The Joint Commission has issued new requirements for hospitals in an effort to prevent infections from multidrug-resistant organisms, central line-associated bloodstream infections, and surgical site infections.
The requirements, which are part of the organization's 2009 National Patient Safety Goals for hospitals, include a 1-year phase-in period with full implementation by Jan. 1, 2010.
It is critical for hospitals to begin addressing the issue of health care-associated infections and to try to keep the problem from worsening, said Dr. Peter Angood, vice president and chief patient safety officer for the Joint Commission. "We're in a bit of a tight spot and we need to work our way out of it," he said.
The new infection control requirements build on an existing National Patient Safety Goal on health care-associated infections that had previously included only requirements for compliance with hand hygiene guidelines and had called on hospitals to manage serious infections as sentinel events. Those requirements will remain in place along with the new elements of the goal.
"Infection control is high on our priority list overall," Dr. Angood said.
Under the new 2009 requirements, hospitals are being asked to begin preparing to prevent infections resulting from multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus, Clostridium difficile, vancomycin-resistant enterococci, multidrug-resistant gram negative bacteria, and other epidemiologically important organisms.
Starting in January 2010, hospitals will need to conduct periodic risk assessments for acquisition and transmission of multidrug-resistant organisms, and educate staff and independent providers about prevention strategies and their roles. Hospitals also will be required to provide education about infection control strategies to patients and families who are infected or colonized with multidrug-resistant organisms.
Hospitals will be required to have a surveillance program up and running by Jan. 1, 2010, that is based on the hospital's risk assessment.
When indicated by the risk assessment, hospitals will need to implement a laboratory-based alert system to identify new patients with multidrug-resistant organisms, and an alert system to identify readmitted or transferred patients who have multidrug-resistant organisms.
The Joint Commission also has put new requirements in place to prevent central line-associated bloodstream infections and surgical site infections.
As part of the requirements related to central line-associated bloodstream infections, hospitals will be expected to use a catheter checklist and a standardized protocol for central venous catheter insertion and an all-inclusive standardized supply cart or kit for insertion of central venous catheters.
The requirements also call for the use of standardized protocols for maximum sterile barrier precautions during insertion of a central venous catheter and when disinfecting catheter hubs and injection ports before accessing the ports.
As part of its effort to prevent surgical site infections, the Joint Commission is requiring hospitals to conduct periodic risk assessments, select surgical site infection measures based on evidence, and evaluate the effectiveness of their prevention efforts. Also, hospital staff will need to measure infection rates for the first 30 days following most procedures and for the first year after procedures involving implantable devices.
The surgical site infection requirements were developed to be in line with well established guidelines and should help organizations move toward compliance with those guidelines, Dr. Angood said.
All of the new requirements related to health care-associated infections include a 1-year phase-in period, with milestones for planning, development, and testing throughout 2009. Allowing organizations to phase in complex requirements over the course of a year helps them to perform better by achieving concrete goals before full compliance is expected, Dr. Angood said.
Addressing health care-associated infections is a worthy goal, said Dr. Franklin Michota, who is director of academic affairs for the department of hospital medicine at the Cleveland Clinic. There is sufficient evidence to show a clinical benefit from implementing infection control strategies. "It's not an experiment to see if these things work," he said.
Hospitals are likely to face some up-front costs when implementing the new requirements, Dr. Michota said, especially if they need to put a new educational process in place to prepare staff. For that reason, hospitals may be looking to involve hospitalists, who are already on the payroll, in a variety of activities related to preventing health care-associated infections, he said.
Hospitalists may be involved in developing process improvement plans, tracking requirements, or tracking infections. Those who are not involved on the quality side may be asked to champion changes at the floor level by modeling appropriate hand hygiene or compliance with contact precautions.
"Shining additional light on [health care-associated infections] is good," said Dr. Patrick J. Cawley, president of the Society of Hospital Medicine and executive medical director at the Medical University of South Carolina, Charleston.