Dentist Infection Control

Infection Control Consulting Services Blog


Infection Control Standard is Joint Commission's Most Challenging for Ambulatory Care in 2016

Joint Commission reports that in 2016, an infection control standard was the most challenging for ambulatory health care organizations accredited by the organization.

This is according to The Joint Commission's annual summary of the Top 10 Challenging Standards for its ambulatory care program.

The infection control standard is IC.02.02.01 (The organization reduces the risk of infections associated with medical equipment, devices, and supplies.). Fifty-three percent of organizations received Requirements for Improvement for the standard, based on Joint Commission accreditation surveys and certification reviews from January 1, 2016, through December 31, 2016.

This standard, in particular, has gained increased attention in both the ambulatory and inpatient setting over the course of the past few years. During this time, medical device reprocessing  was identified as an issue after failures in reprocessing duodenoscopes resulted in fatal infections. The elements of performance for IC.02.02.01 include "cleaning and performing low-level disinfection of medical equipment, devices and supplies (such as stethoscopes and blood glucose meters)." They also include "performing intermediate and high-level disinfection and sterilization of medical equipment, devices and supplies (for semi-critical and critical items)." Disposing and storage of equipment, devices and supplies as well as single-use device reprocessing is also addressed. 

The Joint Commission holds ambulatory care settings to the same standards as inpatient/acute care settings as it relates to standard IC.02.02.01. Facilities that are accredited can expect surveyors to closely scrutinize related practices.

Joining the infection control standard in the top three were human resources standard HR.02.01.03 (The organization grants initial, renewed, or revised clinical privileges to individuals who are permitted by law and the organization to practice independently.) and environment of care standard EC.02.03.05 (The organization maintains fire safety equipment and fire safety building features).

For assistance with Joint Commission survey preparation, contact the infection control experts at Infection Control Consulting Services by clicking here.


CDC Study Puts Dental Antimicrobial Stewardship in the Spotlight

A Centers for Disease Control and Prevention (CDC) study published in the Journal of the American Dental Association (JADA) shows that dentists prescribed 24.5 million antibiotic prescriptions in 2013. This equates to 10% of all antibiotic prescriptions in the outpatient setting.

The study found dentists usually prescribe within recommended guidelines. However, they sometimes prescribe antibiotics not indicated for dental conditions, such as fluoroquinolones and others used to treat urinary tract infections. CDC notes that additional study is needed to better understand the reasons for the variability and identify areas of possible intervention and improvement.

As the study author's state, "Continued efforts to combat antibiotic resistance will require all prescribers, including dentists, to examine prescribing behaviors for appropriateness and the effectiveness of guidelines to identify opportunities to optimize antibiotic use."

In a blog, CDC identifies the following dos and dont's for responsible antibiotic prescribing practices in dentistry.

  • prescribe antibiotics only for a documented diagnosis of an oral bacterial infection
  • recognize that antibiotics are not always necessary
  • prescribe only for patients of record
  • prescribe only for bacterial infections you have been trained to treat
  • review patient’s medical history to assess medical allergies, potential for adverse drug events, and medical conditions that would affect antibiotic selection
  • prescribe only when clinical signs and symptoms of bacterial infection suggest systemic spread
  • use the most narrow-spectrum antibiotic for the shortest duration possible (after clinical signs and symptoms subside) for otherwise healthy patients
  • advise patients to take antibiotics exactly as directed
  • ensure antibiotic expertise or references are available during patient visits
  • collaborate with referring specialists about prescribing protocols
  • provide training to staff members to improve probability of patient adherence
  • keep up to date on appropriate management of oral infections (continuing education courses, conferences, accessing dental journals, pharmacology texts) 
  • revise antibiotic regimens on basis of patient progress and, if needed, culture results 
  • advise patients that they should NOT take antibiotics prescribed for someone else
  • advise patients that they should NOT save antibiotics for future illnesses

  • prescribe for viral infections, fungal infections or oral ulcerations related to trauma or aphthae
  • prescribe in lieu of dental interventions
  • prescribe based on demand or expectations from patients
  • prescribe based on non-evidence-based historical practices
  • prescribe based on pressure from another health care provider

Over the course of the past few years, a major emphasis has been placed on antimicrobial stewardship program development and maintenance. As publication of the study's results and blog indicate, CDC is bringing attention to the importance of dental antimicrobial stewardship.

Dental offices and oral surgery centers in need of assistance with development of AMS programs or other infection prevention and control initiatives are encouraged to contact Infection Control Consulting Services (ICCS). The ICCS team of consultants serve all healthcare facility types, including dentists, ambulatory surgery centers and outpatient care facilities.


Reports: Redesigned Olympus Duodenoscopes Tied to Infection Outbreak

An infection outbreak at a foreign health facility is linked to redesigned Olympus duodenoscopes, according to multiple reports from news organizations, including the Los Angeles Times.

Olympus redesigned its duodenoscopes following reported issues with cleaning, disinfection and sterilization of medical devices, particularly duodenoscopes. They feature a complex design that creates challenges for first-step cleaning and subsequent high-level disinfection. Several deaths have occurred as a result of highly resistant bacteria that were transmitted from patient to patient, primarily during a procedure known as endoscopic retrograde cholangiography (ERCP).

The outbreak happened in December 2016. According to an adverse event report submitted to the U.S. Food & Drug Administration (FDA), Olympus was informed that five patients tested positive for OXA48-producing Klebsiella pneumonia after having undergone ERCP using the EVIS EXERA II duodenovideoscope. One patient died, although the death was blamed on a pre-existing condition rather than the infection. The other four patients are reported to be doing well.

An FDA spokeswoman told the Los Angeles times that the agency was "was aware of these reports and continues to investigate adverse events associated with duodenoscopes as appropriate."

Olympus announced it would voluntarily recall the original scopes in January 2016. This was after it received FDA approval for a duodenoscope with modifications to the device's design and labeling intended to help reduce the risk of bacterial infections. Olympus has also published new reprocessing instructions on cleaning the products to reduce infection risk.

Central Sterile Processing Infection Prevention

The Infection Control Consulting Services (ICCS) team, as part of it services to hospitals, ambulatory surgery centers and endoscopy suites, continues to closely scrutinize reprocessing practices, including disinfection of  scopes. ICCS consultants monitor central sterile technicians performing the step-by-step disinfection process. The ICCS consultant takes note of any deficiencies while providing feedback to the staff.

If your organization needs assistance with sterile processing compliance, contact ICCS. Our team of infection control consultants provides a wide range of services, including working with facilities to ensure they properly follow rules and guidelines for reprocessing of instruments and scopes, and monitoring of these processes.


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.