Update: CMS will issue Proposed Rule on Hospital Antibiotic Stewardship June 16

June 12th, 2016

By Gary Evans, AHC Media Senior Staff Writer

The Centers for Medicare & Medicaid Services will issue new proposed regulations June 16 for infection control in hospitals that would require antibiotic stewardship programs to reign in drug-resistant bacteria and stop the rise of Clostridium difficile infections, Hospital Infection Control & Prevention has learned.

A first take on the changes is that infection preventionists would have flexibility to adopt the nationally recognized guidelines and drug stewardship efforts of their choice. A couple of matters that may get some pushback are the CMS call for hospital-wide surveillance, which may run afoul of IPs who prefer to do targeted surveillance on high risk infections. Also -- in the "what's in a name category?" -- the CMS refers to IPs by their former title Infection Control Professionals. This after promising to stop calling them "officers" in recent long-term care proposed changes.

According to the CMS, revisions “would require a hospital to develop and maintain an antibiotic stewardship program as an effective means to improve hospital antibiotic -prescribing curb patient risk for possibly deadly Clostridium difficile infections, as well as other future, and potentially life-threatening, antibiotic-resistant infections. We would promote better alignment of a hospital’s infection control and antibiotic stewardship efforts with nationally recognized guidelines and heighten the role and accountability of a hospital’s governing body in program implementation and oversight. We believe that these changes, together, would promote a more patient-centered culture of safety focused on infection prevention and control as well as appropriate antibiotic use, while allowing hospitals the flexibility to align their programs with the guidelines best suited to them."

In its present form, the “Infection Control” CMS CoP 482.42 requires hospitals to provide a sanitary environment to avoid sources and transmission of infections and communicable diseases. Hospitals are presently required to have a designated infection control officer, or officers, who are required to develop a system to identify, report, investigate and control infections and communicable diseases of patients and personnel. The hospital’s CEO, medical staff, and director of nursing services are charged with ensuring that the problems identified by the infection control officer or officers are addressed in hospital training programs and their QAPI program. The CEO, medical staff, and director of nursing services are also responsible for the implementation of successful corrective action plans in affected problem areas.

The CMS proposes a change to the title of this CoP to “Infection Prevention and Control and Antibiotic Stewardship Programs.”

"By adding the word “prevention” to the CoP name, the CMS is promoting larger, cultural changes in hospitals so "that prevention initiatives are recognized on balance with their current, traditional control efforts," Adding “antibiotic stewardship” to the title emphasizes the important role that hospitals should play in combatting antimicrobial resistance through implementation of a robust stewardship program that follows nationally recognized guidelines for appropriate antibiotic use, the CMS explained.

"Along with these changes, we propose to change the introductory paragraph to require that a hospital’s infection prevention and control and antibiotic stewardship programs be active and hospital-wide for the surveillance, prevention, and control of HAIs and other infectious diseases, and for the optimization of antibiotic use through stewardship," the proposed rule states. "We would also require that a program demonstrate adherence to nationally recognized infection prevention and control guidelines for reducing the transmission of infections, as well as best practices for improving antibiotic use, for reducing the development and transmission of HAIs and antibiotic-resistant organisms."

The CMS changes are slated to be published as a proposed rule Thursday June 16th in the Federal Register and will be open for a 60-day comment period. For updates watch for more blog reports and look for a definitive analysis of the changes in the August 2016 issue of HIC.