CMS tool for hospitals will go beyond ASC survey

Hand hygiene, needle use likely included

A survey tool to assess infection control in ambulatory surgical centers (ASCs) was created by the Centers for Disease Control and Prevention for use by inspectors for the Centers for Medicare & Medicaid Services. As the two agencies discuss creating a similar tool for hospital inspections, an expansion beyond the ambulatory care model is expected. That survey tool included some basic environmental cleaning, disinfection and sterilization requirements along with soliciting a "yes" or "no" response in the following areas:

I. Hand Hygiene

  1. Soap and water are available in patient care areas
  2. Alcohol-based hand rub is available in patient care areas
  3. Staff perform hand hygiene:
    1. Before and after an invasive procedure (e.g., insertion of IV catheter, intubation/extubation, surgical procedure) even if gloves are worn
    2. After contact with blood, body fluids, or nonintact skin (even if gloves are worn)
    3. After contact with used, contaminated medical equipment or visibly contaminated environmental surfaces (even if gloves are worn)

    Note: To ensure consistency between site visits, hand hygiene should be observed during the "follow-through" of patients from arrival to discharge, with particular attention paid to invasive procedures.
  4. Regarding gloves, staff:
    1. Wear gloves for procedures that might involve contact with blood or body fluids
    2. Wear gloves when handling potentially contaminated patient equipment
    3. Remove soiled gloves before moving to next task
  5. If a surgical scrub is required, the surgical team performs surgical hand scrub

II. Injection Practices (medications, saline, other infusates)

  1. Needles and syringes are used for only one patient
  2. Injections are prepared in a clean area that is free from contamination with blood, body fluids, other visible contamination, or used contaminated equipment
  3. The patient's skin is prepped with an antiseptic before IV placement
  4. List all injectable medication/infusates that are in a vial/container used for more than one patient. This should include the medication name, size of vial (cc/mL) and the typical dose per patient (cc/mL)
  5. Single-dose medications/infusates are used for only one patient and not collected or combined (bags of normal saline are ALWAYS single use)
  6. Multidose medications/infusates are used for only one patient (note: a "No" answer here is not necessarily a breach in infection control. Circle N/A if no multidose medications/infusates are used.)
  7. Medication vials used for more than one patient are always entered with a new needle and new syringe
  8. The rubber septum on a medication/ infusate vial is disinfected with alcohol prior to piercing after initial entry
  9. Medications/infusates that are packaged as prefilled syringes are used for only one patient
  10. Medications/infusates are drawn up at start of each procedure
  11. Fluid infusion and administration sets (e.g., intravenous bags, tubing, and connectors) are:
    1. Used for one patient only
    2. Disposed of after use
  12. Needles and syringes are discarded intact in an appropriate sharps container after use.