February 11, 2011 Vlume 16 Number 2 Infectin Cntrl F441 On December 12, 2009, the Centers fr Medicare and Medicaid Services (CMS) issued new guidance fr F441 Infectin Cntrl. Several F tags 441, 442, 443, 444 and 445, were cmbined int ne all cmprehensive tag, F441. Althugh the regulatins themselves were nt changed, the expansin frm eight t 32 pages nw includes definitins, educatin, explanatins and examples fr surveyrs t reference. Recently, HCCI received calls abut renewed survey scrutiny fr cmpliance with these regulatins. Surveyrs have been asking fr staff illness tracking and prf f staff educatin n infectin cntrl practices. This mnth s Clinical Capsule will review the regulatins under F441 Infectin Cntrl and lk at the Investigative Prtcl. Future nursing newsletters will cver the educatinal cmpnent f these regulatins in a frmat facilities can use fr staff educatin, an imprtant requirement f the regulatins. Regulatins fr F441 Infectin Cntrl The regulatins cver fur separate areas f cncern: infectin cntrl, infectin cntrl prgrams, preventin and linens. 483.65 Infectin Cntrl The facility must establish and maintain an Infectin Cntrl Prgram designed t prvide a safe, sanitary and cmfrtable envirnment and t help prevent the develpment and transmissin f disease and infectin. 483.65(a) Infectin Cntrl Prgram The facility must establish an Infectin Cntrl Prgram under which it (1) Investigates, cntrls, and prevents infectins in the facility; (2) Decides what prcedures, such as islatin, shuld be applied t an individual resident; and (3) Maintains a recrd f incidents and crrective actins related t infectins. 483.65(b) Preventing Spread f Infectin (1) When the Infectin Cntrl Prgram determines that a resident needs islatin t prevent the spread f infectin, the facility must islate the resident. (2) The facility must prhibit emplyees with a cmmunicable disease r infected skin lesins frm direct cntact with residents r their fd, if direct cntact will transmit the disease. (3) The facility must require staff t wash their hands after each direct resident cntact fr which hand washing is indicated by accepted prfessinal practice. 483.65(c) Linens
Persnnel must handle, stre, prcess and transprt linens s as t prevent the spread f infectin. Intent f Regulatins Accrding t CMS, the intent f this regulatin is t assure that the facility develps, implements, and maintains an Infectin Preventin and Cntrl Prgram in rder t prevent, recgnize, and cntrl, t the extent pssible, the nset and spread f infectin within the facility. The prgram will: Perfrm surveillance and investigatin t prevent, t the extent pssible, the nset and the spread f infectin; Prevent and cntrl utbreaks and crss-cntaminatin using transmissin-based precautins in additin t standard precautins; Use recrds f infectin incidents t imprve its infectin cntrl prcesses and utcmes by taking crrective actins, as indicated; Implement hand hygiene (hand washing) practices cnsistent with accepted standards f practice, t reduce the spread f infectins and prevent crss-cntaminatin; and Prperly stre, handle, prcess, and transprt linens t minimize crss-cntaminatin. Thrughut the survey, the surveyr(s) will be bserving staff, cnducting interviews and recrding reviews t determine cmpliance. They will als review the facility s infectin cntrl plicies, prcedures and dcumentatin f staff training, as well as interview facility staff with respnsibility fr versight f the infectin preventin and cntrl prgram. Surveyr Observatins The surveyrs are instructed t bserve the fllwing facility practices and then answer the questins: D all disciplines fllw apprpriate infectin cntrl practices and transmissin-based precautin prcedures? Are linens handled, prcessed, transprted, and stred t prevent cntaminatin and the transmissin f infectin? Are emplyees wh are exhibiting signs f illness r cmmunicable disease (e.g., cld symptms, infected, pen lesins n hands), that have the ptential t transmit disease, prhibited frm cntact with the resident r the resident s fd? D staff and visitrs adhere t precautins and related prcesses, including the use f Persnal Prtective Equipment (PPE)? They will als bserve: Residents fr signs and symptms f ptential infectin; Use f apprpriate cleaning and disinfecting agents and practices in resident rms requiring transmissin-based cntact, drplet, and airbrne precautins; Apprpriate disinfectin fr small nn-dispsable equipment such as glucse meters, scissrs, and thermmeters used fr individual resident care fr; Prper dispsal f single-use items (e.g., bld glucse lancet, ther sharps); Prper maintenance f individual resident use items (e.g., basins, bed pans); Prper strage and dispsal f resident dressings and supplies; Prper cleaning/disinfecting f multiple use items (e.g., shwer chairs, bedside scales, resident lifts, cmmdes, tubs); Hand hygiene and use f glves (when indicated) fr use in accrdance with current standards f practice, and the availability f glves/equipment/prducts t perfrm hand hygiene;
Apprpriate infectin cntrl practices fr medicatin administratin (e.g., eye drps, sublinguals, and injectins); Apprpriate infectin cntrl practices fr dressing changes that require the use f glves (e.g., anticipated cntact with bdy fluid, excretins, tissue and specimens); Adherence with current infectin cntrl standards f practice. In the insertin r remval f a catheter and any invasive prcedure. Surveyr Interviews The fllwing peple will be interviewed regarding infectin cntrl practices: The resident, family r respnsible party t see if they have received educatin and infrmatin abut infectin cntrl practices, such as apprpriate hand hygiene and any special precautins applicable t the resident. Direct care staff t determine: If they knw hw t bserve fr and reprt any signs r symptms exhibited by the resident that may be assciated with an infectin; Whether they are aware which residents are n transmissin-based precautins, the specific actins required and any special precautins fr these particular residents; Whether they knw when t wash their hands and/r use alchl-based prducts, and understand the basis fr the use f glves and glve remval. Designated Infectin Cntrl Representative The regulatins state, If cncerns are identified, (e.g., practices are nt cnsistent with accepted principles f infectin cntrl r residents are exhibiting symptms f infectins, but have nt been assessed r surveillance data are nt available r being utilized) interview the facility staff members wh are respnsible fr implementing and verseeing the infectin preventin and cntrl prgram. The fllwing areas will be investigated: Des the facility identify where infectins are acquired (e.g., nursing hme, hspital, r cmmunity)? Is there, in additin t the medicatin regimen review, a review f whether antibitic use in the nursing hme is apprpriate and effective? Des staff training include critical areas f infectin cntrl such as hand hygiene, areas fr imprvement frm surveillance data, and apprpriate use f prtective equipment and islatin precautins and hw staff are apprised f changes in plicies and prcedures? Des the facility cllect, analyze, and use data related t infectins t identify and prevent the spread f infectins and adjust its infectin preventin and cntrl prgram, (e.g., plicies and prcedures) as apprpriate? Des the prgram implement prcesses t identify and address infectin cntrl issues, mnitr staff hand hygiene, and practice sterile technique when apprpriate? Des the facility apprpriately implement and discntinue transmissin-based precautin prcedures, and cmmunicate initiatin and discntinuatin f these transmissin-based precautin plicies acrss departments? Des the facility have in place effective means t identify individuals (residents, staff, visitrs, vlunteers, practitiners) with infectins? Des the facility have plicies and prcedures fr handling linens and hw it mnitrs the strage, transprt, and prcessing t prevent the spread f infectin? Des the infectin preventin and cntrl prgram identify and address infectin cntrl issues, fr example, whether the facility s infectin cntrl practices are cnsistent with CDC recmmendatins?
Des the facility effectively identify and prevent emplyees with a cmmunicable disease r infected skin lesins frm direct cntact with residents r their fd, if direct cntact will transmit the disease? Recrd Review The last part f the surveyr prcess will be a recrd review. The regulatins state the fllwing areas will be checked: Des the resident s recrd include: An evaluatin f the risk factrs fr infectin (e.g., indwelling urinary catheters, intravenus catheters, and trachestmy tubes); If an infectin is present, whether the resident s recrd reflects the identificatin f the infectin, ptential causes and cntributing factrs; Whether the resident s plan f care identifies interventins (device management and islatin precautin measures) t prevent the transmissin f the infectin; and Dcumentatin related t the review f the apprpriateness and effectiveness f antibitics fr residents that are identified as receiving antibitics? Is the facility identifying, recrding, and analyzing infectins and taking crrective actin? Are the facility s infectin cntrl plicies cnsistent with current prfessinal standards f practice and defined by department (e.g., dietary, nursing, laundry)? Is there dcumentatin that cllects, analyzes, and uses data t guide all disciplines in the preventin f infectins in a standardized and systematic way? Are there plicies regarding handling and prcessing siled linens as well as handling, transprting, and string clean linens? Are there plicies, prcedures, and dcumentatin regarding identifying and prhibiting cntact with residents r fd by emplyees with pen lesins r cmmunicable diseases? Are there plicies addressing ccupatinal cmmunicable disease expsure and pstexpsure fllw up? D emplyee recrds shw initial and nging emplyee infectin cntrl training regarding critical elements f the infectin cntrl plan? Des the facility identify issues related t staff infectin cntrl practices, as part f its infectin preventin and cntrl prgram, and they fllw up t identify the cause, and institute measures t crrect the prblems? Mst facilities already have an infectin cntrl prgram in place. These regulatins and the investigative prtcl spell ut what that prgram shuld cntain. Facilities need t lk at what they have in place and make sure all the abve areas have been cvered. Mst facilities have all the pieces but may just need t rganize the prgram. Gather yur QA and facility dcuments t see where they all fit int yur particular prgram. Future nursing newsletters will prvide educatinal pieces fr facilities t use t meet the educatinal requirements cntained in the regulatins.
Questins abut this mnth s Clinical Capsule can be addressed t Susan Gardiner at (773) 478-6613. Past issues f the Clinical Capsule can be referenced at the HCCI website www.hccil.rg. Cpyright Health Care Cuncil f Illinis Vlume 16 Number 2, February 11, 2011