Infection Control Requirements and survey activity
North Division Condition Level CitationsCondition Citation 59 Conditions 57 Conditions 45 Conditions 2009 2010 2011 – YTD AugV110 Infection Control 7 15 4V175 Water/Dialysate 7 3 3V 400 Physical Environment 4 1 5V450 Patient Rights 0 0 1V500 Patient Assessment 10 11 10V540 Patient Plan of Care 10 12 11V580 Care at Home 2 2 0V625 QAPI 2 4 3V675 Laboratory Services 1 0 0V680 Personnel Qualification 1 1 1V710 Responsibilities of 8 6 3 Medical DirectorV725 Medical Record 1 0 0V750 Governance 5 2 4V 760 Grievance 1 0 0
North Division - Standard Level Citations HD Standard Level Citations 2009 - 988 2010 - 1281 2011- Aug YTD - 933V100 Compliance /Fed, State, Local Laws 4 9 2V110 Infection Control 247 370 200V175 Water and Dialysate 105 134 76V400 Physical Environment 146 158 108V450 Patient Rights 37 33 30V500 Patient Assessment 142 186 162V540 Patient Plan of Care 151 187 162V580 Patient Care at Home 22 16 5V625 QAPI 22 42 56V675 Laboratory Services 3 0 1V680 Personnel Qualifications 15 22 27V710 Responsibilities of Medical Director 44 54 58V725 Medical Records 23 48 25V750 Governance 27 22 21
ObjectivesReview the Conditions for Coverage Infection Control requirementsReview related survey citationsUnderstand 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 RI1 V113 V 113 V 520 V541 117 515 V751 1122 V 122 V 541 V 113 V113 114 143 1223 V 403 V 520 V 101 V111 184 1224 V 715 V 501 V 541 V114 122 1135 V 541 V 122 V 684 V544 113 7146 V 543 V 114 V 501 V143 115 6277 V 767 V 101 V 504 V542 755 4048 V 401 V 117 V 323 V501 110 3209 V 402 V 115 V 715 V634 250 31810 V 116 V 542 V 726 V191 143
Conditions for Coverage494.30 V111-V148The dialysis facility must provide andmonitor a sanitary environment tominimize the transmission ofinfectious agents within and betweenthe unit and any adjacent hospital orother 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 patients Routine serologic testing for hepatitis B virus infections Vaccination of susceptible patients against hepatitis B Isolation 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 designedto 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.
References• 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.