Joint Commission Revises Infection Control Scoring

The Joint Commission recently announced it is reevaluating the way it scores high-level disinfection (HLD) and sterilization to focus more closely on those process steps that pose the highest risk to patients and safety were they to fail.

More specifically, the revisions concern infection control standard IC.02.02.01, which requires organizations to reduce the infection risk associated with medical equipment, devices and supplies.

The decision comes following analysis by the Joint Commission of its survey data that indicated 72% of surveyed hospitals and critical access hospitals were found to be noncompliant with IC.02.02.01 while 79% of percent of ambulatory health care organizations and nearly 81% of office-based surgery centers practices surveyed in 2017 had at least one finding in the infection prevention and control chapter.

Areas of scoring that were revised are as follows:

  • Visible bioburden and dried blood found on instruments

  • Enzymatic solution was not applied to maintain moisture on instruments

  • Instruments were not transported from the point of use in a leak-proof puncture-resistant container with the biohazard symbol or color red

  • Instruments in the closed position

  • Instruments are released prior to the biologic indicator being read

  • Items in the high level-disinfected area that are stored in drawers

  • Stored scopes exceeded the hang time

View the new scoring revisions in the table on the bottom of this webpage.

The revised scoring took effect Sept. 1, 2018, with the Joint Commission noting that IC.02.02.01 findings recorded before that date will not be removed.

It is important to note that Joint Commission standards are applicable to all healthcare facilities providing services that require HLD and sterilization. Inpatient and outpatient facilities that are accredited by the Joint Commission are required to follow these standards if they are performing HLD and/or sterilization, regardless of setting. This includes hospitals, outpatient surgery centers, office-based surgery practices and outpatient clinics. In addition, dental clinics that are located within a health system accredited by the Joint Commission will be held accountable to these standards.

Study: Widespread Antibiotic Overprescribing by Outpatient Clinics

A new study reveals that outpatient clinics are prescribing antibiotics at an unwarranted rate, according to a news release from the Infectious Diseases Society of America. 

The research, which was presented at IDWeek 2018 and funded by the Agency for Healthcare Research and Quality, examined more than half a million prescriptions given to nearly 280,000 patients by more than 500 outpatient clinics from November 2015 through October 2017.

Key takeaways from the study are as follows:

  • 46% of antibiotics were prescribed without an infection-related diagnosis.

  • 20% of prescriptions were provided without an in-person visit.

  • For those antibiotics prescribed outside of an in-person visit, most were by phone, with others completed through electronic health record system.

  • 29% of prescriptions noted something other than an infection diagnosis (e.g., high blood pressure, annual visit).

  • 17% percent of prescriptions were written without a diagnosis indicated.

  • For those prescriptions without a diagnosis, researchers speculated that while some may be tied to poor diagnosis coding, much of it likely reflects prescribing for vague or inappropriate reasons (e.g., infections caused by viruses).

In the release, Jeffrey Linder, MD, MPH, lead author of the study, said, "We looked at all outpatient antibiotic prescribing and results suggest misuse of these drugs is a huge problem, no matter the symptom. We found that nearly half the time, clinicians have either a bad reason for prescribing antibiotics, or don't provide a reason at all. When you consider about 80% of antibiotics are prescribed on an outpatient basis, that's a concern."

The results of this study echo those of many others pointing to antibiotic misuse as a significant issue. Prescribing the correct dose of the correct antibiotic at the appropriate time and for the correct duration can help fight antibiotic resistance, protect patients from unnecessary side effects and help ensure antibiotics will work when they are needed. 

If your organization requires expert assistance with developing and maintaining an antimicrobial stewardship program, contact Infection Control Consulting Services (ICCS). ICCS is a national consulting firm providing services to healthcare facilities including outpatient clinics, ambulatory surgery centers, hospitals and nursing homes. 

CDC Publishes New Healthcare-Associated Infection Progress Report

The Centers for Disease Control and Prevention (CDC) has published its 2016 Healthcare-Associated Infection Progress Report. The report provides year-to-year progress on the prevention of key healthcare-associated infections (HAIs) in acute care hospitals, long-term acute care hospitals and inpatient rehabilitation facilities.

The HAI Progress Report consists of national and state-by-state summaries of HAIs across the settings. The 2016 HAI Progress Report is the first report to measure year-to-year HAI prevention progress using the 2015 baseline (reference point). 

While progress was seen in some areas, improvements are greatly needed in others. Here are some national highlights from the 2016 HAI Progress Report:

Acute Care Hospitals

  • About 11% decrease in central line-associated bloodstream infections (CLABSIs) 

  • About 7% decrease in catheter-associated urinary tract infections (CAUTIs) 

  • About 13% decrease in abdominal hysterectomy surgical site infections (SSIs) 

  • About 7% decrease in colon surgery SSIs 

  • About 7% decrease in methicillin-resistant Staphylococcus aureus (MRSA) bacteremia 

  • About 8% decrease in Clostridium difficile (C. difficile) infections

Long-Term Acute Care Hospitals

  • About 4% decrease in CLABSIs

  • About 15% decrease in C. difficile infections

  • About 5% increase in ventilator-associated events (VAEs) 

Inpatient Rehabilitation Facilities

  • About 7% increase in CAUTIs

  • About 17% increase in MRSA bacteremia

  • About 4% decrease in C. difficile infections

Working toward the elimination of HAIs is a CDC priority, and should be a priority of all healthcare organizations. Data indicates that on any given day, about 1 in 25 hospital patients has at least one HAI. They lead to the loss of tens of thousands of lives and cost the U.S. health care system billions of dollars annually.

If your organization needs assistance with developing, implementing and maintaining evidence-based infection prevention and control programs, contact Infection Control Consulting Services (ICCS), a nationally renowned consulting firm offering expert services to healthcare facilities and organizations.

Patient Infection Risks Prominent on ECRI Annual List of Health Tech Hazards

ECRI Institute has included three potential sources of patient infections on its "2019 Top 10 Health Technology Hazards" list.

They are as follows:

  • #2: Mattresses Remaining Contaminated After Cleaning. ECRI notes, "Blood and other body fluids that remain on, or within, mattresses or mattress covers after cleaning can contact subsequent patients, posing an infection risk."

  • #3: Retained Surgical Sponges. ECRI notes, "Surgical sponges that are unintentionally left inside the patient after the surgical site is closed can lead to infection and other serious complications, including the need for secondary operations."

  • #5: Recontamination of Endoscopes After Disinfection. ECRI notes, "Failure to precisely follow a robust reprocessing protocol can lead to debilitating or even fatal infections. Less well known is that improper handling and storage practices can recontaminate previously disinfected scopes, heightening the risk of patient infections."

Rounding out the top 5 were "Hackers Exploiting Remote Access Vulnerabilities" (#1) and "Improperly Set Ventilator Alarms" (#4).

To select topics for its 2019 list, ECRI stated it accepted nominations from ECRI engineers, scientists, clinicians and other patient safety analysts and also considered health-technology-related problem reports received through its Problem Reporting Network and through data that participating facilities share with its patient safety organization. ECRI hopes its lists can serve as a "starting point for discussions, helping healthcare organizations plan and prioritize their patient safety efforts," according to news release.

Infection risks also took top spots in ECRI's 2018 health technology hazards list, with endoscope reprocessing at #2, mattress and mattress cover contamination at #3 and improper cleaning and device failures at #5.

In a recent column for Becker's Clinical Leadership & Infection Control, Infection Control Consulting Services (ICCS) Founder and President Phenelle Segal, RN, CIC, FAPIC, shared common infection prevention and control deficiency findings in healthcare facilities. It's not surprising to see how deficiencies identified in this article can contribute to patient infection risks highlighted in ECRI's report.

The 2019 Top 10 Health Technology Hazards executive brief is available for complimentary download at www.ecri.org/2​019hazards.

September 2018 Issue of Infection Prevention & Control Newsletter Published

The September 2018 issue of the ICCS Infection Prevention & Control Newsletter has published.

The issue identifies some of the most pertinent infection prevention and control news from September. Topics covered in this issue include common deficiencies, challenging Joint Commission standards, surgical site infections, high-touch surfaces, sepsis, privacy curtains, jet air dryers and antibiotic resistance.

Access the issue by clicking here.

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