CDC drafts performance measures for IC programs

Big three: Administration, process, outcomes

In revising patient isolation guidelines, the Centers for Disease Control and Prevention (CDC) and its advisors have drafted infection control performance measures for health care facilities. While there is some discussion indicating that the measures may be picked up by patient safety groups as quality indicators, the following list from the second draft of the document is expected to undergo further revision and reduction.1 As currently proposed, the performance measures under discussion include these categories:

A. Administrative Measures

1. Organizational structure that provides for a designated person(s) or group/committee to manage the development, selection, implementation, and monitoring of patient care procedures to prevent transmission of infectious agents.

2. Process that requires an annual review of effectiveness of procedures to prevent transmission of infectious agents including review by an executive committee, senior management, or administration.

B. Process Measures

1. Provision of education and training via orientation and/or annual inservice education to 95% of employed patient care staff.

2. Provision of education and training via orientation and/or annual inservice education to 95% of contracted patient care staff.

3. Standardized observational studies comparing required activities for adherence to standard precautions vs. observed activities. Apply to selected high-risk areas at least annually.

4. Concurrent record review to determine the identification and documentation of the need for enhanced precautions and documentation of the implementation of enhanced precautions in appropriate patients/residents.

5. Retrospective record review, using ICD-9 codes, to determine the identification and documentation of the need for enhanced precautions, and documentation of the implementation of enhanced precautions in appropriate patients/residents.

6. Assessment of availability of waterless hand hygiene products and monitoring amounts purchased for intensive care units.

C. Outcome Measures

1. Use of Occupational Safety and Health Administration (OSHA) 200 logs to identify occupational exposures to airborne infections including tuberculosis. Exposure investigation should determine if lack of diagnosis, lack of implementation of appropriate precautions or lack of compliance contributed to the exposure.

2. Use of OSHA 200 logs to identify occupational exposures to infections spread via the droplet route. Exposure investigation should determine if lack of diagnosis, lack of implementation of appropriate precautions, or lack of compliance contributed to the exposure.

3. Use of health care-associated infection data to identify potential patient-to-patient transmission of infectious agents and multidrug-resistant organisms.

Reference

1. Strausbaugh L, Jackson M, Rhinehart, et al and the Centers for Disease Control and Prevention Healthcare Infection Control Practices Advisory Committee. Guideline to Prevent Transmission of Infectious Agents in Healthcare Settings 2002. Draft # 2. Feb. 15, 2002.