The Joint Commission Update for Infection Control
SSI goal: Look for infections a month after procedure
A new call for post-discharge surveillance
The Joint Commission new national patient safety goal to prevent surgical-site infections (SSIs; NPSG.07.05.01) includes a requirement to look for SSIs out to 30 days after the procedure — raising the difficult but critical issue of post- discharge surveillance.
As previously reported in The Joint Commission Update for Infection Control, post-discharge surveillance was not originally included in the version of the goals sent out for field review. However, the Joint Commission could scarcely avoid the issue, given that the Centers for Disease Control and Prevention estimates that between 12% and 84% of SSIs are detected after patients are discharged from the hospital.1 However, many hospitals do not do sufficient post- discharge follow-up on patients to record subsequent infections. Such programs can be labor-intensive, so some epidemiologists and surgeons have suggested targeting SSIs that require additional hospitalization or antibiotic prescriptions.
(Editor's note: Look for a full story on this topic — including practical tips for compliance — in upcoming issues.)
Best practices against SSIs
The new Joint Commission patient safety goal is to "implement best practices for preventing surgical-site infections." Like the other new goals, the requirement has a one-year phase-in period that includes defined expectations for planning, development, and testing at three, six, and nine months in 2009, with the expectation of full implementation by Jan. 1, 2010. Key dates and elements of performance include:
- As of April 1, 2009, the hospital's leadership has assigned responsibility for oversight and coordination of the development, testing, and implementation of NPSG.07.05.01.
- As of July 1, 2009, an implementation work plan is in place that identifies adequate resources, assigned accountabilities, and a timeline for full implementation of NPSG.07.05.01 by Jan. 1, 2010.
- As of Oct. 1, 2009, pilot testing in at least one clinical unit is under way, for the requirements in NPSG.07.05.01.
- As of Jan. 1, 2010, the elements of performance in NPSG.07.05.01 are fully implemented across the hospital.
That means as of New Year's Day 2010, hospitals must be doing the following unless if they expect to pass muster with Joint Commission surveyors:
- The hospital educates health care workers involved in surgical procedures about health care-associated infections, SSIs, and the importance of prevention. Education occurs upon hire, annually thereafter, and when involvement in surgical procedures is added to an individual's job responsibilities.
- Prior to all surgical procedures, the hospital educates patients — and their families as needed — who are undergoing a surgical procedure about SSI prevention.
- The hospital implements policies and practices aimed at reducing the risk of SSIs that meet regulatory requirements and are aligned with evidence-based standards (for example, CDC and/or professional organization guidelines).
- The hospital conducts periodic risk assessments for SSIs, selects SSI measures using best practices or evidence-based guidelines, monitors compliance with best practices or evidence-based guidelines, and evaluates the effectiveness of prevention efforts.
- Measurement strategies follow evidence-based guidelines and SSI rates are measured for the first 30 days following procedures that do not involve inserting implantable devices and for the first year following procedures involving implantable devices.
- The hospital provides SSI rate data and prevention outcome measures to key stakeholders including leaders, licensed independent practitioners, nursing staff, and other clinicians.
- Antimicrobial agents for prophylaxis used for a particular procedure or disease are administered according to evidence-based standards and guidelines for best practices.
— Administer intravenous antimicrobial prophylaxis within one hour before incision (two hours are allowed for the administration of vancomycin and fluoroquinolones).
— Discontinue the prophylactic antimicrobial agent within 24 hours after surgery (within 48 hours is allowable for cardiothoracic procedures). (Editor's note: See Joint Commission core measures at: www.jointcommission.org/PerformanceMeasurement.)
- When hair removal is necessary, the hospital uses clippers or depilatories. Shaving is an inappropriate hair removal method.
Reference
- Mangram AJ, Horan TC, Pearson ML, et al. Centers for Disease Control and Prevention, The Hospital Infection Control Practices Advisory Committee Guideline for prevention of surgical-site infection, 1999. Infect Control Hosp Epidemiol 1999; 20:247-278.
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