[Prevention of nosocomial infections in the medical office]

Nosocomial infections are usually considered to be a problem of hospitals. However, outpatient care is also not without risks to the patient or to the healthcare workers. Cases of iatrogenic infections following invasive acts such as intramuscular injections in medical offices have occurred repeatedly and have resulted in malpractice charges against the physicians involved. This illustrates a need for physicians in private practice to establish a concept for the prevention of nosocomial infections in their office. This concept should include patients as well as healthcare workers and must be adapted to the particular setting of the practice. After implementation of such a concept, it will be possible to provide care to all patients--the routine patient, the routine patient undergoing an invasive procedure, the patient who is colonized with a resistant microorganism, as well as the patient who presents himself with an infectious disease--under conditions that minimize the risk of nosocomial infection to the patient as well as to the healthcare workers. The essential elements of such a concept include written guidelines for disinfection, sterilization and personnel protection. Depending on the type of practice, additional guidelines, i.e. guidelines for reprocessing of endoscopes in a gastroenterology practice, will be needed.