Outpatient Facilities Struggling With Joint Commission Infection Control Standards

The Joint Commission has released its top 10 challenging standards through the first half of 2019 for accredited ambulatory healthcare organizations and office-based surgery practices. High on both lists are multiple infection control standards.

These are requirements identified most frequently as "not compliant" during surveys and reviews from January through June.

For ambulatory healthcare organizations, infection control standards take two of the top three spots on the list. IC.02.02.01 (The organization reduces the risk of infections associated with medical equipment, devices and supplies.) is first with a reported 60% non-compliance. Coming in third is IC.02.01.01 (The organization implements infection prevention and control activities.) with 52% non-compliance.).

The non-infection control standard rounding out the top three is LS 03.01.35 (The organization provides and maintains equipment for extinguishing fires.), which came in second with a reported 56% non-compliance.

The same infection control standards in the top three for ambulatory healthcare organizations are in the top three most challenging for office-based surgery practices. IC.02.02.01 is second with a reported 56% non-compliance. Coming in third is IC.02.01.01 with 30% non-compliance.

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.) took the first spot with 61% non-compliance.

Two other infection control standards appear on the office-based surgery practices list and are tied with several other standards as the sixth most challenging with a reported 22% non-compliance: IC.01.03.01 (The organization identifies infection risks based on the following: Its geographic location, community and population served.) and IC.02.04.01 (The organization facilitates staff receiving the influenza vaccination.).

It comes as no surprise to see infection control standards proving difficult for outpatient organizations. These requirements were also some of the most challenging from 2018 and reflect ongoing observations made by ICCS infection control consultants during on-site visits.

FDA: Facilities Should Transition to Duodenoscopes With Disposable Parts

The U.S. Food and Drug Administration (FDA) has issued a safety communication advising hospitals and endoscopy facilities to transition away from fixed endcap duodenoscopes and begin using duodenoscopes with disposable components that help with or even eliminate the need for reprocessing.

In the communication, the FDA states it believes the most effective solution to reducing the risk of disease transmission by duodenoscopes is through "innovative device designs that make reprocessing easier, more effective or unnecessary." 

As an example, FDA highlights duodenoscopes that incorporate disposable components. Such components, FDA states, can "facilitate cleaning, reduce contamination and reduce disease transmission following reprocessing. Disposable designs may reduce between-patient duodenoscope contamination by half as compared to reusable, or fixed, endcaps."

To date, FDA has cleared two duodenoscopes with disposable endcaps that facilitate reprocessing: Fujifilm's duodenoscope model ED-580XT and Pentax Medical's duodenoscope model ED34-i10T.

FDA shared the following recommendations for hospitals and endoscopy facilities:

• Use duodenoscopes that have disposable components, if available.

• Ensure staff always follow reprocessing instructions.

• Institute a quality control program that includes sampling, microbiological culturing and other monitoring methods.

• Consider reprocessing with supplemental measures, such as sterilization or use of a liquid chemical sterilant processing system consistent with the device's labeling.

• Monitor reprocessing procedures.

• Develop schedules for routine inspection and periodic maintenance in accordance with duodenoscope manufacturer's instructions.

FDA acknowledged that transitioning to newer duodenoscope designs will take time due to cost and market availability challenges, stating, "We encourage healthcare facilities purchasing new duodenoscopes to begin developing a transition plan and work to replace their conventional duodenoscopes with newer models."

In the meantime, FDA noted it is encouraging and working with manufacturers to increase supply of disposable cap duodenoscopes and develop new designs that can further minimize or eliminate patient infection risk.

The safety communication comes just a few weeks after a New York Times article examined the difficulty providers face in properly sterilizing duodenoscopes. The article prompted multiple gastroenterology societies to issue a joint statement challenging points in the piece.

August 2019 Issue of Infection Prevention & Control Newsletter Published

The August 2019 issue of the ICCS Infection Prevention & Control Newsletter has published.

The issue includes stories on hepatitis A, duodenoscopes, a new long-term care law, total knees, antibiotic use, immunization schedules and C. diff.

Access the latest issue of our infection prevention and control newsletter.

Receive the free ICCS Newsletter by signing up here.

Survey: Nursing Home Antibiotic Stewardship Programs Improving

The results of a nationally representative survey of nursing homes reveal noteworthy improvements in the development of antibiotic stewardship programs.

The 2018 survey of more than 860 nursing homes analyzed antibiotic stewardship program "comprehensiveness" as well as issues such as infection preventionist training and participation in Quality Innovation Network-Quality Improvement Organization (QIN-QIO) initiatives. Survey results were published in the American Journal of Infection Control.

Comprehensiveness was evaluated based upon a nursing home's number of reported antibiotic stewardship program policies based on the Centers for Disease Control and Prevention's (CDC) core stewardship elements, reports the Center for Infectious Disease Research and Policy (CIDRAP). 

Of the nursing homes participating in the survey, about a third had what was defined as "comprehensive" antibiotic stewardship program policies (six or more policies based on CDC core stewardship elements), about 41% had "moderately comprehensive" antibiotic stewardship program policies (4-5 policies) and about a quarter had "not comprehensive" antibiotic stewardship program policies (three or fewer policies).

The survey also revealed that more than 91% of nursing homes reported collecting data on antibiotic use, but just 19% reported restricting the use of specific antibiotics. Also, while the number of nursing home infection preventionists trained in infection control had increased, gaps remain.

CIDRAP noted that a 2013-2014 national survey found that only about half of nursing homes certified by the Centers for Medicare & Medicaid Surveys (CMS) collected antibiotic use data, and less than half had written antibiotic initiation guidelines. In October 2016, CMS finalized a rule requiring nursing homes to have an antibiotic stewardship program, which likely contributed to the increase in the development of more comprehensive programs.

New Jersey Passes Law Requiring Long-Term Care Outbreak Response Plans

New Jersey has passed a new law requiring some long-term care (LTC) facilities to submit outbreak response plans to the state's department of health (DOH).

The legislation was prompted in response to a 2018 adenovirus outbreak at an LTC facility for severely ill children in Haskell, N.J., that killed 11 patients.

As a press release from N.J. Governor Phil Murphy notes, the law — A5527 — requires certain LTC facilities to develop and submit an outbreak response plan to the N.J. DOH within 180 days after the bill's effective date. These plans should include protocols for isolating infected and at-risk patients in the case of an outbreak, policies for notification of family and staff and additional requirements for containing outbreaks.

The legislation also requires facilities like the one in Haskell that provide care for particularly vulnerable, ventilator-dependent residents to submit a more detailed response plan for review.

"Breaches in infection control practices are a major contributing factor in the spread of disease in healthcare facilities," said Acting Health Commissioner Judith Persichilli, in the release. "Outbreak response plans help facilities remain aware of the need to contact and work with public health to implement practices to minimize further spread of disease."