Infection prevention in 2016: 10 key areas of focus

2015 was a critical year for infection prevention, with several "pivotal moments" shaking the industry and further emphasizing the need for integration into organizations' quality assurance performance improvement (QAPI) program with tightened processes to ensure patient safety.

Looking ahead as we begin 2016 and knowing that many issues that came to the forefront in 2015 will carry forward this year, the following are 10 key areas of focus that should be on the priority list for facilities.

1. Endoscope reprocessing. The 2015 shakeup for infection prevention began with endoscope reprocessing failure. Highly resistant bacterial infections, with subsequent morbidity and mortality, connected to reprocessed duodenoscopes made headlines in the first quarter.

While final guidance for reprocessing of medical devices was released almost a year ago, in March 2015, this significant issue continues to be of utmost importance for manufacturers and healthcare facilities that reprocess instruments and other items, including inpatient hospital settings, ambulatory surgery centers (ASCs) and other outpatient care settings.

The federal government continues to place major emphasis on instructions for use (IFUs) and directions for use (DFUs). Facilities are mandated by the federal government to follow guidelines and standards when conducting cleaning, disinfection and sterilization. In addition, following nationally recognized guidelines is critical. Surveyors have been focusing on reprocessing for several years, and with each year's surveys they become more focused on these processes and this will continue for at least the entire year if not well beyond.

2. Bronchoscope reprocessing. The reprocessing of bronchoscopes became a topic of interest as well. While these scopes are less likely to cause infection than endoscopes, the FDA released a statement regarding bronchoscope reprocessing highlighting two recurrent themes: "failure to meticulously follow manufacturer instructions for reprocessing" and "continued use of devices despite integrity, maintenance and mechanical issues."

3. Internal and external review of reprocessing practices. In September, the CDC issued an advisory alert to all healthcare facilities, including outpatient surgery centers, other outpatient settings as well as physician practices and clinics, that utilize reusable medical devices urging them to "immediately review current reprocessing practices at their facility to ensure they (1) are complying with all steps as directed by the device manufacturers, and (2) have in place appropriate policies and procedures that are consistent with current standards and guidelines."

They further stipulated in the advisory that facilities should "arrange for a healthcare professional with expertise in device reprocessing to immediately assess their reprocessing procedures." Organizations that have not completed these steps must make them a high priority.

4. ASC surveyor worksheet. Since 2009, CMS has been aggressively employing its "infection control surveyor worksheet" (ICSW) when conducting surveys in ASCs. This includes ASCs with deemed status that have surveys by other organizations. The original worksheet was updated with minor changes in 2013, followed by a detailed revision in June 2015. Many additions were made and surveyors implemented the updated ICSW worksheet immediately.

5. Written infection prevention risk assessment. In 2015, AAAHC announced it will require accredited organizations to complete a written infection prevention risk assessment for 2016. ASCs need to prepare for more stringent requirements as infection prevention continues to draw parallels between inpatient and outpatient settings. CMS-certified hospitals are required to have a fully descriptive infection control risk assessment as part of their annual plan, which includes goals and strategies for prevention of healthcare-associated infections (HAIs) in patients and staff. There are several additional components to the risk assessment.

AAAHC has not provided direction as to how the risk assessment should be conducted but there are tools available that should make the process easier.

6. HAI reporting. Mandatory reporting requirements for HAIs have been at the forefront of infection prevention, along with several other initiatives. In the acute care setting, hospitals have been reporting HAI rates to CDC via the NHSN reporting system for several years.

More recently, mandatory reporting to CDC has been mandated for outpatient surgery centers as CMS works to restructure its reimbursement models and works together with other federal agencies to promote patient safety. In a joint statement by the CDC and CMS, healthcare facilities, namely hospitals, were reminded of the mandatory reporting requirements after anecdotal reports of intentional non-reporting of infection data were received. Facilities were given a stern reminder of the consequences resulting from intentionally reporting incorrect data or failing to report data that is public information — it is a violation of the mandates and subject to action by the federal agencies. Healthcare facilities should be on their guard during 2016 as these agencies become more vigilant in their approach towards patient safety.

7. CAUTI NPSG. In 2015, The Joint Commission reached out to healthcare facilities to request input for revisions to the catheter-associated urinary tract infection (CAUTI) national patient safety goals (NPSGs). Facilities that will be impacted by changes would include hospitals, critical access hospitals and nursing care centers (i.e., nursing homes). CAUTI, amongst other HAIs, is preventable. Practice strategies for improving insertion technique and care of urinary catheters continue to be monitored very closely.

8. Overhaul of nursing home and long-term care rules. 2016 begins a period of major changes for the nursing home and long-term care industry as CMS proposes a major overhaul of the Medicare Conditions of Participation (CoP) or Conditions for Coverage (CfC) that would revise the requirements that long-term care facilities (LTCF) must meet to participate in the Medicare and Medicaid programs. CMS released the proposed rule on July 16, 2015. The proposed requirements are part of the Affordable Care Act.

The last time the LTCF CoPs were comprehensively reviewed and updated was in 1991, despite substantial changes in service delivery in this setting since then.

9. Hand hygiene. While significant progress has been made in hand-hygiene compliance over the past several years, including the introduction of various methods to measure and monitor practices, a report released in 2015 from The Leapfrog Group showed that there is still work to be done.

Hand hygiene is the first step in prevention of transmission of infection both in the inpatient and outpatient sectors. As the industry works towards improving the quality of care for patients, the importance of not only practicing hand hygiene but also monitoring the process will continue to remain top priority for clinicians, infection prevention personnel and QAPI programs.

10. MRSA. From 2010-2015, the incidence of healthcare-associated MRSA decreased by approximately 50% in the United States, proving a significant point: diligent practices and attention to detail can drive down rates of transmission and subsequent infection. Despite reports signifying lower transmission rates, healthcare organizations (hospitals in particular) are looking at strategies to further reduce the rate of MRSA and other multi-drug resistant organization transmission while revisiting traditional procedures. 2016 should be a year of change with respect to screening, nasal decolonization and contact precautions. Newer technologies to assist with these efforts made their way onto the market in 2015 and more will likely follow, which may result in future practice changes.

Phenelle Segal, RN, CIC, is president of Infection Control Consulting Services, which specializes in providing comprehensive infection prevention and infection control assistance to a wide variety of healthcare organizations, including hospitals, ambulatory surgery centers, outpatient care facilities, clinics and physicians' offices.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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