The 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
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.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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