Dentist Infection Control

Infection Control Consulting Services Blog


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.


Antimicrobial Stewardship in Ambulatory Care and Ambulatory Surgery Settings

Antimicrobial stewardship (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.

For the past few years, a major emphasis has been placed on developing and maintaining AMS programs in acute care settings as well as outpatient centers.

AMS efforts at the federal level began in September 2014 when President Obama issued an executive order to combat antibiotic resistant bacteria. The order detailed plans for reducing the risk of resistance through a number of initiatives, including introducing AMS into ambulatory care. Ambulatory settings include, but are not limited, to outpatient clinical practices, ambulatory surgery centers (ASCs) and dialysis centers.

In March 2015, the White House issued a national action plan which includes an extensive list of goals and expectations. By 2020, significant outcomes in this area will include:

  • Establishment of antimicrobial stewardship programs in all acute care hospitals and improved stewardship across all healthcare settings.
  • Reduction of inappropriate antibiotic use by 50% in outpatient settings and 20% in inpatient settings.
  • Establishment of State Antibiotic Resistance Prevention (Protect) Programs in all 50 states. 

In June 2016, The Joint Commission released a new standard relating directly to AMS: medication management (MM) standard MM.09.01.01. This standard will be enforced in January 2017 for all acute care hospitals, critical access hospitals and nursing care centers. According to The Joint Commission, "This standard was developed following the White House Forum on Antibiotic Stewardship, held on June 2, 2015. At the forum, The Joint Commission joined major health care organizations, food companies, retailers, and animal health organizations at the forum to express commitment for implementing changes over the next five years to slow the emergence of antibiotic-resistant bacteria, detect resistant strains, preserve the efficacy of existing antibiotics, and prevent the spread of resistant infections."

Infection Control Consulting Services (ICCS) stresses the need for ASCs and other outpatient facilities to develop their AMS programs without delay as the White House and 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).

Looking for assistance with developing compliant AMS programs? Contact ICCSs, a national leader in developing compliant infection prevention programs for a wide range of facility types, including outpatient care centers, ASCs and hospitals.


Free Webinar on Setting Goals for Antibiotic Prescribing in Outpatient Settings (June 28)

The Centers for Disease Control and Prevention (CDC) is hosting a free webinar on "United States Outpatient Antibiotic Prescribing and Goal Setting."

The program takes place June 28, 2016, from 1:00-2:00 p.m. EDT.

The issues of antibiotic and antimicrobial stewardship are receiving great attention. The CDC, in collaboration with Pew Charitable Trusts and others, released data in May showing that at least 30% of all prescriptions written in doctors' offices and emergency rooms are completely unnecessary.

The Joint Commission recently released a new antimicrobial stewardship standard for acute care hospitals, critical access hospitals and nursing care centers, which will take effect January 1, 2017.

The webinar will be presented by pediatrician and pediatric emergency medicine doctor Katherine Fleming-Dutra, MD, medical epidemiologist with CDC’s Office of Antibiotic Stewardship.

She will discuss:

To register for the CDC webinar, click here.