CMS to inspect 1/3 of all Ambulatory Surgery Centers this Year Regarding Infection Prevention Practices

In a press release from HHS Secretary Kathleen Sebelius on June 8, a clear signal was sent to ambulatory surgery centers that they will be receiving additional attention from CMS regarding their infection prevention and control practices.

The press release is cut and pasted here. Sections of interest to the healthcare quality professional are highlighted in red.


FOR IMMEDIATE RELEASE
Tuesday, June 8, 2010
Contact: HHS Press Office
(202) 690-6343


HHS Secretary Kathleen Sebelius Statement on Recent Study of Infection Control Practices in Ambulatory Surgical Centers

“Today, the Journal of the American Medical Association published a new study from the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS), which underscored the urgency behind the Obama Administration’s efforts to reduce healthcare-associated infections (HAIs).

The study found that among a sample of ambulatory surgical centers (ASCs) in three states, two-thirds had infection control lapses identified during routine inspections. This is concerning, because when lapses in infection control occur, in any healthcare setting, it puts patients at risk.

The good news is that we have seen progress in the reduction of HAIs in the hospital setting. Just last month, a new report from CDC demonstrated progress made in reducing HAIs in hospitals, further indicating that the steps we’re taking to reduce these often preventable infections are working. The report showed an 18-percent decrease in national central-line associated bloodstream infection incidence in hospitalized patients.

Ensuring the safety of all patients in all healthcare settings is a top priority for HHS. That’s why I announced last year that $50 million of American Recovery and Reinvestment Act funds to help states fight HAIs. Of that funding, $10 million went to states to improve the process and increase the frequency of inspections for ambulatory surgical centers.

In addition, the Affordable Care Act calls for improvements in healthcare quality and HAIs. Research shows that when healthcare facilities identify where and when infections are likely to occur and take concrete steps to prevent them, some infection rates have dropped more than 70 percent in hospitals.

We also continue to strengthen our collaborative efforts to achieve the goals in the HHS Action Plan to Prevent Healthcare-Associated Infections (http://www.hhs.gov/ophs/initiatives/hai/). In 2010, HHS will expand its Action Plan to include strategies to eliminate HAIs in ambulatory surgical centers and hemodialysis centers.

HHS’ Agency for Healthcare Research and Quality (AHRQ) is contributing to the reduction of infections in ASCs by investing in research projects to better understand the factors that lead to HAIs in ambulatory surgical settings. HHS agencies are also working together to incorporate infection control into the inspection process. CMS has committed to inspecting one-third of all ASCs nationwide this year. All ASCs have a responsibility to correct deficient practices. Failing to correct serious deficiencies will mean the risk of termination from the Medicare program.

Just because procedures are being performed outside the hospital doesn’t mean patient safety standards and attention to infection control do not need to be met. All healthcare providers and suppliers should take this as an opportunity to evaluate their current infection control policies, and more importantly, make sure their staff understand and follow them.”

To view the infection control audit tool currently used by CMS to better assess infection control practices in ambulatory surgical centers, please visit: http://www.cms.gov/manuals/downloads/som107_exhibit_351.pdf

Ventilator Bundle Adjusted: Daily Oral Care with Chlorhexidine

The following was posted on the IHI website regarding adjustments to the ventilator bundle made in May 2010. You can read the update (as well as implementation tips) in its entirity here.

You can read the updated description of the IHI Ventilator Bundle here: here



Daily Oral Care with Chlorhexidine
IHI added this element to the Ventilator Bundle in May 2010 following continued review of the literature and use of the element in the IHI Ventilator Bundle in Scotland for over a year. The recommended chlorhexidine solution strength is 0.12%.

Dental plaque biofilms are colonized by respiratory pathogens in mechanically ventilated patients. Dental plaque develops in patients that are mechanically ventilated because of the lack of mechanical chewing and the absence of saliva, which minimizes the development of biofilm on the teeth. Dental plaque can be a significant reservoir for potential respiratory pathogens that cause ventilator-associated pneumonia (VAP). Chlorhexidine antiseptic has long been approved as an inhibitor of dental plaque formation and gingivitis. As early as 1996, DeRiso and colleagues published a study that provided evidence to support the use of 0.12% chlorhexidine oral rinse as a prophylactic measure to reduce nosocomial respiratory tract infections in cardiac surgery patients. [1]

Since that time there has been much discussion about the utilization of chlorhexidine as an important adjunct to oral hygiene, but there have been few studies published that provide firm evidence that the use of chlorhexidine as a decontamination antiseptic reduces the incidence of ventilator-associated pneumonia. Chlorhexidine has been studied in two strengths: 0.12% and 0.2%. The US Food and Drug Administration recommends 0.12% oral chlorhexidine for use as mouth rinse. In a meta-analysis published in 2007 by Chan and colleagues in the British Medical Journal, eleven studies were evaluated for effect of oral decontamination on the incidence of ventilator-associated pneumonia and mortality in mechanically ventilated adults. Results of that analysis concluded that oral decontamination of mechanically ventilated adults using chlorhexidine is associated with a lower risk of ventilator-associated pneumonia. [2]

There is little if any evidence of other oral care processes having an effect on the development of VAP, but it makes sense that good oral hygiene and the use of antiseptic oral decontamination reduces the bacteria on the oral mucosa and the potential for bacterial colonization in the upper respiratory tract. This reduction in bacteria has been shown to reduce the potential for the development in ventilator-associated pneumonia for patients on mechanical ventilation.

References:

1. DeRiso AJ, Ladowski JS, DillonTA, Justice JW, Peterson AC. Chlorhexidine gluconate 0.12% oral rinse reduces the incidence of total nosocomial respiratory infection and nonprophylactic systemic antibiotic use in patients undergoing heart surgery. Chest. 1996;109:1556-1561.
2. Chan EY, Ruest A, O’Meade M, Cook DJ. Oral decontamination for prevention of pneumonia in mechanically ventilated adults: Systematic review and meta-analysis. British Medical Journal. 2007;10:1136.

Additional Reference:
Munro CL, Grap MJ, Jones DI, McClish DK, Sessler CN. Chlorhexidine, tooth brushing and preventing ventilator-associated pneumonia in critically ill adults. American Journal of Critical Care. 2009 Sep;18(5):428-437.

Hospitals in 16 Indiana Counties Qualify for Higher Medicare IPPS Payment

In the June 2, 2010 updated CMS IPPS Proposed rules for FY2011, increased payment was described for hospitals in counties with the lowest per capita Medicare spending (lowest quartile).

Counties in Indiana that qualified are:

• Adams
• Brown
• DeKalb
• Elkhart
• Franklin
• Huntington
• Jackson
• Kosciusko
• LaGrange
• Marshall
• Monroe
• Noble
• Orange
• Wabash
• Wells
• Whitley

The following is excerpt of text from the proposed rule. You can read the complete proposed rules at the following: http://edocket.access.gpo.gov/2010/pdf/2010-12567.pdf (starts on page 30926)

E. Additional Payments for Qualifying Hospitals With Lowest Per Capita Medicare Spending

1. Background
Section 1109 of Public Law 111–152, provides for additional payments for FY2011 and 2012 for ‘‘qualifying hospitals.’’ Section 1109(d) defines a ‘‘qualifying hospital’’ as a ‘‘subsection (d) hospital * * * that is located in a county that ranks, based upon its ranking in age, sex and race adjusted spending for benefits under parts A and B * * * per enrollee within the lowest quartile of such counties in the United States.’’ Therefore, a ‘‘qualifying hospital’’ is one that meets the following conditions: (1) A ‘‘subsection (d) hospital’’ as defined in section 1886(d)(1)(B) of the Act; and (2) located in a county that ranks within the lowest quartile of counties based upon its spending for benefits under Medicare Part A and Part B per enrollee adjusted for age, sex, and race. Section 1109(b) of Public Law 111–152 makes available $400 million to qualifying hospitals for FY 2011 and FY 2012. Section 1109(c) of Public Law 111–152 requires the $400 million to be divided among each qualifying hospital in proportion to the ratio of the individual qualifying hospital’s FY 2009 IPPS operating hospital payments to the sum of total FY2009 IPPS operating hospital payments made to all qualifying hospitals.

Thoughts on Pay-for-Performance

IHI Open School posted this video on their blog yesterday. It is very thought provoking.

The title of this RSA Animate is: Drive: The surprising truth about what motivates us. It is based on a talk by Dan Pink.

(note: This is a youtube video. If you don't see anything below, it is probably being blocked)