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

Patient Safety ...in 3 words?

The following is cut and pasted directly from Abington Memorial Hospital's patient safety & quality web page.

You can go directly to the page here: http://www.amh.org/aboutus/patientsafetyandquality/three-words-video.aspx

You can go directly to the video here: http://amhweb.cachefly.net/Videos/aboutus/3Wordsvideo.swf

It only takes three words to tell someone how you feel, what you believe in or what’s important to you. At Abington Memorial Hospital, three words can describe our entire culture — Patient Safety First.

Patient Safety is AMH’s number one priority, and AMH employees are letting their patients, and each other, know just how important that priority is — with just three words.

Inspired by the popular Good Morning America segment, “Your Three Words,” AMH’s Center for Patient Safety and Healthcare Quality made a four-minute long video using the three-word concept. The video
features AMH employees from all departments — clinical, ancillary, support staff — offering their own personal three-word message of patient safety, while promoting safe behavior and teamwork.

Healthy People 2020 - Review Draft Objectives

Early last week the US Dept of Health and Human Services released the draft Healthy People 2020 objectives for public comments via the internet.

Historically, federal agencies have been guided somewhat by the objectives set in Healthy People. Every 10 years, the objectives are developed, reviewed, updated, and/or archived.

You can download the draft objectives here: http://www.healthypeople.gov/hp2020/Objectives/files/Draft2009Objectives.pdf

Or,...you can go to the following webpage to review the objectives and comment directly:
http://www.healthypeople.gov/hp2020/Objectives/TopicAreas.aspx

Note that Healthcare IT and Hospital Aquired Infections are established objectives in Healthy People 2020.

The entire press release from the AHRQ is below:

Opportunity for public comment on draft Healthy People 2020 objectives

The U.S. Department of Health and Human Services invites you to comment on the DRAFT set of objectives for Healthy People 2020. For three decades, Healthy People has provided a set of national 10-year health promotion and disease prevention objectives aimed at improving the health of all Americans.

Visit www.healthypeople.gov/hp2020 to
· View proposed draft objectives for Healthy People 2020
· Comment on the proposed objectives
· Comment on the topic areas
· Suggest additional objectives
· Suggest topic areas you feel are missing from the draft set

Your comments will help ensure issues important to you are included in Healthy People. Establishing objectives and providing benchmarks to track progress motivates, guides, and focuses action. Be part of the change. Comments will be accepted through December 31, 2009.

Visit www.healthypeople.gov/hp2020 today. Your feedback will help define the vision and strategy for building a healthier Nation.

AHRQ Tools and Resources to Prevent HAIs.

In early September, the AHRQ released a webpage highlighting research and resources related to the prevention of hospital acquired infections. This is an excellent site that links to tools and resources for both healthcare providers as well as healthcare consumers.

You can find the website here.

2008 Indiana Medical Errors Report Released

On 8-20-09 the Indiana State Dept. of Health released its 2008 report on medical errors reported by hospitals, ambulatory surgery centers, and abortion clinics via the reporting system mandated by the Governor in 2005 to start CY2006.

The State's Medical Error Reporting System webpage is here: http://www.in.gov/isdh/23433.htm (Note: The State frequently changes its webpage urls and thus the link may become useless at any time. It was working this morning.)

The 2008 report itself can be found here: http://www.in.gov/isdh/files/2008_MERS_Report.pdf
Data Tables: http://www.in.gov/isdh/files/2008_MERS_Data_Tables.pdf
Appendix: http://www.in.gov/isdh/files/2008_MERS_Appendices.pdf

The 2008 Report also contains descriptions of patient safety improvements efforts and activities that are ongoing throughout the state.

Note that the reporting rules have changed for CY2009. Prior to 1-1-09, 27 events had to be reported. Twenty-Eight events are now covered by the reporting system. The new list is here: http://www.in.gov/isdh/files/28_REPORTABLE_EVENTS.pdf

The release of the report has been lightly covered by local media:
IndyStar: http://www.indystar.com/apps/pbcs.dll/article?AID=2009908210343
WTHR: http://www.wthr.com/Global/story.asp?s=10964770

APIC Study Finds Hospitals Are Cutting Back on Infection Prevention???

The Association for Professionals in Infection Control and Epidemiology issued a press release on June 9th reporting its findings that hospitals are cutting back on the infection control/prevention function across the country.

You can download the press release here.

Excerpts:

The “2009 APIC Economic Survey” found that of nearly 2,000 infection preventionists who responded, 41 percent reported reductions in budgets for infection prevention in the last 18 months due primarily to the economic downturn.

According to the survey, three-quarters of those whose budgets were cut experienced decreases for the necessary education that trains healthcare personnel in preventing the transmission of healthcare-associated infections (HAIs) such as MRSA and C. difficile. Half saw reductions in overall budgets for infection prevention, including money for technology, staff, education, products, equipment and updated resources. Nearly 40 percent had layoffs or reduced hours, and a third experienced hiring freezes.

“Infection prevention departments at our nation’s healthcare facilities are severely understaffed and under-resourced,” said APIC CEO Kathy L. Warye. “Without enough trained professionals, funding and high-tech solutions that speed access to infection-related data, we are not going to continue to make progress in eliminating preventable infections. While cuts in staff, training and technology may ease budgets in the shortterm, the effect of increased infections will erode the bottom line over time, not to mention cause needless pain, suffering and death.”

TJC: Measuring Hand Hygiene Adherence: Making the What, Why and How Decisions

The Joint Commission issued a press release tonight about a monograph they have been working on. The full text of the press release follows.

WARNING: The monograph is 232 pages and weighs 4.46MB!
You can download the monograph here.

(OAKBROOK TERRACE, Ill. – April 14, 2009) Preventing infections is critical to patient safety. Effective hand hygiene practices have long been recognized as the most important way to reduce the transmission of potentially deadly germs in health care settings. To help health care organizations target their efforts in measuring hygiene performance, The Joint Commission is releasing “Measuring Hand Hygiene Adherence: Overcoming the Challenges.”

The monograph is the result of a two-year collaboration with major infection control leadership organizations in the United States and abroad to identify effective approaches for measuring adherence to hand hygiene guidelines in health care organizations. In addition to The Joint Commission, the participating organizations include the Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), the Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiology of America (SHEA), the World Health Organization (WHO) World Alliance for Patient Safety, the Institute for Healthcare Improvement (IHI) and the National Foundation for Infectious Diseases (NFID).

Measuring compliance with hand hygiene practices has long been complicated because of the need to monitor the practices of many different care providers in numerous locations for sufficient periods of time. Without standardized approaches to measuring hand hygiene performance, it is impossible to determine whether overall performance is improving, deteriorating or unchanged as new strategic interventions are introduced. The Joint Commission’s National Patient Safety Goals require credited organizations to follow recognized hand hygiene guidelines; however, studies continue to show that adherence to these guidelines is lacking. This is due, in part, to the variation in approaches to measurement, which makes rates of adherence difficult to compare.

The monograph provides a framework to help health care workers make necessary decisions about when, why and how to measure compliance with hand hygiene. The monograph systematically reviews the strengths and weaknesses of commonly used approaches. Examples of measurement methods and tools in the monograph, which also includes references to evidence-based guidelines and published literature, were submitted by organizations through the Consensus Measurement in Hand Hygiene project. The project was supported by an unrestricted educational grant from GOJO Industries, Akron, Ohio.

“Measuring hand hygiene adherence is not a simple matter,” says Jerod M. Loeb, Ph.D., executive vice president, Division of Quality Measurement and Research, The Joint Commission. “The monograph can help health care organizations more effectively measure compliance and strengthen improvement activities that save lives and money.”

“Monitoring hand hygiene is useful only if the methods are valid and reliable and the results are widely disseminated and used to improve practice,” says Elaine Larson, R.N., Ph.D., F.A.A.N., C.I.C., scientific advisor for the project and associate dean for research at the Columbia University School of Nursing, New York. “This Monograph will be an invaluable resource to institutions struggling to do it right.”

Electronic copies of the monograph are available on The Joint Commission’s Web site at http://www.jointcommission.org/PatientSafety/InfectionControl/hh_monograph.htm. A free printed copy is available by calling The Joint Commission’s Department of Customer Service Center at 630-790-5800, option 5, or sending an email to customerservice@jointcommission.org.

Carbapenem-Resistant Enterobacteriaceae

The IHI today posted CDC guidelines regarding Carbapenem-Resistant Enterobacteriaceae (CRE) on its website.

You can find IHI post here.
You an go directly to the CDC guidelines here.

Excerpt of IHI posting:

Infection with carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemase-producing enterobacteriaceae is emerging as an important challenge in health care settings. This threatens to become a problem akin to MRSA. Institutions must be alert for this and other very resistant organisms (ESBL, CTX producing gram negatives, etc.) and not limit foci to C. difficile and MRSA.

NQF Releases Safe Practices for Better Healthcare 2009 Update: A Consensus Report

A few days ago, the NQF released its 2009 Update of a previously released consensus report: Safe Practices for Better Healthcare.


The following is an excerpt of the document description posted on the NQF website:

Safe Practices for Better Healthcare—2009 Update presents 34 practices that have been demonstrated to be effective in reducing the occurrence of adverse healthcare events. This revised set of NQF-endorsed safe practices has been updated with current evidence and expanded implementation approaches, and it provides additional measures for assessing the implementation of the practices.

As of today, only the electronic pdf version of the report is available. You can buy it here for $29.99.
A free summary report is here.


Did you miss out on the 2006 version? ...Not sure if your hospital can pay you back the $30? You can download the 2006 version for free at: http://www.qualityforum.org/pdf/projects/safe-practices/SafePractices2006UpdateFINAL.pdf

Interestingly, a quick Internet search will reveal the draft version of the 2009 version here.

Mandatory MRSA Reporting in Indiana?

Last Friday (January 16th) Indiana Representative Cynthia Noe (District 87) introduced legislation (House Bill 1539) which calls for mandatory public reporting of hospital MRSA rates. The current text of the bill is as follows:

SECTION 1. IC 16-21-2-17 IS ADDED TO THE INDIANA CODE AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY 1, 2009]:
Sec. 17. (a) As used in this section, "methicillin resistant staphylococcus aureus" means the strain of staphylococcus aureus bacteria, also known as MRSA, that is:
(1) resistant to oxacillin or methicillin; and
(2) identified according to the Clinical Laboratory Standards Institute's Performance Standards for Antimicrobial Susceptibility Testing.
(b) Each hospital shall develop a plan to reduce the incidence of persons contracting the methicillin resistant staphylococcus aureus infection at the hospital. The plan must include the specific strategies, patient screening practices, and infection control practices that the hospital will implement to reduce the incidence of methicillin resistant staphylococcus aureus infections.
(c) Before January 1, 2010, each hospital shall submit a plan prepared under this section to the state department. Each hospital shall submit an updated plan to the state department biennially.
(d) Before March 1 of each year, each hospital shall submit to the state department a report of the methicillin resistant staphylococcus aureus infection rate at the hospital during the previous year in a form determined by the state department.
(e) Information submitted to the state department under this section is a public record.

Although transparency in healthcare is a good thing, I don't think this legislation will accomplish much beyond creating a lot of busy work for hospitals. The resulting data will be of questionable value.

• The information submitted to the State Department of Health will be a public record.
• However, will the State Department of Health have the resources to crunch the numbers in a way that will allow for fair comparisons between hospitals? The financial impact statement for this bill has already been published. It says that this bill is not expected to have a financial impact on the ISDH. What that tells me is that there is no intention to create a system to risk-adjust the rates. In other words, it is the raw data that the public will have access to.
• How will the hospital know if the MRSA infection was pick up in the hospital or before the patient entered the hospital? Test EVERYONE upon admission to a hospital? Who will pay for that?
• What is the purpose of requiring all hospitals to submit an infection control plan to the ISDH? Will anyone read it? Will there be consequences for a hospital submitting a crappy plan? What if a hospital does submit a lame plan? Who's to say that it is lame? Who has the authority to send it back to the hospital for improvement? Ultimately, what's the point?

An alternative to the proposed legislation may be:

• Rather than reporting MRSA data to the state, why not require all Indiana hospitals to participate in the MDRO module of the CDC National Healthcare Safety Network (NHSN). Thus, all hospitals will be reporting data in a consistent method and contributing to a national surveillance database. One of the stated purposes of the NHSN is to "provide facilities with risk-adjusted data that can be used for inter-facility comparisons and local quality improvement activities." The problem with this is that facility level NHSN data is confidential and not available to the public. However, it is better to collect data that has a purpose (ie, for the CDC NHSN) than collect data that has questionable purpose (ie, for ISDH). Either way, facilities become aware of their own MRSA rates. By participating in the NHSN, the data becomes useful to the hospital.
• Rather than having hospitals submit MRSA control plans to ISDH every 2yrs , why not change 410 IAC 15-1.5-2 (the Infection Control section of the state regulations for hospitals)? Sec 2(b) currently says "There shall be an active, effective, and written hospital-wide infection control program. Included in this program shall be a system designed for the identification, surveillance, investigation, control, and prevention of infections and communicable diseases in patients and health care workers." Why not add a subsection here to say that the written plan must specifically include the surveillance, internal reporting, control, and prevention of MRSA? This way, all hospitals will have an opportunity to show the ISDH the effectiveness of their MRSA control plan during the annual licensing survey. Poor or non-existent MRSA control plans will result in citations.

These two alternate ideas will accomplish what Indiana Representative Noe intended with her legislation but in a manner that will produce less "busy work" and more useful information for the purpose of quality improvement.