New NPSG addresses central line infection risks

Requirements on anticoagulation therapy cut

The importance of reducing deadly drug- resistant, health care-acquired infections is the basis for the requirement in The Joint Commission's (TJC's) 2009 National Patient Safety Goals (NPSGs) to reduce the risk of infection associated with central lines.

"The issue of health care-acquired infections continues to get bigger," says Peter B. Angood, MD, vice president and chief safety officer for TJC. There are many different types of infections that require different approaches by each entity, he adds.

The element that requires hospices and home health agencies to "implement best practices or evidence-based guidelines to prevent central line-associated bloodstream infections" has a one-year phase-in period, but there are specific deadlines to meet within the year, Angood points out. Appropriate guidelines include guidelines from the Centers for Disease Control and Prevention or other professional organizations.

"This will be a complicated process for many entities, which is the reason we designed a phase-in period," admits Angood. "Although most home health personnel don't insert central lines, they are often responsible for maintaining them." Staff members should receive proper education on prevention of possible infections and should be able to educate patients and their families, he says.

Hospice managers received good news with the release of the 2009 goals, because several requirements for compliance with the goal to reduce harm from anticoagulation therapy were removed from home care's manual, says Angood. Elements 3 through 7 of the requirement were too specific and did not apply to home care, he explains. "Removing these elements for home care did make life easier for home health managers," he admits.

The anticoagulation safety goal was published last year with a one-year implementation period and specific checkpoints throughout the year. Hospice and other home health agencies already should have their implementation plan to meet this goal in place and should have conducted a pilot test of the plan by Oct. 1, says Angood. The plan to reduce the risk of anticoagulation therapy in the hospice agency should be fully implemented by Jan. 1, 2009.

Overall, home health agencies are complying with the National Patient Safety Goals well, says Angood. "Medication reconciliation is still difficult for home health, but there are many tools, including electronic health records, that can help," he suggests. "Because the elements of the goal related to medication reconciliation were revised this year, home health managers should review them to make sure their programs still meet requirements."

Two other requirements were added to the goal to reduce health care-associated infections, but the multidrug-resistant organism and surgical site infection requirements do not apply to hospice and other home health services.


  • To see a copy of the 2009 National Patient Safety Goals for home care, go to Select "Patient safety" from top navigational bar, then select "National patient safety goals." Scroll down to "home care."
  • For a copy of the Centers for Disease Control and Prevention's "Guidelines for the Prevention of Intravascular Catheter-Related Infections," go to