The Joint Commission Update for Infection Control
Implement best practices to prevent CA-BSIs
Checklist on insertion, feedback rates to staff
The Joint Commission new 2009 national patient safety goal to prevent central line-associated bloodstream infections (CA-BSIs; NPSG.07.04.01) calls for use of use of a common-sense — but once controversial — checklist to ensure a standardized protocol is followed for central venous catheter insertion.
The practice has gone from being banned to endorsed, as a federal agency temporarily blocked such efforts as possibly violating human research protocols. The issue has been resolved to the point of garnering the endorsement and encouraged use by all parties, but you might want to run it by your institutional review board to get a waiver of informed consent.
Prevent CA-BSIs
The new Joint Commission patient safety goal is to "implement best practices or evidence-based guidelines to prevent central line-associated bloodstream infections." The requirement covers short- and long-term central venous catheters and peripherally inserted central catheter (PICC) lines. The requirement has a one-year phase-in period that includes defined expectations for planning, development, and testing ("milestones") at three, six, and nine months in 2009, with the expectation of full implementation by Jan. 1, 2010. Here are the key dates and requirements:
- As of April 1, 2009, the hospital's leadership has assigned responsibility for oversight and coordination of the development, testing, and implementation of NPSG.07.04.01.
- 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.07.04.01 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.07.04.01.
- As of Jan. 1, 2010, the elements of performance in NPSG.07.04.01 are fully implemented across the hospital.
That means as of New Year's Day 2010, hospitals must do the following unless they want to draw the ire of Joint Commission surveyors:
- The hospital educates health care workers who are involved in these procedures about health care-associated infections, CA-BSIs, and the importance of prevention. Education occurs upon hire, annually thereafter, and when involvement in these procedures is added to an individual's job responsibilities.
- Prior to insertion of a central venous catheter, the hospital educates patients, and their families as needed, about central line-associated bloodstream infection prevention.
- The hospital implements policies and practices aimed at reducing the risk of central line-associated bloodstream infections that meet regulatory requirements and are aligned with evidence-based standards (for example, the Centers for Disease Control and Prevention and/or professional organization guidelines).
- The hospital conducts periodic risk assessments for SSIs, measures CA-BSI rates, monitors compliance with best practices or evidence-based guidelines, and evaluates the effectiveness of prevention efforts.
- he hospital provides central line-associated bloodstream infections rate data and prevention outcome measures to key stakeholders including leaders, licensed independent practitioners, nursing staff, and other clinicians.
- Use a catheter checklist and a standardized protocol for central venous catheter insertion.
- Perform hand hygiene prior to catheter insertion or manipulation.
- For adult patients, do not insert catheters into the femoral vein unless other sites are unavailable.
- Use a standardized supply cart or kit that is all inclusive for the insertion of central venous catheters.
- Use a standardized protocol for maximum sterile barrier precautions during central venous catheter insertion.
- Use a chlorhexidine-based antiseptic for skin preparation during central venous catheter insertion in patients over 2 months of age, unless contraindicated.
- Use a standardized protocol to disinfect catheter hubs and injection ports before accessing the ports.
- Evaluate all central venous catheters routinely and remove nonessential catheters.
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