon as possible – whether it’s a change in an IFU or a product backorder – that obviously can cause significant changes to our workflow, to the care staff’s workflow,” Price explained. “The earlier we know about something like that, the earlier we can begin planning for that change. That makes it easier for us to come up with ways to continue providing the same standard of care as before.”
Even small changes can ripple throughout the system, he noted. “Even if it seems minor – a short backorder or a small change in IFU – that can actually have significant effects. The earlier we know, the easier it is for us to adapt.” In the fast-paced outpatient environment, proactive communication isn’t just helpful – it’s essential.
Removing complexity from instrument reprocessing
Instrument reprocessing can be a challenge in outpatient clinics, where nurses or medical assistants often handle cleaning and sterilization. Northside Hospital has transitioned almost all of their reusable instrument sterilization to SPD, but they do still have some in-office sterilization. “Those staff do maintain training and competency checks to make sure they’re providing the same level of safety as staff working in SPD,” Price said.