HHS Secretary Kathleen Sebelius today provided the down payment for a nationwide effort to reduce health care associated infections in stand-alone or same-day surgical centers.  The first effort will begin later this month in 12 states under provisions of the American Recovery and Reinvestment Act of 2009, administered by the Centers for Medicare & Medicaid Services (CMS).

"Keeping patients healthy is one of the requirements of the Recovery Act, and the first 12 states that have volunteered to focus attention on these surgical centers are taking a giant step in helping to reduce infections that affect millions of patients every year," said Secretary Sebelius.  "CMS's efforts with states to reduce the number of infections quickly are just one part of protecting the health of the nation's health care system."

"People go to the hospital to get well, not take on a new infection.  These Recovery Act funds will help to identify why there has been such an increase in health care associated infections and, importantly, what can be done to prevent them," Sebelius said.  "This is what the Recovery Act is all about:  putting people to work to solve an important issue and improve the quality of life for Americans for many years to come."

Increasingly, health care delivery is being shifted to outpatient settings such as ambulatory care facilities, long term care facilities, and free standing specialty care sites.  The number of ambulatory surgical centers has grown dramatically and continues to increase.  Health care associated infections (HAIs) are infections that patients acquire during the course of their stay in a health care setting. The Centers for Disease Control and Prevention (CDC) saw an increase in the number of HAIs in outpatient settings due to unsafe medical practices.  The overall burden of HAIs in outpatient settings is unknown; however, it is evident from the infections that have been identified that it is a significant problem resulting from very basic infection control failures, and requires additional oversight by CMS.

The 12 states - Maine, New Jersey, Maryland, Florida, North Carolina, Indiana, Michigan, Arkansas, Oregon, Utah, Wyoming and Kansas - will survey more than 125 ambulatory surgical centers (ASCs) before September 30, 2009, at an estimated cost of up to $1 million.  The onsite reviews, paid for out of Recovery Act funds, are designed to ensure that the facilities are following Medicare's health and safety standards.  As part of the new initiative, state surveyors will employ a new CMS survey process that uses a tool developed in conjunction with CDC.  In addition, Recovery Act funds will increase the number of ASCs surveyed.

ASCs account for 43 percent of all same-day (ambulatory) surgery in the United States  , amounting to about 15 million procedures every year.  Typical surgical procedures conducted in ASCs include endoscopies and colonoscopies (including removal of identified polyps), orthopedic procedures, plastic/reconstructive surgeries, and eye, foot, and ear/nose/throat surgeries. 

In addition to the funds being made available today, an additional $9 million will be available in October 2009 for all states to make additional inspections of ASCs with the new, improved survey tool.  The CDC will also make $40 million available to state public health departments to create or expand state-based HAI prevention and surveillance efforts, and strengthen the public health workforce trained to prevent HAIs.  These funds support activities outlined in HHS' 2009 Action Plan to Prevent Health care-Associated Infections, available at

"We will make sure that providers have good information about ways to prevent serious infections," said Secretary Sebelius.  "And we will make onsite inspections to ensure that good infection control practices are being followed."

Recovery Funding to Improve Care in Ambulatory Surgical Centers


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New Jersey


North Carolina








Total for States & DC