Infection Prevention Remains National Patient Safety Goal for All Programs

The Joint Commission continues to stress the importance of infection prevention by including it as a 2020 National Patient Safety Goal (NPSG) for all eight of its programs.

The infection prevention NPSG — goal #7 — is described as "Reduce the risk of healthcare-associated infections."

For the hospital and critical access hospital programs, the infection prevention NPSG includes the following standards:

• NPSG.07.01.01: Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning. Use the goals to improve hand cleaning.

• NPSG.07.03.01: Use proven guidelines to prevent infections that are difficult to treat.

• NPSG.07.04.01: Use proven guidelines to prevent infection of the blood from central lines.

• NPSG.07.05.01: Use proven guidelines to prevent infection after surgery.

• NPSG.07.06.01: Use proven guidelines to prevent infections of the urinary tract that are caused by catheters.

For the nursing care center program, the infection prevention NPSG includes the following standards:

• NPSG.07.01.01: Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning. Use the goals to improve hand cleaning.

• NPSG.07.03.01: Use proven guidelines to prevent infections that are difficult to treat.

• NPSG.07.04.01: Use proven guidelines to prevent infection of the blood from central lines.

• NPSG.07.06.01: Use proven guidelines to prevent infections of the urinary tract that are caused by catheters.

For the ambulatory healthcare and office-based surgery programs, the infection prevention NPSG includes the following standards:

• NPSG.07.01.01: Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning. Use the goals to improve hand cleaning.

• NPSG.07.05.01: Use proven guidelines to prevent infection after surgery.

For the behavioral healthcare, home care and laboratory programs, the infection prevention NPSG includes the following standard:

• NPSG.07.01.01: Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning. Use the goals to improve hand cleaning.

The 2020 NPSGs become effective Jan. 1, 2020.

Sterile Processing Errors Earns Spot on ECRI Top Health Technology Hazards List

ECRI Institute has issued its annual list of the top 10 health technology hazards, and sterile processing errors in some ambulatory settings, including medical and dental offices, comes in at #3.

As ECRI notes in a news release, the challenge associated with sterile processing concerns the "failure to consistently and effectively sterilize contaminated items can lead to patient infections."

An executive brief for the "Top 10 Health Technology Hazards for 2020" report elaborates, stating the following: "Insufficient attention to sterilization processes in medical offices, dental offices and some other ambulatory care settings can expose patients to contaminated instruments, implants or other critical items. … failure to consistently and effectively clean and disinfect or sterilize contaminated items before use can expose patients to virulent pathogens. This concern exists in all healthcare settings where patients may come in contact with contaminated items, particularly those intended to enter sterile tissue or the vascular system."

ECRI also highlighted the infection risks associated with the #4 hazard on the list: central venous catheter (CVC) risk in at-home hemodialysis. ECRI notes that the risks associated with CVCs can be particularly dangerous in the home setting because family members may lack the ability to effectively manage such risks. The executive brief states, "CVCs are typically placed through the jugular vein (or other large central vein), providing a pathway directly from the outside of the body to the patient’s heart. As a result, the conse­quences of infection, clotting, disconnection and air embolism can be severe."

The hazards taking the top spots on the 2020 list are surgical stapler misuse (#1) and point-of-care ultrasound (#2).

The 2019 top hazards list included mattresses remaining contaminated after cleaning, retained surgical sponges and recontamination of endoscopes after disinfection.

Study: Serious Side Effects Associated With Antibiotics Before Dental Visits

The results of a national study raise significant red flags concerning antibiotic prescribing practices in the dental setting.

Researchers examined nearly 170,000 dental visits from 2011-2015 that included the prescribing of antibiotics to prevent infections before the visits. When evaluating practices against current American Dental Association (ADA) and American Heart Association (AHA) guidelines, researchers found that antibiotics were prescribed unnecessarily for about 80% of the visits. Of those, nearly 4% were associated with an adverse event within two weeks, including nearly 4,000 allergic reactions, about 1,600 emergency room visits and several Clostridioides difficile (C. diff) infections.

As a press release about the study notes, antibiotics are often prescribed before dental visits to help prevent infections in certain patients, such as those who have undergone joint replacements. However, current ADA and AHA guidelines no longer recommend this use of antibiotics in most cases. 

In the release, Dr. lan Gross, clinical associate professor at the University of Illinois at Chicago College of Pharmacy and a co-author, is quoted as saying, "While antibiotics can be lifesaving, they can cause significant adverse events even after being taken for only a day or two. Also, misuse can lead to antibiotic resistance. Antibiotics should only be prescribed when necessary and people should talk with their dentist or physician to ask if they truly need antibiotics prior to a dental visit."

The study was recently presented at IDWeek 2019, the annual meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA) and the Pediatric Infectious Diseases Society (PIDS).

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