R111 Infection Prevention and Control - IHCA Handouts/R111.pdf3 F880 –Phase one effective 11/28/17 The facility must establish and maintain an infection prevention and control program

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Infection Prevention and Control: Beyond Phase 3

Peace Love and Quality

Karen Sautbine MSN, NHA, RAC- CT, Senior Healthcare Consultant

Date September 12, 2019

Find Peace as you will be able to state the Infection Prevention and Control (IPC) Requirements for phases 1 through 3.

Find Love and Passion for Infection Prevention and Control as you learn a comprehensive system for Infection Prevention from facility assessment to Antibiotic Stewardship

Discover the Quality Expectations that the Infection Preventionist (IP) brings to the Quality Assurance program

Today’s Agenda/Objectives

I have no conflicts of interest

Disclaimers

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Phase 3 Requirements of Participation ‐ IPCEffective 11/28/2019

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Introduction:

Phase 3 implementation is effective 11/28/2019.

The Infection Prevention and Control Program requirements have been identified in phases 1 and 2.

Phase 3 adds additional expectation for the IP role and defines additional responsibilities in the areas of education and quality assurance. Learn how to have an effective Infection Prevention and Control program to ensure regulatory compliance, resident outcomes and reimbursement.

483.80 Infection Control

483.80• F880 – Infection Prevention and Control• F881 – Antibiotic Stewardship• F882 – Infection Preventionist***• F883 – Influenza and Pneumococcal Immunization

483.75• F868 – Quality Assessment and Assurance***

483.95• F945 – Infection Control Training Requirements***

*** Phase 3 ROP effective 11/28/2019

Phase 1-2-3 IPC - F tags

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F880 – Phase one effective 11/28/17

The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary and comfortable environment to help prevent the development and transmission of communicable diseases and infections

The elements to include are…

483.80 Infection Control – what do the regs say…

The facility must establish an infection prevention and control program (IPCP) that at a minimum, must include the following:

• A system for preventing, identifying, reporting, investigating and controlling infections

• Written standards, policies and procedures for the program

• A system for recording incidents

• Linens

• Annual Review

F880 – Elements of the IPC Program

Develop and implement an ongoing IPCP to prevent, recognize and control the onset and spread of infection to the extent possible

Reviews the IPCP annually and as necessary, updates to meet current standards of practice

Develops and implements written P&P’s that at a minimum…

Requires staff handle, store, process and transport linen…

F880 – What is the intent of this regulation?

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Establish facility wide systems for the prevention, identification, investigation and control of infections of residents, staff and visitors.

• To include ongoing surveillance designed to identify possible communicable diseases before they can spread

• Procedures for reporting possible incidents of communicable disease or infection

F880 – What is the intent of this regulation

Develops and implements written P&P’s that at a minimum:

• Explain standard precautions and when transmission-based precaution should be utilized, including type and duration, least restrictive for the resident

• Prohibit staff with a communicable disease or infected skin lesion from direct contact with residents or their food if direct contact will transmit the disease

• Require staff to follow hand hygiene practices consistent with accepted standard of practice

F880 – What is the intent of this regulation:

Requires staff handle, store, process and transport all linens and laundry in accordance with accepted standards in order to produce hygienically clean laundry and prevent the spread of infection to the extent possible.

F880 – What is the intent of this regulation?

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Annual IPCP review – includes annual Facility Assessment

Standard Precautions – Spaulding classification system

Medical Device SafetyPoint of Care testingFingerstick devicesBlood Glucose Meters

Safe Medication Administration

LinensPillows and Mattress

F880 – Did you know?

Resources for Facility Infection Assessment:

• APIC: https://apic.org/About-APIC/Vision-and-Mission• Infection Prevention Guide for Long-Term Care 2nd Ed.• Forms and Checklist for Infection Prevention 2nd Ed.

• CDC Training for LTC IP’s: https://www.cdc.gov/longtermcare/training.html

• IPC Risk Assessment Spread Sheet

F880 – Facility Assessment and Annual Review

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IPC PRACTICE FAILURESPROBABILITY OF OCCURRENCE

IMPACT ON RESIDENT/STAFF SAFETY CAPACITY TO DETECTREADINESS TO PREVENT

(How likely is this to occur?)

(Will this failure directly impact safety?)(Are processes in place to identify this failure?)

(Are policies, procedures, and resources available to address this failure?)

Score High Med. Low None High Med. Low None Poor Fair Good Poor3 2 1 0 3 2 1 0 3 2 1 3

Care activityLack of accessible alcohol-based hand rubLack of accessible personal protective equipment (PPE)Inappropriate selection and use of PPEInadequate staff adherence to hand hygieneInadequate staff adherence to glove and gown use when resident in Contact Precautions

Inadequate staff adherence to facemask use when resident in Droplet Precautions

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Developed by the CDC and identifies 3 risk levels associated with med/surg instruments: Critical, semi-critical and non-critical

• Critical items include are needles, catheters, and if not one time use are sterilized between use (Blood Bourne)

• Semi-critical items include dental and podiatry equipment and require high level disinfection between use (Mucous membranes)

• Non-critical items come in contact with intact skin. BP cuffs, stethoscopes, lifts and equipment. Require low level disinfection periodically and if visibly soiled. EPA-registered disinfectant

• https://www.epa.gov/pesticide-registration/selected-epa-registered-disinfectants

F880 Spaulding Classification System

Point of Care Testing: usually a portable hand held device

• Fingerstick devices: CDC recommends single-use, auto-disabling fingerstick devices. CDC and FDA prohibit use of fingerstick devices for more than one resident = IJ citation!

• Blood Glucose Meters: Must be cleaned and disinfected after each use according to manufacturers direction if used for more than one resident. Follow dwell/contact times of disinfectant

• Single use meters should be stored individually and identified for the resident it is intended

F880 Medical Device Safety

All injectable medications must be prepared and administered in accordance with safe infection practice:• Prepare injection using aseptic technique in a clean area

• Needles and syringes are used one time and only for one resident

• Single does vials and bags are used for one resident only

• Insulin pens are designed to be used multiple times by a SINGLEresident only and must be labeled for the single resident

• Cite at IJ level citation if insulin pen is shared

F880 Safe Medication Administration

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Monitor mattress for tears and holes, patches do not provide an impermeable surface – Provide for inspection and proper cleaning processes

Pillows are laundered in a hot water laundry cycle between use for different residents

Mattresses are discarded if bodily fluids have penetrated the mattress fabric/cover

F880 Mattress and Pillow

Survey Process for Infection Control – Mandatory facility task:

• Observe for breaks in infection control throughout the survey• Hand Hygiene• PPE• Transmission based precautions• Laundry

• Review the Antibiotic Stewardship program

• Influenza Immunization

• Pneumococcal Immunization

F880 Infection Control – Survey Expectations

Auditing and monitoring of Infection Control and Prevention:

Critical Element Pathways:

• Infection Prevention Control and Immunizations Critical Element Pathway

• Urinary Catheter or UTI Critical Element Pathway

Surveyor Training materials

Facility Quality Measures

F880 Infection Control – Compliance

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Antibiotic Stewardship

Phase one effective 11/28/2017

The facility must establish an infection prevention and control program (IPCP) that includes at a minimum, the following elements:

• An Antibiotic Stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use

F881 Antibiotic Stewardship

F881 Antibiotic Stewardship How to…

CDC Core Elements of Antibiotic Stewardship – referenced in F881:

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The core elements are:

• Facility leadership and commitment• Appropriate facility staff accountable for oversight• Accessing pharmacists and others with experience • Implement policies or practices to improve ABX use• Track measures of antibiotic use in the facility• Regular reporting on antibiotic use and resistance levels• Educate staff and residents

CDC Core Elements of Antibiotic Stewardship

Ensure that the facility:

• Develops and implements protocols to optimize the treatment of infections by ensuring that residents who require an ABX receive the appropriate ABX

• Reduces the risk of adverse events including development of resistant organisms for unnecessary ABX use

• Develops, promotes and implements a facility wide system to monitor use of antibiotics

F881 What is the intent?

Leadership:

Administrator

Director of Nursing

Medical Director

Consultant Pharmacist

Provider Laboratory

Antibiotic Stewardship – where to start

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Surveillance:

What standard/source do you use to determine the criteria/need for the initiation of an antibiotic? • Loeb Criteria: downloaded from: https://asap.nebraskamed.com/wp-

content/uploads/

What standard/source do you use to define an infection for the purpose of surveillance• McGeer Criteria: downloaded from: https://asap.nebraskamed.com/wp-

content/uploads/sites/3/2018/04/Revised-McGeer-criteria-for-infection-surveillance-checklist.pdf

• NHSN Criteria

Antibiotic Stewardship – Next Step

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Loeb Criteria for Initiation of an Antibiotic

Suspected Infection Syndrome Minimum Criteria for Starting Antibiotic Therapy

Urinary tract infection

without catheter Either one of the following criteria

□ Acute dysuria, OR

□ Temp >37.9 ⁰C (100 ⁰F) or 1.5 ⁰C (2.4 ⁰F) above baseline, AND

≥1 of the following new or worsening symptoms

□ Urgency □ Frequency

□ Suprapubic pain □ Gross hematuria

□ Urinary incontinence □ Costovertebral angle tenderness

with catheter At least one of the following criteria

□ Rigors □ Temp >37.9 ⁰C (100 ⁰F) or 1.5 ⁰C (2.4 ⁰F) above baseline

□ New onset delirium □ New costovertebral angle tenderness

Note: Residents with intermittent catheterization or condom catheter should be categorized as ‘without catheter’

Urine culture should be sent prior to starting antibiotics

Antibiotics should not be started for cloudy or foul smelling urine

Table 2. Urinary Tract Infection (UTI) Surveillance DefinitionsSyndrome Criteria Selected Comments*

UTI without indwelling

catheter

Must fulfill both 1 AND 2.

□ 1. At least one of the following sign or symptom

□ Acute dysuria or pain, swelling, or tenderness of testes, epididymis, or prostate

□ Fever or leukocytosis, and ≥ 1 of the following:

□ Acute costovertebral angle pain or tenderness

□ Suprapubic pain

□ Gross hematuria

□ New or marked increase in incontinence

□ New or marked increase in urgency

□ New or marked increase in frequency

□ If no fever or leukocytosis, then ≥ 2 of the following:

□ Suprapubic pain

□ Gross hematuria

□ New or marked increase in incontinence

□ New or marked increase in urgency

□ New or marked increase in frequency

□ 2. At least one of the following microbiologic criteria

□ ≥ 105 cfu/mL of no more than 2 species of organisms in a voided urine sample

□ ≥ 102 cfu/mL of any organism(s) in a specimen collected by an

in‐and‐out catheter

The following 2 comments apply to both UTI with or without catheter:

UTI can be diagnosed without localizing symptoms if a blood isolate is the same as the organism

isolated from urine and there is no alternate site of infection

In the absence of a clear alternate source of infection, fever or rigors with a positive urine culture result

in the non‐catheterized resident or acute confusion in the catheterized resident will often be treated as

UTI. However, evidence suggests that most of these episodes are likely not due to infection of a urinary

source.

Urine specimens for culture should be processed as soon as possible, preferably within 1‐2 h

If urine specimens cannot be processed within 30 min of collection, they should be refrigerated and

used for culture within 24 h

UTI with indwelling

catheter

Must fulfill both 1 AND 2.

□ 1. At least one of the following sign or symptom

□ Fever, rigors, or new‐onset hypotension, with no alternate site

of infection

□ Either acute change in mental status or acute functional decline, with no alternate diagnosis and

leukocytosis

□ New‐onset suprapubic pain or costovertebral angle pain or tenderness

□ Purulent discharge from around the catheter or acute pain, swelling, or tenderness of the testes,

epididymis, or prostate

□ 2. Urinary catheter specimen culture with ≥ 105 cfu/mL of any organism(s)

Recent catheter trauma, catheter obstruction, or new onset hematuria are useful localizing signs that

are consistent with UTI but are not necessary for diagnosis

Urinary catheter specimens for culture should be collected after replacement of the catheter if it has

been in place >14 d

□ UTI criteria met □ UTI criteria

NOT met

McGeer Criteria for Surveillance of an infection

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According to the RAI manual, Chapter 3, page I-11, the following 2 criteria must be met to code UTI on the MDS:

Item I2300 Urinary tract infection (UTI): — The UTI has a look-back period of 30 days for active disease instead of 7 days. — Code only if both of the following are met in the last 30 days: 1. It was determined that the resident had a UTI using evidence-based criteria such as McGeer, NHSN, or Loeb in the last 30 days, AND 2. A physician documented UTI diagnosis (or by a nurse practitioner, physician assistant, or clinical nurse specialist if allowable under state licensure laws) in the last 30 days.

How to code a UTI on the MDS?

In accordance with requirements at §483.80(a) Infection Prevention and Control Program, the facility must establish routine, ongoing and systematic collection, analysis, interpretation, and dissemination of surveillance data to identify infections. The facility’s surveillance system must include a data collection tool and the use of nationally recognized surveillance criteria. Facilities are expected to use the same nationally recognized criteria chosen for use in their Infection Prevention and Control Program to determine the presence of a UTI in a resident.

—

More from the RAI Manual Page I-12

Example: • if a facility chooses to use the Surveillance Definitions of Infections

(updated McGeer criteria) as part of the facility’s Infection Prevention and Control Program, then the facility should also use the same criteria to determine whether or not a resident has a UTI.

• If the diagnosis of UTI was made prior to the resident’s admission, entry, or reentry into the facility, it is not necessary to obtain or evaluate the evidence-based criteria used to make the diagnosis in the prior setting. A documented physician diagnosis of UTI prior to admission is acceptable. This information may be included in the hospital transfer summary or other paperwork.

More from the RAI Manual Page I-12 (cont.)

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Antibiotic Stewardship - Surveillance

Process Measures:

Measure specific steps in a process that lead to an intended outcome

• Does the documentation in the chart support the criteria for the antibiotic?

• Completeness of ABX order; dose and duration, correct antibiotic ex: antibiogram or Culture and Sensitivity

• Antibiotic Starts• Antibiotic Days of Therapy

CORE ELEMENTS OF ANTIBIOTIC STEWARDSHIP FOR NURISNG HOMES

Process Measures:

• Audit Completeness of clinical assessment documentation at the time of the antibiotic prescription. If a facility has algorithms for evaluating a resident suspected of having an infection, then perform audits of the assessment to ensure that algorithm was followed.

• Antibiotic starts. Generally, rates of antibiotic starts are based on the prescriptions written after the resident has been admitted to the facility. Data on antibiotic starts can be calculated and reported in the following ways:

Antibiotic Stewardship – Surveillance cont.

Antibiotic Starts:

• Rate of new antibiotic starts initiated in nursing home (per 1,000 resident-days): (Number of new antibiotic prescriptions/total number of resident-days) X 1,000

• Rate of antibiotic starts can be calculated by indication, for example: (Number of new antibiotic starts for urinary tract infection/total number of resident-days) X 1,000

• Rates of antibiotic starts could also be calculated for individual prescribers in the nursing home to compare


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Antibiotic days of therapy (DOT):

Tracking antibiotic DOTs requires more effort than tracking antibiotic starts, but may provide a better measure to monitor changes in antibiotic use over time. The ratio of antibiotic DOT to total resident-days has been referred to as the antibiotic utilization ratio (AUR).3 Below are the steps for calculating monthly rates of antibiotic DOT and AUR.


Antibiotic days of therapy (DOT):

• An antibiotic day: each day that a resident receives a single antibiotic

• For example, if a resident is prescribed a 7-day course of amoxicillin, that course equals 7 antibiotic days. However, if a resident is prescribed a 7-day course of ceftriaxone plus azithromycin, then that course equals 14 antibiotic days.

• Antibiotic DOT: the sum of all antibiotic days for all residents in the facility during a given time frame(e.g., 1 month or 1 quarter)

• Rate of antibiotic DOT (per 1,000 resident-days)=(Total monthly DOT/total monthly resident-days)X 1,000

• Antibiotic utilization ratio: Total monthly DOT/total monthly resident-days


Outcome Measures:

Outcome measures reflect the impact of the health care service or intervention on the health status of patients.

For example: How many residents on an antibiotic develop c. Diff within 30 days of antibiotic start.


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Outcome Measures:

• Track adverse drug events related to antibiotic use. Ex: developing C. diff following antibiotic therapy, drug-drug interaction such at increased INR value.

• Track costs related to antibiotic use. This metric can be useful in justifying support of staff time and external consultant support for ASP activities. Compare DOT cost now and after implementation of a stewardship program. Show how the IP role is cost effective

Antibiotic Stewardship - Surveillance

Antibiotic Stewardship Program: Critical Element Pathway:

Determine whether the facility has an antibiotic stewardship program that includes:

• Written antibiotic use protocols on antibiotic prescribing, including the documentation of the indication, dosage, and duration of use of antibiotics;

• Protocols to review clinical signs and symptoms and laboratory reports to determine if the antibiotic is indicated or if adjustments to therapy should be made and identify what infection assessment tools or management algorithms are used for one or more infections (e.g., SBAR tool for urinary tract infection (UTI) assessment, Loeb minimum criteria for initiation of antibiotics);

• A process for a periodic review of antibiotic use by prescribing practitioners: for example, review of laboratory and medication orders, progress notes and medication administration records to determine whether or not an infection or communicable disease has been documented and whether an appropriate antibiotic has been prescribed for the recommended length of time

• Protocols to optimize the treatment of infections by ensuring that residents who require antibiotics are prescribed the appropriate antibiotic;

• A system for the provision of feedback reports on antibiotic use, antibiotic resistance patterns based on laboratory data, and prescribing practices for the prescribing practitioner.

Antibiotic Stewardship – Survey Expectations

Start Preparing for survey now:

Gather policies and procedures – review and revise

Collet data, analyze data, develop interventions when goals not met

Audit your compliance – utilize the Critical Element Pathway for Antibiotic Stewardship

Utilize free learning resources:

• Surveyor Training Materials @ https://surveyortraining.cms.hhs.gov/index.aspx. I am a provider > Course Catalog > LTC Survey Process SME videos

• CMS website and National Calls (MLN)

Antibiotic Stewardship - Compliance

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Agency for Healthcare Research and Quality (AHRQ): Guide and Toolkit for Antimicrobial Stewardship

American Medical Directors (AMDA): Common Infections in the Long-Term Care Setting (2011)

Association for Professionals in Infection Control and Epidemiology (APIC): Elements of an Antimicrobial Stewardship

Interact 4.0 for Long-Term Care: Care Paths and Change in Condition file cards

Additional Antibiotic Stewardship Resources:






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Phase 3 effective 11/28/2019

The facility must designate one or more individual(s) as the infection preventionist(s) who are responsible for the facilities IPCP:

• Have primary professional training in nursing, medical technology, microbiology or related field

• Be qualified by education, training, experience or certification

• Work at least part-time at the facility

• Have completed specialized training in infection prevention and control

• Participate on the quality assessment and assurance committee

F882 Infection Preventionist

Specialized Training in Infection Prevention and Control

• CMS has not stated which specific program/certification is needed

Resources for Specialized Training include:

• CDC Training for LTC IP’s (FREE)https://www.cdc.gov/longtermcare/training.html

• APIC: Certification in Infection Prevention and Control (CIC)https://apic.org/education-and-events/certification/

• Local and national provider organizations such a Leading Age and Health Care Associations have or are offering IPC training and Education

F882 Infection Preventionist

F883 Phase One effective 11/28/2017

The facility must develop policies and procedures to ensure that:

• Resident/POA receives education on benefits and side effects

• Resident/POA has the opportunity to refuse the immunization

• Medical Record documentation indicates at a minimum:

F883 Influenza and Pneumococcal Immunizations

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Medical Record Documentation indicates at a minimum:

• Resident or resident representative was provided education regarding benefits and potential side effects of the influenza immunization (VIS)

AND

• That the resident either received the influenza immunization or did not due to medical contraindications or refusal


An effective immunization program includes collaborating with the Medical director for policy and procedures and practice that represents the current standards of practice:

• Physician approved policies, standard orders for immunization, physician orders for immunization

• Review of resident record for immunization status and potential medical contraindications

• How the educational resources will be provided to residents or their representative

• Vaccination schedule including recording and monitoring


When is the influenza vaccine given?

“When it becomes available each season” rather than a specific date (CDC via SOM at F883)

When is the influenza vaccine stopped for the season?

“When your supply expires”“When you supply exhausts and there is no more vaccine available”

(CDC via SOM at F883)


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Recommended Immunization Schedule for Adults Aged 19 Years or Older: Per CDC

F883 Influenza and Pneumoccocal Immunizations

Pneumococcal conjugate(PCV13)

1 1 dose

Pneumococcal polysaccharide(PPSV23) 1 or 2 doses depending on indication 1 dose

Per the SOM at F883:

Facilities MUST follow the CDC and ACIP recommendations for vaccines

• Influenza

• PPSV23

• PCV14_______________________________________________________________• ?Tetanus, diphtheria and pertussis?

• ?Zosters?

F883 Influenza and Pneumococcal

Influenza and Pneumococcal Immunizations:

Select five residents in the sample to review for the provision of influenza/pneumococcal immunizations.

Document the names of residents selected for review.

Give precedence in selection to those residents whom the survey team has selected as sampled residents.

Review the records of the five residents sampled for documentation of:

Screening and eligibility to receive the vaccine; The provision of education related to the influenza or pneumococcal immunizations (such as the benefits and potential side effects); The administration of pneumococcal and influenza vaccine, in accordance with national recommendations. Facilities must follow the CDC

and ACIP recommendations for vaccines; and Allowing a resident or representative to refuse either the influenza and/or pneumococcal vaccine. If not provided, documentation as to why

the vaccine was not provided. For surveys occurring during influenza season, unavailability of the influenza vaccine can be a valid reason why a facility has not implemented the influenza vaccine program, especially during the early weeks of the influenza season. Ask the facility to demonstrate that:

The vaccine has been ordered and the facility received a confirmation of the order indicating that the vaccine has been shipped or that the product is not available but will be shipped when the supply is available; and

Plans are developed on how and when the vaccines are to be administered.

F883 Critical Element Pathway – Compliance Audit

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This tag has been effective since 11/28/17.

Effective 11/28/19 The facility must maintain a QA&A committee consisting of a minimum: The infection preventionist

What are you reporting at your quarterly QA&A Meetings?• # of infections for UTI/Respiratory/Skin/GI – trends/benchmarks• Outbreaks and outcome summary• Antibiotic Stewardship – What are the outcomes of your surveillance• Audit reports and POC for opportunities identified• Education provided in the quarter• Facility IPC Assessment and Annual Review

483.76 – F868 Quality Assessment and Assurance (QA&A)






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Phase 3 effective 11/28/2019:

Infection Control: A facility must include as part of its infection prevention and control program mandatory training that includes the written standards, policies and procedures for the program as described at 483.80(a)(2)…F880

483.95 – F945 Infection Control Training Requirements

Develops and implements written P&P’s that at a minimum:

• Explain standard precautions and when transmission-based precaution should be utilized, including type and duration, least restrictive for the resident

• Prohibit staff with a communicable disease or infected skin lesion from direct contact with residents or their food if direct contact will transmit the disease

• Require staff to follow hand hygiene practices consistent with accepted standard of practice

F880 – What is the intent of this regulation:

F940: Effective Training based on facility assessmentF941: CommunicationF942: Resident RightsF943: Abuse, neglect and exploitation…plus more!

State of Il: Title 77, Chapter 1, Part 300, Section 300.660: Nursing Assistants demonstrate competency in principles, techniques and procedures covered by Nursing Assistant Training Program

Utilize your facilities Infection Prevention and Control Annual Assessment AND your facilities Annual Assessment to direct education and training

F945 Infection Control Training Requirements Phase 3

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OSHA Recommendations include:• Blood Bourne Pathogen• Needlestick Injuries• Hand Hygiene• TB• Transmission Based Precautions• Chain of Infection• Hepatitis• PPE• Chemical and Blood Spills

F945 Infection Control Training Requirements






Summary:

Infection Control and Prevention is a core element of resident care and safety, quality measures, and quality outcomes.

Infection Control and Prevention is a focused area for compliance and quality measures

Compliance is possible and achievable with the support of facilities leadership, partnering with experts, education and training and the numerous resources and tools to help you and your facility in their success

483.80 Infection Control

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F-tags: State Operations Manual, Appendix PP – Guidance to Surveyors for Long-Term Care Facilities, Rev. 11/22/17. Download at: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/som107ap_p_ltcf.pdf

Spaulding Classification System:https://www.cdc.gov/infectioncontrol/guidelines/disinfection/rational-approach.html

https://www.cdc.gov/infectioncontrol/guidelines/disinfection/index.html

Infection Prevention and Control Resources:

Point of Care Testing:http://www.ascquality.org/Library/pointofcaredevicestoolkit/Point%20of%20Care%20Devices%20-%20What%20CMS%20Surveyors%20Are%20Looking%20For.pdf

https://www.aacc.org/publications/cln/articles/2013/january/psf-poct-infections

Infection Prevention and Control Resources

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Safe Injection Administration:https://www.cdc.gov/injectionsafety/index.html

https://www.cdc.gov/injectionsafety/providers/provider_faqs_med-admin.html

https://www.cdc.gov/injectionsafety/providers.html

https://www.oneandonlycampaign.org/


Loeb Criteria:

CDC: https://www.cdc.gov/nhsn/pdfs/ltc/ltcf-uti-protocol-current.pdf

http://trainingserver3.org/SNIP/mod3/lesson8/story_content/external_files/LoebMinimumCriteria.pdf

https://www.health.state.mn.us/diseases/antibioticresistance/hcp/asp/ltc/loebmcgeer.pdf

https://asap.nebraskamed.com/wp-content/uploads/...


McGeer Criteria:

https://asap.nebraskamed.com/wp-content/uploads/sites/3/2018/04/Revised-McGeer-criteria-for-infection-surveillance-checklist.pdf

https://phpa.health.maryland.gov/Documents/McGeer%20Criteria%20-%20Respiratory.pdf

CDC: https://www.cdc.gov/nhsn/pdfs/ltc/ltcf-uti-protocol-current.pdf


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CDC. The Core Elements of Antibiotic Stewardship for Nursing Homes. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. Available at: http://www.cdc.gov/longtermcare/index.html

RAI Manual V.1.16. October 2018. https://downloads.cms.gov/files/1-MDS-30-RAI-Manual-v1-16-October-1-2018.pdf

Training Website: https://surveyortraining.cms.hhs.gov/index.aspx• I am a Provider - Course Catalog – LTC Survey Process SME

Videos

Infection Prevention and Control Resources:

Questions?

Karen Sautbine RN, MSN, NHA, RAC-CTSenior Consultant, Health Care414-529-6750 [email protected]

Today’s Presenters

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