CMS Finalizes Rule Requiring Hospital Antibiotic Stewardship Programs

The Centers for Medicare & Medicaid Services (CMS) has finalized a rule that includes a requirement for hospitals and critical access hospitals (CAHs) to establish and maintain antibiotic stewardship programs.

As CMS notes in a fact sheet about the new CMS conditions of participation rule, "By requiring that hospitals have antibiotic stewardship programs that are not only active and hospital-wide, but also demonstrate adherence to nationally recognized guidelines for the optimization of antibiotic use through stewardship, the changes are aimed at effectively reducing the development and transmission of healthcare-associated infections and antibiotic-resistant organisms that ultimately will greatly improve the care and safety of patients while adding cost benefits for hospitals."

The rule also mandates hospitals and CAHs to have infection prevention and control programs.

As the Center for Infectious Disease Research and Policy (CIDRAP) notes, CMS advises hospitals to follow guidance on implementing antibiotic stewardship and infection prevention and control programs from nationally recognized sources (e.g., Centers for Disease Control and Prevention (CDC), Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA)). The programs must be implemented six months from September 30, 2019 — the date the finalized policy was published in the Federal Register.

For most hospitals, the requirements are not likely to have much of an impact. Infection Control Consulting Services (ICCS) consultants have yet to work with a Joint Commission-accredited hospital lacking antibiotic stewardship and infection prevention and control programs. For several years, hospitals have generally taken a proactive position concerning such programs because of accreditation requirements (e.g., Joint Commission added an antimicrobial stewardship standard in 2017) and the likelihood of CMS mandating these programs. However, as ICCS consultants have observed, properly instituting such programs often proves difficult, leading many to seek out professional assistance for the development of antibiotic stewardship programs and the development of infection prevention and control plans.

Global Survey: Nearly All Surgeons Encounter Needlestick Injury

A global survey of surgeons has found that 95% have either been personally affected by a needlestick injury or seen a colleague experience one.

More than 500 surgeons from six countries participated in the survey, which was commissioned by medical solutions company Mölnlycke.

As a press release on the survey notes, about two million needlestick injuries occur among health workers annually, which result in increased risk of infection and exposure to HIV, hepatitis C and other bloodborne viruses.

The survey also asked surgeons about "high-quality" gloves, with 93% believing that such gloves reduce the chance of bloodborne virus exposure and 83% indicating that they believe the quality of gloves affect their sense of being protected from needlestick injuries.

The Centers for Disease Control and Prevention (CDC) advises healthcare workers who experience a needlestick or sharps injury to follow these steps:

• Wash needlesticks and cuts with soap and water

• Flush splashes to the nose, mouth, or skin with water

• Irrigate eyes with clean water, saline, or sterile irrigants

• Report the incident to your supervisor

• Immediately seek medical treatment

Study: High-Risk Antibiotics Linked to Increase in C. Diff Infections

A new study indicates that usage of high-risk antibiotics is connected to increases in hospital-associated Clostridioides difficile (C. diff) infection.

The research, published in Infection Control and Epidemiology, analyzed data from 171 community and teaching hospitals gathered from June 2016 through July 2017. It looked at use of high-risk antibiotics — specifically second-, third- and fourth-generation cephalosporins, fluoroquinolones, carbapenems and lincosamides — and their impact on hospital-associated C. diff.

As a Center for Infectious Disease Research and Policy report notes, the researchers found that for every 100-day increase in the use of these antibiotics, there was a correlating 12% increase in hospital-associated C. diff.

The authors conclude, "High-risk antibiotic use is an independent predictor of hospital-associated C. diff infection. This assessment of poststewardship implementation in the United States highlights the importance of tracking trends of antimicrobial use over time as it relates to C. diff infection.

The 'Licking Challenge' is Another Reason to Switch From Bulk Items

Is your organization still using bulk supplies? Better be careful: They may prove too alluring to be resisted by some people who just "need" to lick them.

In the latest in strange, antisocial behavior, people are being caught opening containers and licking the contents. Examples include a tongue depressor and cartons of ice cream.

While the likelihood of your organization encountering such an individual is low, these incidents serve as a reminder of the risks associated with using bulk items. When bulk supplies are not individually wrapped, such as tongue depressors and cotton balls or gauze pads (in containers for use with refillable alcohol dispensers; see example image), they are a source of hand contamination when healthcare workers reach into the container repeatedly. They are also subject to contamination in other ways, including having their containers knocked over, spilling the contents, and, more recently, the "licking challenge."

Infection Control Consulting Services (ICCS) advises clients and all healthcare organizations still using bulk items to consider switching to individually wrapped. While individually wrapped supplies are likely to be a bit more expensive, the savings captured does not justify the potential contamination risk posed by these items.

OIG Report: ASCs Struggling to Comply With Infection Control Requirements

The HHS Office of the Inspector General (OIG) has issued a new report suggesting many ambulatory surgery centers (ASCs) are coming up short in their efforts to meet infection control requirements.

The report claims that more than three out of every four Medicare-certified ASCs were cited for at least one deficiency during their most recent state-government inspection, and one out of every four had a serious — or "condition-level" — deficiency. Infection control deficiencies were the most frequency cited type of deficiency from fiscal year (FY) 2013 to FY 2017, comprising roughly one-fifth of all violations.

Furthermore, states cited 55% of all nondeemed ASCs with one or more infection control deficiency in these ASCs' most recent certification surveys — easily tops on the list of the types of Conditions for Coverage (CfC) deficiency citations. Coming in second was pharmaceutical services-related deficiencies (37%), with environment deficiencies rounding out the top three at 33%.

Infection control also had the highest percentage of condition-level deficiencies at 12%. The OIG defines a condition-level deficiency as indicating that "… substantial noncompliance with multiple standards of a CfC adds up to pervasive noncompliance, or that noncompliance with one or more standards poses a serious threat to patient health and safety."

Patients also flagged infection control as a significant concern. Between FY 2013 and FY 2017, the most common complaint allegations related to quality of care and treatment (35%). The second most common was infection control (24%), with patient rights coming in third (19%).

The OIG states that it completed its review and report by analyzing state data on ASC certification surveys for nondeemed ASCs and complaints about deemed and nondeemed ASCs from FY 2013 to FY 2017, as provided by Medicare. Using these data, OIG assessed state survey performance against Medicare's requirements and analyzed trends in deficiency citations from state surveys and trends in complaint surveys.

Among its conclusions: The Centers for Medicare & Medicaid Services (CMS) can use the report to help focus its efforts on "… ASCs' recurring challenges in meeting health and safety requirements, especially for infection control."

In need of CMS and/or accreditation survey assistance? Infection Control Consulting Services can help your organization with survey preparation and developing a plan of correction, among many other infection control services.