The Joint Commission Update for Infection Control

Joint Commission, CDC to study rapid flu test use

Study targets outpatient settings, EDs, doc offices

The Joint Commission recently announced that its Division of Quality Research and Measurement will study how rapid tests for influenza are implemented in outpatient medical settings including solo and group practice physician offices, community health centers, and acute care hospital emergency departments throughout the United States.

The study is funded by a cooperative agreement from the Centers for Disease Control and Prevention (CDC), with Nancy Kupka, DNSc, MPH, RN, designated as the principal investigator. Influenza kills approximately 36,000 people in the United States each year. Rapid diagnostic tests have been developed to test for influenza outside of the clinical laboratory. However, the current extent and quality of testing for influenza outside the clinical laboratory is unknown, especially in places such as physicians' offices, emergency departments, and community health centers. "Surveillance is the most important tool for identifying new or reemerging infectious diseases or pandemics and establishes the scientific foundation for a public health response," says Jerod M. Loeb, PhD, executive vice president, Division of Quality Research and Measurement.

The project will examine outpatient settings that have adopted the use of rapid tests for influenza, including the types of rapid tests in use and how they are selected; the training and competency of individuals performing testing; the extent to which good laboratory practices and testing guidelines are being followed; the impact of use of the rapid tests on antiviral and antibiotic prescribing practices; and the perceived advantages and disadvantages of using rapid influenza testing. The first phase of the three-year project began in October 2007 plans to survey 5,000 outpatient medical settings to determine how rapid tests for influenza are being implemented. Later in the study, 300 survey participants will be interviewed to identify the factors that influence the adoption of rapid testing for influenza, barriers to implementation and strategies to overcome the barriers in outpatient settings. This study is completely independent from The Joint Commission accreditation process.

"Many rapid influenza tests are available for widespread use in outpatient settings such as physician's offices, clinics and emergency rooms, but the reliability of results from these tests is influenced by a number of variables that deserve examination," says Devery Howerton, PhD, chief of laboratory practice evaluation in the CDC's National Center for Preparedness, Detection and Control of Infectious Diseases. "We are also interested in evaluating the extent to which these testing sites are linked to their local public health system," he adds.

The Joint Commission requires accredited organizations to meet both federal Clinical Laboratory Improvement Amendment of 1988 (CLIA) requirements and Joint Commission standards regarding the use of waived tests such as rapid influenza tests. Accreditation surveys conducted by The Joint Commission in hospitals and ambulatory facilities, including physician offices and community health centers, in 2005, 2006, and the first quarter of 2007 found that test controls are not always used as directed by the manufacturer; test kits are improperly stored and sometimes used past their expiration date; individuals conducting the tests are not always trained to use the test or evaluated and deemed to be competent to conduct or interpret the test; staff within organizations are confused about the use of confirmatory tests and whether the waived test is done for screening purposes or for definitive diagnosis; and there were insufficient policies and procedures in place to support conducting the tests.

The Joint Commission will convene a technical advisory panel to assist with the study, composed of public health officials and representatives from the following professional associations: The American Public Health Association, American Medical Association, National Association of Community Health Centers, American College of Physicians, American College of Emergency Physicians, American Academy of Pediatrics, American Academy of Family Physicians and the Association of Public Health Laboratories.