JCAHO establishes new infection control standard
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has approved an infection control standard that requires accredited organizations to offer influenza vaccinations to staff, which includes volunteers, and licensed independent practitioners with close patient contact. The standard will be effective Jan. 1, 2007, for the critical access hospital and hospital programs.
The Joint Commission developed the standard in response to recommendations by the Centers for Disease Control and Prevention (CDC) making the reduction of influenza transmission from health care professionals to patients a top priority in the United States. While the CDC has urged annual influenza vaccination for health care workers since 1981, a Morbidity and Mortality Weekly Report1 published by the CDC earlier this year calls for stronger steps to increase influenza vaccination of health care workers. Despite the recommendations, health care-associated transmission of influenza has been documented among many patient populations in a variety of clinical settings, and infections have been linked epidemiologically to unvaccinated health care workers. Typically, fewer than 40% of health care workers are immunized each year, according to the CDC.
The new Joint Commission standard requires organizations to:
- establish an annual influenza vaccination program that includes at least staff and licensed independent practitioners;
- provide access to influenza vaccinations on-site;
- educate staff and licensed independent practitioners about: flu vaccination; nonvaccine control measures (such as the use of appropriate precautions); and diagnosis, transmission, and potential impact of influenza;
- annually evaluate vaccination rates and reasons for nonparticipation in the organization's immunization program;
- implement enhancements to the program to increase participation. (The entire standard is published on pages 10 and 11 of the June 2006 edition of the Joint Commission's publication "Perspectives," which is distributed to administrators at all accredited facilities.)
EDs feel impact
The standard is directed at health care organizations in general. However, "while the ED is not directly targeted, obviously a lot of patients with influenza present at the ED, so hopefully this will be an important patient safety and employee safety initiative," says Louise Kuhny, RN, MPH, CIC, associate director of standards interpretation for the Joint Commission.
Of the five elements of performance outlined above, perhaps the greatest challenge for EDs is providing access to vaccinations. "The ED is located far away from other departments, and if vaccinations are not convenient, people will not get them," notes Kuhny, who says the literature indicates that simply increasing the distance to the vaccination point decreases the rate of participation. "One of the recommendations from the CDC is to use proven strategies like mobile carts," she says. "They also recommend providing access during all shifts."
Education is very important, adds Kuhny, because "there are still a lot of myths out there about vaccination." One of the biggest, she says, is that "people — even health care workers — think they can get the flu from the vaccine, and that's not possible." Another myth that Kuhny says even some health care workers believe is that women who are pregnant should not get the flu shot. "In fact, the opposite is true: It's recommended during pregnancy," she responds.
Buy-in by leaders can strengthen the education process, Kuhny continues. "Some facilities even post pictures of leaders who get the vaccine," she shares.
Finally, she says, the elements dealing with annual evaluation and enhancing your program offer the opportunity for a "built-in" performance improvement project. "Every year you can look at why you've not been able to achieve your goal, and based on what you find, you can develop the needed enhancements," she concludes.
Reference
- Centers for Disease Control and Prevention. Influenza vaccination of health-care personnel: Recommendation of the Healthcare Infection Control Practices Advisory Committee (HICPAC) and the Advisory Committee on Immunization Practices (ACIP). MMWR 2006; 55:1.
Source
For more information on the influenza vaccination standard, contact:
- Louise Kuhny, RN, MPH, CIC, Associate Director, Standards Interpretation, Joint Commission on the Accreditation of Healthcare Organizations, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Phone: (630) 792-5900.
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