Ppt 300040878

Infection Control Requirements and survey activity

North Division Condition Level Citations

Condition Citation 59 Conditions

2009

57 Conditions

2010

45 Conditions

2011 – YTD Aug

V110 Infection Control 7 15 4

V175 Water/Dialysate 7 3 3

V 400 Physical Environment 4 1 5

V450 Patient Rights 0 0 1

V500 Patient Assessment 10 11 10

V540 Patient Plan of Care 10 12 11

V580 Care at Home 2 2 0

V625 QAPI 2 4 3

V675 Laboratory Services 1 0 0

V680 Personnel Qualification

1 1 1

V710 Responsibilities of

Medical Director

8 6 3

V725 Medical Record 1 0 0

V750 Governance 5 2 4

V 760 Grievance 1 0 0

North Division - Standard Level Citations HD

Standard Level Citations 2009 - 988 2010 - 1281 2011- Aug YTD - 933

V100 Compliance /Fed, State, Local Laws 4 9 2

V110 Infection Control 247 370 200

V175 Water and Dialysate 105 134 76

V400 Physical Environment 146 158 108

V450 Patient Rights 37 33 30

V500 Patient Assessment 142 186 162

V540 Patient Plan of Care 151 187 162

V580 Patient Care at Home 22 16 5

V625 QAPI 22 42 56

V675 Laboratory Services 3 0 1

V680 Personnel Qualifications 15 22 27

V710 Responsibilities of Medical Director 44 54 58

V725 Medical Records 23 48 25

V750 Governance 27 22 21

Objectives

Review the Conditions for Coverage Infection Control requirements

Review related survey citations

Understand individual infection control responsibilities

2nd Leading Cause of Death

• Infection accounts for 15% of all deaths

• 57% due to Vascular Access infections

• Risk for bacteremia is seven fold the risk in patients with catheters

• MRSA is 100 times higher

Rank US NE CT MA NH VT ME RI

1 V113 V 113 V 520 V541 117 515 V751 112

2 V 122 V 541 V 113 V113 114 143 122

3 V 403 V 520 V 101 V111 184 122

4 V 715 V 501 V 541 V114 122 113

5 V 541 V 122 V 684 V544 113 714

6 V 543 V 114 V 501 V143 115 627

7 V 767 V 101 V 504 V542 755 404

8 V 401 V 117 V 323 V501 110 320

9 V 402 V 115 V 715 V634 250 318

10 V 116 V 542 V 726 V191 143

Conditions for Coverage

494.30V111-V148

The dialysis facility must provide and monitor a sanitary environment to minimize the transmission of infectious agents within and between the unit and any adjacent hospital or other public areas

CDC’s Components of a comprehensive infection control program

• Infection control practices for hemodialysis units Infection control precautions specifically designed to prevent transmission of bloodborne viruses and pathogenic bacteria among patientsRoutine serologic testing for hepatitis B virus infections Vaccination of susceptible patients against hepatitis BIsolation of patients who test positive for hepatitis B surface antigen

• Surveillance for infections and other adverse events

• Infection control training and educationhttp://www.cdc.gov/mmwR/preview/mmwrhtml/rr5005a1.htm

CDC’s Central Venous Catheter Guidelines

• Incorporated into the Conditions for Coverage

• CDC’s “ Guidelines for the Prevention of Intravascular Catheter-Related Infections”

• Recently updated • Guidelines for the Prevention of Intravascular Catheter-Related Infections

Frequent Citations Related to V111

• Infection control precautions specifically designed to prevent transmission of bloodborne viruses and pathogenic bacteria among patients

• Routine serologic testing for hepatitis B virus infections

• Vaccination of susceptible patients against hepatitis B

Infection control precautions specifically designed to prevent transmission of bloodborne viruses and

pathogenic bacteria among patients• Hand Hygiene

• Glove Use

• Caring for one or more HBV+ patients and one or more immune patients at the same time, but may not simultaneously care for Hepatitis B susceptible patients.

• Clearly designated clean areas

• Cleaning and disinfection of contaminated surfaces, medical devices, and equipment

Hand Hygiene

• Single MOST important procedure

• Hand washing uses soap and water

• Hand hygiene uses waterless alcohol based

Gloves

• Wear Gloves– When doing patient care– When administering medications– When handling equipment

• Change Gloves– When working between patients or machines – When going between clean and dirty tasks– Whenever contaminated

Caring for HBsAg positive patients.

• Staff members caring for HBsAg positive patients should not care for HBV susceptible patients at the same time, including during the period when dialysis is terminated on one patient and initiated on another.

• Hepatitis B status should be considered when patients are assigned to stations nearest the isolation area. (immune)

• Patients who require a booster dose of the HBV vaccine should not be assigned to a staff member concurrently caring for HBV+ positive patients.

• When possible, only HBV immune staff should be assigned to care for HBV+ patients

Clearly Designated Clean Areas

• Areas designated for preparation, handling and storage or medications.

• Clean areas clearly separated from contaminated areas where used supplies and equipment are stored

• Medications or clean supplies are not stored in or adjacent to the area where used equipment or blood samples are handled.

Cleaning and disinfection of contaminated surfaces, medical devices, and equipment

• Follow manufactures guidelines for disinfection

• Appropriate dilution and contact time of disinfectant

• Correct cleaning and disinfection of environmental surfaces

• Prompt cleaning of blood spills

Routine serologic testing for hepatitis B virus infections

• Routinely test all patients for Hepatitis B virus

• Test HBV susceptible, including nonresponders to vaccine: – HBsAg monthly– Anti-HBs is <10mIU/mL, patient is considered

susceptible

Vaccination of susceptible patients against hepatitis B

• Vaccinate all susceptible patients and staff members against hepatitis B.

• Test for anti-HBs 1-2 months after last primary vaccine dose

– If anti-HBs is <10mIU/mL, consider susceptible, revaccinate with an additional three doses and retest for anti_HBs

– If anti-HBs ≥ 10mIU/mL, consider immune, and retest patients annually

– Give booster dose of vaccine to patients if anti-HBs declines to <10mIU/mL and continue to retest patients annually.

• Centers for Disease control and Prevention. (2001). Recommendations for preventing transmission of infections among chronic hemodialysis patients. Morbidity and Mortality Weekly Report, 50 (RR-5).

• Centers for Medicare & Medicaid Services. (2008) Conditions for coverage for end stage renal disease facilities: Final rule, Federal Register. Retrieved from http://www.cms.gov/cfsandcops/downloads/esrdfinal rule0415.pdf

• Gomez, N. (Ed.). (2011). Nephrology Nursing Scope and Standards of Practice (7th ed.) . Pitman, NJ: American Nephrology Nurses’ Association.

References

Questions