A proposed rule on antibiotic stewardship by the CMS would broaden the scope of infection control beyond the hospital.1
“Given the number of facilities through which a patient might travel, [the CMS] proposes to increase the involvement of hospital infection prevention and control programs [to] facilitate communication across settings,” the agency states in the proposed rule.1
With this requirement, the CMS is addressing a longstanding issue across the healthcare continuum. There have been frequent communication breakdowns between hospitals, nursing homes, and other facilities as patients with multidrug resistant pathogens or some other infectious condition move to various points of care. Thus better “communication across settings” is needed to avoid situations like failure to isolate an infected patient, potentially triggering an outbreak in the receiving facility.
The CMS goes further in this provision in calling for IPs to “address infection control issues identified by public health authorities,” which typically would be related to an investigation of an outbreak in the community.
In a more nebulous application of this concept, the CMS proposes language at 482.42(a)(2) that would “adjust the scope of the hospitals’ prevention and control programs from its current focus on the transmission of infections between patients and personnel.” The CMS calls for IPs to focus on infections in a broader sense, including visitors, the hospital environment and again transitions of care between facilities.
In other proposed revision, the CMS is dropping the antiquated term “infection control officer” in favor of infection preventionists or the previous name of choice, “infection control professional.” In a nod to professionalism that APIC has long been pushing for, the CMS called for hospitals to “ensure that the individuals so designated are qualified through education, training, experience, or certification - such as that offered by the Certification Board of Infection Control and Epidemiology Inc. (CBIC).” The CMS also said IPs continue training and ongoing education.
In another move that elevates the profession, the CMS proposed rule calls for consulting with physician and nursing leadership in hiring an IP.
“The proposed requirement would be a subtle, but important, departure from the current requirement 482.42(a), which simply requires that an officer or officers be designated to implement and develop the program,” the CMS said in the rule.
The idea is in part to get clinical leadership involved in infection control and more invested in promoting a culture of safety.
In terms of basic duties, the IPs would be responsible for “all documentation, written or electronic, of the prevention and control program, and its surveillance, prevention, and control activities,” the CMS states. Similarly, IPs are responsible for training staff on infection control measures and policies.
“[CMS] believes that this proposed revision is more specific and more in keeping with current standards of practice in hospitals than the current provision …that requires a hospital to ensure that its training programs address problems identified by the infection control officer,” the agency explained in the rule.
- CMS. Medicare and Medicaid Programs; Hospital and Critical Access Hospital (CAH) Changes To Promote Innovation, Flexibility, and Improvement in Patient Care. Proposed Rule. Fed Reg June 16, 2016: http://1.usa.gov/291FtIc