Joint Commission Update for Infection Control: Joint Commission takes on decolonization issue
Joint Commission Update for Infection Control
Joint Commission takes on decolonization issue
The Joint Commission takes on the controversial issue of decolonization of patients carrying multidrug-resistant organisms (MDROs) in a new report aimed at health care CEOs. With more hospitals adopting active surveillance cultures to detect MDROs, the question of attempting to decolonize patients has become controversial due to issues of cost and long-term efficacy. There are also concerns that decolonization may increase resistance to mupirocin and other drugs used to eradicate carriage of MDROs.
The Joint Commission's advice to CEOs on the topic is included in a new report: "What Every Health Care Executive Should Know: The Cost of Antibiotic Resistance," a free, online multimedia toolkit developed by Joint Commission Resources (JCR) for hospital executives. Key points from the report include:
The decision to introduce an MDRO decolonization program into the hospital or select units must be considered carefully and with direct input from institutional experts in infection prevention and health care epidemiology.
The CEO can play an integral part in this process by establishing an environment that fosters interactions between individuals from different disciplines and by setting an agenda that seeks to maximize adherence to the core transmission prevention activities - hand hygiene, isolation precautions, and environmental hygiene. When these core transmission prevention activities have been maximized, it may be reasonable to consider whether quality can be improved further through an antibiotic or antiseptic decolonization program.
At that point, the increased costs of such a program can be discussed, and potential unintended consequences can be examined. In this situation, the CEO or his or her designated representative can provide critical leadership by doing the following:
- Insisting that the program go through a risk-assessment process
- Establishing a clearly defined set of procedures
- Implementing a system for monitoring appropriate use of decolonization agents and adverse events (e.g., the emergence of high-level mupirocin resistance)
- Ensuring that the program is meeting its stated objectives to reduce the numbers of infections caused by MDROs
Joint Commission deadline on MDRO goal is Jan. 1
The Joint Commission's 2009 patient safety goal regarding multidrug-resistant organisms (MDROs) includes the following key provisions and deadlines:
Implement evidence-based practices to prevent health care-associated infections due to multidrug-resistant organisms in acute care hospitals. This requirement applies to, but is not limited to, epidemiologically important organisms such as methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (CDI), vancomycin-resistant Enterococci (VRE), and multiple drug-resistant gram-negative bacteria.
This requirement had a one-year, phase-in period that includes defined expectations for planning, development, and testing (milestones at three, six, and nine months in 2009, with the expectation of full implementation by Jan. 1, 2010.) As of Jan. 1, 2010, hospitals should have addressed the following issues to comply with this goal.
Based on the a risk assessment, the hospital educates staff and licensed independent practitioners about health care-associated infections, multidrug-resistant organisms, and prevention strategies at hire and annually thereafter. The education provided should recognize the diverse roles of staff and licensed independent practitioners and be consistent with their roles within the hospital.
The hospital implements a surveillance program for multidrug-resistant organisms based on the risk.
The hospital measures and monitors multidrug-resistant organism prevention processes and outcomes including the following:
- Multidrug-resistant organism infection rates using evidence-based metrics
- Compliance with evidence-based guidelines or best practices
- Evaluation of the education program provided to staff and licensed independent practitioners
The hospital provides multidrug-resistant organism surveillance data to key stakeholders, including leaders, licensed independent practitioners, nursing staff, and other clinicians.
The hospital implements policies and practices aimed at reducing the risk of transmitting multidrug-resistant organisms that meet regulatory requirements and are aligned with evidence-based standards (for example, the Centers for Disease Control and Prevention (CDC) and/or professional organization guidelines).
When indicated by the risk assessment, the hospital implements a laboratory-based alert system that identifies new patients with multidrug-resistant organisms. The alert system may be either manual or electronic or a combination of both of these methods. The alert system may use telephones, faxes, pagers, automated and secure electronic alerts, or a combination of these methods. In addition, if indicated by the risk assessment, the hospital implements an alert system that identifies readmitted or transferred multidrug-resistant, organism-positive patients.
The Joint Commission takes on the controversial issue of decolonization of patients carrying multidrug-resistant organisms (MDROs) in a new report aimed at health care CEOs. With more hospitals adopting active surveillance cultures to detect MDROs, the question of attempting to decolonize patients has become controversial due to issues of cost and long-term efficacy.Subscribe Now for Access
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