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Infection Control Consulting Services Blog


Joint Commission: Infection Control Standard Among the Most Challenging for Ambulatory Care, Hospitals

The Joint Commission standard IC.02.02.01 (The [organization] reduces the risk of infections associated with medical equipment, devices, and supplies.) was one of the top requirements cited most frequently as "not compliant" during surveys and reviews of ambulatory care facilities, hospitals and office-based surgery practices for the first half of 2016, according to Joint Commission Online.

For ambulatory care, this standard was the most challenging requirement, with a 49% non-compliance percentage.

For hospitals, it was the second most challenging, with a 59% non-compliance percentage.

For critical access hospitals, it was tied for the most challenging, with 73% non-compliance percentage.

For office-based surgery practices, it was the second most challenging, with a 53% non-compliance percentage.

Infection Control Consulting Services (ICCS) provides a wide range of infection prevention and control consulting services, including infection control survey preparation and preparation of and assistance with corrective plans of action related to survey deficiencies. If your facility requires assistance with meeting Joint Commission requirements, contact ICCS today!


FDA Recommendation: Stop Using System 83 Plus AERs for Duodenoscope Reprocessing

The U.S. Food & Drug Administration (FDA) recently issued a recommendation advising healthcare facilities no longer use Custom Ultrasonics' System 83 Plus automated endoscope reprocessors (AERs) for reprocessing duodenoscopes.

Contained within this notice to facilities that reprocess duodenoscopes is the following FDA advice: "Identify and transition to alternate methods to reprocess duodenoscopes, such as manual high-level disinfection, alternative AERs, liquid chemical sterilization, or other sterilization methods according to the duodenoscope manufacturers' reprocessing instructions."

Infection Control Consulting Services (ICCS) cautions facilities that may choose manual high-level disinfection (HLD) upon ceasing use of System 83 Plus AERs that every step for reprocessing in this manner must follow manufacturers' instructions for use (IFUs). This includes IFUs available from the scope manufacturer, HLD chemical manufacturer and other items that may be used during reprocessing. In addition, facility written policies must be followed. Guidelines set forth by associations and agencies, including the FDA and Centers for Disease Control and Prevention (CDC), if applicable, should be followed as well.

ICCS finds during on-site visits that facilities performing manual HLD are subject to a higher rates of process failure than facilities conducting automated HLD. Breakdown in processes include, but are not limited to, failure to test the temperature and viability of the chemical(s). Documentation of steps taken as well as monitoring of technician methods for conducting this process is important. At a minimum, annual reprocessing competencies should be conducted. They should occur more frequently if a change in procedure or product is introduced. Change of reprocessing personnel requires a competency as well.

Note: FDA communicated that Custom Ultrasonics' System 83 Plus AERs remain in service for the reprocessing of endoscopes other than duodenoscopes.


ASCA Report: Infection Control Issues Top CMS 'Most Cited' List

Infection control issues are the most cited during surveys by the Centers for Medicare & Medicaid Services (CMS), according to a report in ASC Focus, the official magazine of the Ambulatory Surgery Center Association (ASCA).

To access the report, click here (ASCA membership may be required for access).

As the report notes, ASCA requested CMS run a fiscal year 2015 frequency report for both health and Life Safety Code surveys. From a total of more than 1,250 health surveys, infection control was a top area in which ASCs were cited — Q0241 (Sanitary Environment) and Q0242 (Infection Control Program) were the #1 and #3 areas most cited, respectively.

Concerning infection control, Kara Newbury, ASCA's regulatory counsel, writes, "We expect this to continue to be a hot survey topic, since CMS updated the Infection Control Surveyor Worksheet last summer." Note: Learn about the critical changes made to the worksheet in this special report from Infection Control Consulting Services (ICCS).

The ASC Focus report echoes the observation of ICCS consultants, who have seen an increase in the number of infection prevention- and control-related CMS survey citations. Read about five of the top citations in this ICCS special report.



AORN Issues Response to ACS Statement on Surgical Attire

The Association of periOperative Registered Nurses (AORN) has issued a response to the American College of Surgeons (ACS) statement published earlier this month that discusses professional attire for surgeons in and out of the operating room.

As Phenelle Segal, RN, CIC, founder of Infection Control Consulting Services noted in a special report published last week, "... aspects of the statement have created significant confusion amongst hospital and ambulatory surgery center staff."

AORN echoes this sentiment in its response. Of particular concern to AORN is the ACS statement's introduction, which says, "The ACS guidelines for appropriate attire are based on professionalism, common sense, decorum, and the available evidence."

AORN notes that "Regulatory agencies, accrediting bodies, and patients expect health care organizations to follow guidelines that are evidence based rather than conclusions based on professionalism, common sense, or decorum."

The AORN response examines each of the ACS statement's guidelines, stating whether a guideline is supported by evidence or if there is other information perioperative professionals should take into consideration before following the guideline.


FDA Issues Warning About Fluoroquinolone Antibiotics

Acute care hospitals have been tasked with developing antimicrobial stewardship programs for several years as multidrug resistant organisms (MDROs) continue to cause serious health issues, oftentimes due to misuse. In addition, ambulatory care and ambulatory surgery settings are gearing up to combat misuse of antibiotics as per the March 2015 White House "National Action Plan for Combating Antibiotic-Resistant Bacteria."

This week, the FDA updated its warning about the side effects and dangers of a class of drugs called fluoroquinolones. It has been well documented that this class of antibiotics should be cautiously prescribed due to its side effects, which include "disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system."

The warning specifically notes that "fluoroquinolones should be reserved for use in patients who have no other treatment options for acute bacterial sinusitis (ABS), acute bacterial exacerbation of chronic bronchitis (ABECB), and uncomplicated urinary tract infections (UTI) because the risk of these serious side effects generally outweighs the benefits in these patients."

Unfortunately, prescribers often reach for fluoroquinolones as a first resort to treating uncomplicated infections as they are highly effective.

Besides the side effects listed above, fluoroquinoles are known to be a significant contributor to the development of Clostridium difficile infection, contributing to the argument that they should be used wisely.

ICCS works with healthcare organizations, including hospitals, ambulatory surgery centers and outpatient care facilities, to develop and implement antimicrobial stewardship programs. Learn more about ICCS infection prevention services.


Zika Remains a Public Health Crisis

In just the past week, there have been a number of developments that indicate Zika is still a national concern and likely to create havoc in the coming months.

Most concerning may be news out of Utah that health officials have yet to determine how a person became infected with the virus. There are two known sources of transmission: a mosquito bite or sexual contact. According to a news release from the Utah Department of Health, it is believed that the person who contracted the disease had not recently traveled to an area with Zika and had not had sex with someone who is infected with Zika or who had traveled to an area with Zika.

There is no evidence at this time that mosquitoes that commonly spread Zika — aedes species — virus are in Utah. The investigation, the release notes, is focused on determining how the person became infected after providing care to an individual who died from unknown causes and who had been infected with Zika after traveling to an area with Zika.

The number of disease cases continues to rise. As of July 13, there more than 1,300 travel-associated cases reported in U.S. states. New York has the most travel-associated cases: 339, which represents 26% of all cases in the states. Florida comes in second, with 229 cases (18%). There have been more than 2,900 locally acquired cases reported in U.S. territories, with Puerto Rico the source of 98% of cases in territories.

The Centers for Disease Control and Prevention, in its Morbidity and Mortality Weekly Report, shared a report on the first reported occurrence of female-to-male sexual transmission of Zika virus following an investigation by the New York City Department of Health and Mental Hygiene.

There continue to be numerous reports of athletes withdrawing from the Olympics over fear of contracting the virus in Rio. On Friday, two top tennis players withdrew: Simona Halep of Romania and Milos Raonic of Canada. Not long after, Czech tennis player Tomas Berdych also announced he would not participate. They join a growing list that already included golfers Dustin Johnson, Jason Day and Rory McIlroy.

And there was the news of Congress failing to approve more than $1 billion toward federal efforts to combat Zika.

There was some good news: Public Radio International reported that a number of Zika vaccines are ready for human trials, although a lack of funding could stall their progress.


Phenelle Segal of ICCS Writes Report on Impact of Cutting Costs on Infection Prevention Compliance

Phenelle Segal, RN, CIC, founder of Infection Control Consulting Services (ICCS), has written a new special report examining the risks organizations take when they reduce their investment in tasks and services concerning patient safety and regulatory compliance.

The result, Segal notes, is that "small financial gains are often wiped out and easily surpassed by the expenses associated with problems that develop down the road."

These can include patients developing infections, citations by surveyors, fines, damaged reputation, additional expenses to fix issues and declines in staff morale.

Read the ICCS special report on infection prevention compliance.