Objectives. Long Term Acute Care Hospital and Skilled Nursing Facility Infection Prevention & Control Regulations & Survey Preparation

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1 Long Term Acute Care Hospital and Skilled Nursing Facility Infection Prevention & Control Regulations & Survey Preparation Jennifer Hoke, MSN, RN Nurse Consultant III Center for Health Care Quality Licensing and Certification Objectives Describe some of the differences between a Long Term Acute Care Hospital and a Skilled Nursing Facility Identify where to find the Infection Prevention and Control related State and Federal Regulations that can be cited during a complaint investigation or recertification survey Discuss what to expect and how to prepare for a survey when talking about Infection Prevention and Control issues. Locate reference materials such as Internet resources and guidelines What s the Difference? LTAC Licensed as General Acute Care Hospital (GACH) Title 22, Division 5, Chapter 1; (GACH Regulations) Focused on provision of acute services to patients with intensive medical needs for a long period of time State required NHSN reporting SNF Licensed as Skilled Nursing Facility (SNF) Title 22, Division 5, Chapter 3; (SNF Regulations) Focused on provision of continuous skilled nursing care and supportive care on an extended basis No state required NHSN reporting 1

2 Then What is a Distinct Part SNF? Physically distinguishable from the larger institution or institutional complex that houses it Meet participation requirements for Long Term Care Facilities Be operated under common ownership & control by the institution of which it is a DP May be comprised of one or more buildings or designated parts of buildings (that is, wings, wards, or floors) that are in close proximity Must include all of the beds within the designated area, and cannot consist of a random collection of individual rooms or beds that are scattered throughout the physical plant Title 22 Infection Control Related Regulations for LTACs (partial list) Nursing Service P&P Nursing Staff Development Dietetic Service - General Dietetic Service Equipment & Supplies Employee Health Examinations and Health Records Reporting Infection Control Program Provisions for emptying bedpans Isolation Facilities Laundry Service Housekeeping Central Sterile Supply Autoclave and Sterilizers Disinfecting Storage and Disposal of Solid Wastes Solid Waste Containers Infectious Waste Water Supply and Plumbing Ice Federal Infection Control Regulations for LTACs (Partial) A-0747 Main Tag: Condition of Participation: Infection Control A (a) Standard: Organization and Policies A (a)(1) - The infection control officer or officers must develop a system for identifying, reporting, investigating, and controlling infections and communicable diseases of patients and personnel. A (a)(2) - The infection control officer or officers must maintain a log of incidents related to infections and communicable diseases. 2

3 Title 22 Infection Control Regulations for Skilled Nursing Facilities (partial list) Nursing Service- Patients with Infectious Diseases Nursing Service Cleaning, Disinfecting and Sterilizing Dietetic Service Sanitation Dietetic Service Cleaning and Disinfection of Utensils Employees Health Examination and Health Records Reporting of Communicable Diseases Reporting of Outbreaks Unusual Occurrences Space & Equipment for Autoclaving, Sterilizing & Disinfecting Housekeeping Laundry Clean Linen Soiled Linen Provisions for Emptying Bedpans. Federal Infection Control Regulations for Skilled Nursing Facilities SNFs: Main F-Tags: 334; 441; 454 Some other potential related tags: (a)(2), F201, Transfer and Discharge Requirements (b), F272, Comprehensive Assessments (b), F274, Significant Change Assessments (k)(1)(i), F279, Comprehensive Care Plan (k)(2)(iii), F280, Comprehensive Care Plan Revision (l), F329, Unnecessary Drugs (l)(2)(n), F334, Influenza and Pneumococcal Immunizations (i)(2), F371, Sanitary Conditions (a)(6), Life Safety from Fire... ABHRs (h), F465, Other Environmental Conditions (f), F498, Proficiency of Nurse Aides When you see the Orange Hat it is California Regs. When you see the Blue Hat - it corresponds to Federal Regs For those with black and white copies of the presentation the orange hat has a skinnier band and the blue hat has a wider band 3

4 Nursing Service - Patients with Infectious Diseases. Keys: Do not admit patients that you are not equipped to care for Adopt, observe and implement written infection control policies and procedures (See F441) More regarding F Infection Control establish and maintain an Infection Control Program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of disease and infection. More regarding F (a) Infection Control Program The facility must establish an Infection Control Program under which it- (1) Investigates, controls, and prevents infections in the facility; (2) Decides what procedures, such as isolation, should be applied to an individual resident; and (3) Maintains a record of incidents and corrective actions related to infections. 4

5 More regarding F (b) Preventing Spread of Infection (1) When the Infection Control Program determines that a resident needs isolation to prevent the spread of infection, the facility must isolate the resident. (2) prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease. (3) require staff to wash their hands after each direct resident contact for which hand washing is indicated by acceptable professional practice Nursing Service Cleaning, Disinfecting and Sterilizing (h), F465 Other Environmental Conditions Make provisions for the cleaning and disinfecting of contaminated articles and surfaces which cannot be sterilized Nursing Service Cleaning, Disinfecting and Sterilizing (h), F465 Other Environmental Conditions Clean Bedside Equipment including glucometers, BP Cuffs, etc. 5

6 Nursing Service Cleaning, Disinfecting and Sterilizing (h), F465 Other Environmental Conditions Clean Thermometers! Dietetic Service Sanitation Dietetic Service Cleaning and Disinfection of Utensils (i), F371 Dietary Services Sanitary Conditions Employees Health Examination and Health Records. Health Exam and TB Screening 6

7 A Related Tag for Residents not Employees (n) Influenza and Pneumococcal immunizations (Survey Staff will use the Investigative Protocol so you should know what it says!) Influenza develop policies and procedures that ensure : Residents are offered influenza immunization, including documented risk and benefits. From October 1 through March 31 annually. Pneumococcal develop policies & procedures that ensure: Residents are offered pneumococcal immunization including risk & benefits. Residents are offered an pneumococcal immunization unless they have already been immunized Reporting of Communicable Diseases. All cases of reportable communicable diseases shall be reported to the local health officer Reporting of Outbreaks. Any outbreak or undue prevalence of infectious or parasitic disease or infestation shall be reported to the local health officer Unusual Occurrences. Occurrences such as epidemics outbreaks, poisoning, fires, major accidents, death,.of patients, personnel, or visitors, shall be reported by the facility within 24 hours..to the local health officer and the Department Space and Equipment for Autoclaving, Sterilizing & Disinfecting (a) A facility shall: (1) Maintain disposable sterile supplies in the amount necessary to meet the anticipated needs of the patients, or (2) Maintain autoclave equipment, or (3) Make contractual arrangements for outside autoclaving and sterilizing services. (b) If a facility maintains a central supply and sterilizing area, it shall include but not be limited to 7

8 Housekeeping (h)(2), F253 Housekeeping & Maintenance (a) Each facility shall routinely clean articles and surfaces such as furniture, floors, walls, ceilings, supply and exhaust grills and lighting fixtures. (c) Cleaning supplies and equipment shall be stored in rooms for housekeeping use only. (2) Commercial detergent germicide shall be used for all cleaning. (3) Mop heads shall be removable and changed at least daily Laundry Clean Linen (h)(2), F253 Housekeeping & Maintenance 8

9 Soiled Linen (a)(2), F441 Infection Control Program Provisions for Emptying Bedpans. Do you see a flushing attachment here? The Infection Control Investigative Protocol must be completed for every initial certification and recertification survey. Here is the web address for the Interpretive Guidelines for Long- Term Care Facilities. This is where you will find F-Tag 441 & the IC Investigative protocol: All Facility Federal guidelines can be found here: 9

10 Ignaz Philipp Semmelweis (Born July 1, 1818, Buda, Hung., Austrian Empire died August 13, 1865, Vienna, Austria. In 1845, as an assistant at Vienna's Obstetric clinic at a time when death rates from puerperal fever were as high as 30% in European maternity hospitals, Semmelweis noticed that far fewer women died in the midwives' division of the clinic than in the division where students (often coming from the dissecting room) were taught. Concluding that students carried the infection, he had them wash their hands in chlorinated lime before each exam, and mortality dropped from 18% to 1%. Though his ideas were accepted in Hungary, his Etiology, Understanding, and Preventing of Childbed Fever (1861) was widely rejected abroad. What to Expect Observations of all Health Care Workers (HCW) for hand hygiene: What to Expect Observation of: Overall facility cleanliness, presence of offensive odors, pests, overflowing trash Linen Do healthcare workers (HCW), and visitors have exhibit signs of illness and communicable diseases? Cleanliness of resident care equipment such as glucometers, vital sign machines, commodes, weighing devices, (scales), lift devices (slings), shower chairs, going into, and out of resident rooms. Is the equipment cleaned between residents? Glucometers must be cleaned between each resident using a product that destroys bloodborne pathogens (Hepatitis B, Hepatitis C, and HIV). 10

11 What to Expect Observation: Clean and soiled equipment is not stored together. Signage indicating additional precautions required (the facility is not required to use signs, but must have a communication tool), indicating that transmission based precautions have been implemented when necessary. Are HCW & visitors following the posted signage? Availability & use of personal protective equipment Are staff using a single pair of gloves for multiple tasks, multiple residents, direct or indirect contact with the environment or patient care equipment? What to Expect Observation: Cleaning of resident rooms. Dilution/mixing of disinfectant or germicide, & the contact time. Automatic dispenser(s), when was it last calibrated? Cleaning product is EPA approved for use in health care setting. Handling of soiled linen Washing/Storage of linen What to expect Observations: Are single use items, including medication vials used for multiple patients? Are scissors, used for resident care such as dressing changes, disinfected after each use? Are sharp containers replaced according to manufacturer s recommendations? How are Blood glucose lancets and other sharps (needles) disposed of? 11

12 What to Expect Review of the IC program such as: Who is in charge of the IC Program? Who has authority to take action? Who does surveillance? How? Of what? What committee oversees the program? Infection control quality data, including actions taken Is action taken to reduce risk of infection? Antibiotic stewardship program HCW screened for TB and receive infection control training Infection Control tracking system for residents & HCW? Resident screening for TB P&P s for Hand Hygiene, cleaning patient care equipment, handling, processing and transporting of soiled and clean linen, standard and transmission based precautions, etc Healthcare Associated Infections (HAIs) in LTC Settings Website for CDC guidelines and recommendations regarding HAIs in Long Term Care Facilities Includes Clinical Practice Consensus Guidelines CMS SHEA/APIC Evaluating Fever and Infection Minimum Criteria for Initiation of Antibiotics Antimicrobial Use Definitions of Infections for Surveillance in LTCs (McGeer Criteria) California HAI Program This CDPH website includes: Links to outside resources, Information for Infection Prevention Programs, Advisory Committee meeting information Public Reporting Influenza Information Antimicrobial Resistance 12

13 Infection Prevention & Control Consultants (916) Desk (916) FAX (916) Office San Francisco Fresno Santa Rosa San Diego (South) Riverside San Bernardino San Jose LA (shared with Joni) (916) Desk (916) FAX (916) Office Bakersfield Chico East Bay Orange Sacramento Ventura San Diego (North) LA (shared with Evelyn) Review of Objectives Describe some of the differences between a Long Term Acute Care Hospital and a Skilled Nursing Facility Identify where to find the Infection Prevention and Control related State and Federal Regulations that can be cited during a complaint investigation or recertification survey Discuss what to expect and how to prepare for a survey when talking about Infection Prevention and Control issues. Locate reference materials such as Internet resources and guidelines 13