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Infection Control and Prevention Affected by Joint Commission Survey Process Changes

The Joint Commission survey process has undergone some changes for 2017 that affect infection control and prevention and should be of interest to hospitals, ambulatory surgery centers (ASCs) and other provider organizations.

New Scoring Methodology

The Joint Commission is using a new scoring methodology called SAFER (Survey Analysis for Evaluating Risk). It is described as "a transformative approach for identifying and communicating risk levels associated with deficiencies cited during surveys."

Part of The Joint Commission's multiphase process improvement project dubbed "Project REFRESH,"  this new scoring process became effective Jan. 1, 2017, for all accreditation and certification programs. Note: It was first implemented in June 2016 for psychiatric hospitals that use Joint Commission accreditation to meet the Centers for Medicare & Medicaid Services (CMS) deemed status requirements.

The SAFER methodology incorporates the use of the SAFER Matrix. The SAFER Matrix replaces the previous scoring methodology based on predetermined categorizations of elements of performance.

Rather, the SAFER Matrix allows "surveyors to perform real-time, on-site evaluations of deficiencies. These are then placed on the SAFER Matrix according to the likelihood of the issue to cause harm to patients, staff or visitors, according to how widespread the problem is, based on the surveyor's observations."

The Joint Commission says use of the matrix will allow organizations "to see areas of noncompliance at an aggregate level, showing significant components of risk analysis."

As an article from APIC about the new scoring methodology notes provides an example of how different infection prevention- and control-related findings might be placed in the matrix.

Use of the new scoring model also result in changes to post-survey follow-up activities.

Extra On-Site Surveyor for ASCs

In 2017, roughly two-thirds of Joint Commission-accredited ASCs using the Medicare-deemed option may have an extra on-site surveyor and need to allocate a larger time commitment from leaders and staff, according to a report from Michael Kulczycki, The Joint Commission's executive director of ambulatory health care.

Kulczycki notes that one of the reasons for the additional surveyor is the completion of "CMS mandated patient tracers, medical records, credentialing files and an 82-question infection control worksheet."

While the second surveyor will likely lead to increased scrutiny of an ASC's practices and compliance with standards and regulations, it will also, as Kulczycki states, help deliver a "meaningful, consultative survey experience."

Infection Control Consulting Services (ICCS) is a national provider of hospital infection prevention and ambulatory surgery infection prevention consulting services. These services include accreditation survey preparation, utilizing standards set forth by CMS and The Joint Commission; assistance with plans of correction related to survey deficiencies; mock surveys; and on-site or remote educational programs. Contact ICCS to learn how its team of expert consultants can assist your organization.


Antimicrobial Stewardship Named Top Patient Safety Concern By ECRI

ECRI Institute has named antimicrobial stewardship one of its "2017 Top 10 Patient Safety Concerns for Healthcare Organizations."

ECRI Institute is a nonprofit organization that researches approaches to improving patient care.

To select topics for its 2017 list, ECRI Institute stated it used event data from its Patient Safety Organization, concerns raised by healthcare organizations and expert judgment.

Antimicrobial stewardship (AMS) was ranked number five on the list. AMS refers to coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy and route of administration.

In its executive brief summarizing the top 10 list, ECRI wrote the following about AMS: "Today, drug choices for treating many bacterial infections are becoming increasingly limited and expensive — and in some cases, nonexistent. Inappropriate prescribing is a key factor. 'If prescribing habits do not change, more people will die from infections for which there is no treatment,' says Sharon Bradley, RN, CIC, senior infection prevention analyst, ECRI Institute."

Phenelle Segal, RN, CIC, founder and president of Infection Control Consulting Services (ICCS), noted the following in a recent blog about AMS in ambulatory care and ambulatory surgery settings: "ICCS stresses the need for ambulatory surgery centers and other outpatient facilities to develop their AMS programs without delay as ... accreditation agencies ramp up their efforts to implement changes in antimicrobial use. The Joint Commission will more than likely hold its outpatient facilities to the same standards as inpatient and nursing care centers, and it would not be surprising to see other accreditation agencies (e.g., AAAHC) add an AMS standard(s)."

Also in ECRI's top 10 list: information management in EHRs (#1), unrecognized patient deterioration (#2), implementation and use of clinical decision support (#3), and inadequate organization systems or processes to improve safety and quality (#10).


Study: Antibiotic Stewardship Can Reduce Multidrug-Resistant Organism Transmission

A new study reveals the potential power of antibiotic stewardship programs in helping reduce infections.

The research, published in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, looked at reducing antibiotic use in intensive care units and its effect on transmission of multidrug-resistant organisms (MDROs).

Researchers developed models that indicated reductions in antibiotics by 10 percent and 25 percent corresponded to reductions in the spread of the deadly bacteria of 11.2 percent and 28.3 percent, respectively.

"Antibiotic exposure is the most significant driver of resistance," said Sean Barnes, PhD, assistant professor of operations management in the Robert H. Smith School of Business at the University of Maryland, and the study's lead author. "In the hospital setting, nearly 50 percent of all patients receive an antibiotic, including up to 75 percent of all critically ill patients. But what is really troubling is that nearly half of all antibiotics prescribed may be inappropriate. Even moderate reductions in antibiotic use can reduce transmission of MDROs."

Efforts are underway across the country to reduce unnecessary antibiotic use through antimicrobial stewardship programs and other interventions. Research had demonstrated the benefits of these measures on patient care and costs. Now there is research supporting the positive the impact on MDRO rate.

"Antibiotics have been one of the most useful and critical drugs in modern medicine, but our overuse of these drugs has hurt us by supporting the development of MDROs", said Kerri Thom, MD, MS, associate professor at the University of Maryland School of Medicine and a study co-author. "Our model suggests that substantial reductions in infection rates are possible if stewardship programs aggressively pursue opportunities to reduce unnecessary usage of antibiotics."

Antimicrobial Stewardship in the Spotlight
The data from this study, titled "The Impact of Reducing Antibiotics on the Transmission of Multidrug-Resistant Organisms," will likely bring even more attention to the importance of antibiotic stewardship. As a report from The Joint Commission noted, "The global problem of antibiotic resistance results in 2 million illnesses and 23,000 deaths annually."

This was a motivating factor in The Joint Commission's development of antimicrobial stewardship standard MM.09.01.01, which went into effect January 1 for hospitals, critical access hospital and nursing care centers. The Joint Commission has indicated an antimicrobial stewardship standard for accredited ambulatory care organizations and office-based surgery practices is in development.

On March 8, the Centers for Disease Control and Prevention's acting director, Anne Schuchat, MD, presented at the U.S. Capitol about the need for continued action and investment to contain and address the urgent threat of antibiotic resistance to protect Americans.

The issues of antibiotic stewardship and development of antimicrobial stewardship programs, in settings including outpatient care facilities and ambulatory surgery centers, are of great interest to Infection Control Consulting Services (ICCS) President Phenelle Segal, RN, CIC, and the ICCS team. To learn more about these issues, read Phenelle's Becker's Infection Control & Clinical Quality column on ASC antibiotic stewardship program implementation and ICCS blog on ambulatory antimicrobial stewardship.

For assistance with development and implementation of an antimicrobial stewardship program, contact ICCS.


Study: Antibiotic-Resistant Infections Rising in Children

A new study published in the Journal of the Pediatric Infectious Diseases Society indicates that infections caused by a type of bacteria resistant to multiple antibiotics are occurring more frequently in U.S. children.

Infections caused by multidrug-resistant Gram-negative enteric Enterobacteriaceae (MDR-GNE) are also associated with longer hospital stays, a trend towards greater risk of death and increased likelihood of spreading.

The retrospective study, titled "Incidence and Outcomes of Infections Caused by Multidrug-Resistant Enterobacteriaceae in Children, 2007–2015," examined data from 48 U.S. children's hospitals maintained by the Pediatric Health Information System, a comparative pediatric database. From these hospitals, there were approximately 94,000 patients under the age of 18 who were diagnosed with Enterobacteriaceae-associated infections between 2007 and 2015.

The data revealed that the proportion of infections caused by bacteria resistant to multiple antibiotics increased from 0.2% in 2007 to 1.5% in 2015. That is a more than 700% increase in prevalence.

Other study findings including the following:
  • Children with Enterobacteriaceae infections resistant to multiple antibiotics had hospitals stays that were 20% longer than patients with infections that were susceptible to antibiotics.
  • Most of the resistant infections were present when the children were admitted to the hospital, suggesting the bacteria may be increasingly spreading in the community.
  • Older kids, children with other health conditions and those living in the Western United States were more likely to have the infections.

"Antibiotic resistance increasingly threatens our ability to treat our children's infections," said study author Sharon B. Meropol, MD, PhD, of University Hospitals Rainbow Babies and Children's Hospital in Cleveland and Case Western Reserve University School of Medicine, in a press release. "Efforts to control this trend are urgently needed from all of us, such as using antibiotics only when necessary (an essential component of an antimicrobial stewardship program), and eliminating agricultural use of antibiotics in healthy animals."

The study was funded by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health.


American Veterinary Medical Association Targets Antimicrobial Resistance

The American Veterinary Medical Association (AVMA) has announced the release of a report designed to help veterinary practices combat the threat of antimicrobial resistance.

The report from the AVMA Task Force for Antimicrobial Stewardship in Companion Animal Practice is intended to provide a "framework for instituting a clinic-level approach for judicious antimicrobial use" and other educational resources.

AVMA notes that a significant focus of the task force was to assemble the following core elements of a companion animal antimicrobial stewardship program:
  • Each veterinary practice should commit to the reduction in antimicrobial resistance by creating and adopting a clinic-specific plan in which everyone contributes to effective antimicrobial stewardship.
  • Antimicrobial stewardship in a practice begins with the appointment of a principal person to lead the program and to support the practice stewardship goals with all available resources.
  • Practices should address issues of antimicrobial resistance by taking a proactive approach to antimicrobial use and veterinary infection control, using accepted guidelines, recommendations and expertise.           
  • Understanding what is working and what is not requires self-assessment and monitoring, with a goal of continual improvement.

The report, which was released November 2016, includes sections on the following:
  • Why should we promote antibiotic stewardship?
  • Understanding companion animal practitioners’ attitudes toward issues of antimicrobial resistance and stewardship
  • Survey of veterinary laboratories regarding antibiotic susceptibility
  • Practice guidelines
  • Core elements of companion animal antimicrobial stewardship programs

Through the task force, AVMA has made combating antimicrobial resistance a priority. As AVMA states, "Proper use of antimicrobials in companion animals is essential to optimize therapeutic efficacy, enhance treatment success and minimize resistance to antimicrobials; all of which contribute to protecting public health and animal health and well-being."

The task force has developed a wealth of valuable resources, including do's and don'ts of antimicrobial prescribing, and provides links to resources developed by the International Society for Companion Animal Infectious Diseases and the Federation of European Companion Animal Veterinary Associations. Access these resources here.


CDC Brings Attention to Dental Infection Control and Prevention Practices

The Centers for Disease Control and Prevention (CDC) Division of Oral Health has contributed an article to Medscape (free account required for access) discussing the prevention of disease transmission in dental settings.

The article notes that, while rare, transmission of infectious agents between patients and dental healthcare personnel (DHCP) in dental settings do occur. Specifically, CDC references published reports describing the transmission of hepatitis B and hepatitis C in dental settings and a report on a 2015 outbreak of Mycobacterium abscessus infection at a pediatric dentistry practice.

The column then provides tips and advice for dental disease transmission prevention on topics that include:
  • Administering of local anesthesia
  • Use of multi-dose vials
  • Cleaning and heat-sterilizing of handpieces
  • Sterilizer monitoring
  • Water standards

CDC references additional resources to aid in dental infection prevention, such as its "Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care" 2016 report. This is a summary guide of basic infection prevention recommendations for all dental healthcare settings, including traditional settings such as private dental practices, dental clinics, dental schools and educational programs (including dental assisting, dental hygiene, and laboratory). In addition, the recommendations include nontraditional settings that often use portable dental equipment such as clinics held in schools for sealant and fluoride placement and other sites for humanitarian dental missions.

CDC also references its "Infection Prevention Checklist for Dental Settings." CDC notes the checklist should be used to ensure the dental healthcare setting has appropriate infection prevention policies and practices in place, including appropriate training and education of DHCP on infection prevention practices. Systematic assessment of  personnel compliance with the expected infection prevention practices is a critical step in following guidelines. Feedback  to DHCP regarding performance as well as documentation of compliance is important.

As the CDC states in the Medscape report, "Infection prevention should be a priority in all clinical dental care settings. A survey of U.S. dentists looked into implementation of four recommended infection prevention recommendations (have an infection control coordinator in the dental practice, maintain dental unit water quality, document percutaneous injuries, and use safe medical devices such as safer syringes and scalpels). [The survey] found that only 25% of practices had routinely implemented three or four of these recommendations."

Need assistance with dental infection control program development, improvement and/or education? Contact ICCS, a leading national provider of infection control and prevention services for dental offices and oral surgery centers.


CDC Launches App for Dental Infection Prevention

The Centers for Disease Control and Prevention (CDC) has released a mobile application designed to assist facilities with monitoring their ongoing compliance with recommended dental infection prevention practices.

The CDC DentalCheck app is a tool dental practices can use to help evaluate dental healthcare personnel (DHCP) compliance with administrative policies and clinical practice infection prevention and control recommendations.

Note: While the app is a good resource, it is important that dental practices and oral surgery centers do not consider it as a replacement for a robust infection prevention and control program overseen by a trained infection preventionist.

The app is based on recommendations contained in CDC's "Guidelines for Infection Control in Dental Health-Care Settings – 2003" as well as other recommendations relevant to dentistry published by CDC since 2003.

It can be used to help ensure appropriate infection prevention policies and practices are in place, including appropriate training and education of DHCP, and assessment of compliance of personnel with infection prevention practices.

Within the app, users can navigate to references and resources for areas of focus including sterilization, safe injection practices and hand hygiene. They can also access a summary of basic infection prevention principles and recommendations for dental settings.

CDC DentalCheck can be downloaded through the iTunes App Store. It can be displayed on any iOS-enabled mobile device.

Dental practices and oral surgery centers are under increased infection prevention and control scrutiny following a number of high-profile infection outbreaks over the past few years, including a odontogenic infection outbreak related to pediatric patients undergoing a pulpotomy, or "child root canal." Infection Control Consulting Services (ICCS) works with dental practices and oral surgery centers to develop a comprehensive infection prevention plan and provides other services designed to help organizations maintain compliance and keep patients safe. Contact ICCS today to learn more.