The Centers for Medicare & Medicaid Services (CMS) revised its “COVID-19 Focused Infection Control Survey Tool: Acute and Continuing Care” recently.

“CMS is making revisions to the non-long-term care (NLTC) focused infection control survey tool for acute and continuing care providers to reflect COVID-19 guidance updates, provide clarifications to existing information, and update the appropriate CMS regulatory tag considerations if a citation is warranted,” the agency states.1

Effective Dec. 30, 2020, some of the revisions and additional questions for CMS inspectors include the following:

  • Does the facility have a screening process for those entering the facility (patients and visitors) to mitigate the risk of COVID-19 exposure (for example, exposure to COVID-19 screening questions and assessment of symptoms/illness)?
  • Are visitors, if permitted on the premises based on state or federal guidance (e.g., reopening recommendations), instructed to frequently perform hand hygiene; limit their interactions with others in the facility; and restrict their visit to the room of the patient they are visiting or other location designated by the facility?
  • Appropriate hand hygiene practices (e.g., alcohol-based hand rub [ABHR] or soap and water) are followed. Unless hands are visibly soiled, an alcohol-based hand rub is preferred over soap and water in most clinical situations.
  • Appropriate mouth, nose, and eye protection (e.g., face masks or respirator with goggles or face shield) along with isolation gowns are worn for patient care activities or procedures that are likely to contaminate mucous membranes, or generate splashes or sprays of blood, body fluids, secretions, or excretions.
  • Unless additional source control is needed, face masks are worn by all staff while they are in the healthcare facility.

Dialysis Facilities

  • Hands should be washed with soap and water if visibly soiled. If not visibly soiled, hand hygiene with ABHR may be used. Handwashing sinks should be dedicated only for handwashing purposes and should remain clean.
  • The facility’s usual practice for cleaning and disinfection of external surfaces and the internal circuits of hemodialysis machines, including those used for COVID-19 patients, continue to be appropriate. Facilities should ensure cleaning and disinfection procedures are consistent with the manufacturer’s instructions for use and any cleaning agents used for surface disinfection is active against SARS-CoV-2. Healthcare settings should refer to List N2 for Environmental Protection Agency-registered disinfectants qualified for use against COVID-19.2
  • Any surfaces, supplies, or equipment (such as dialysis machines) located within six feet of symptomatic patients should be cleaned and disinfected or discarded, as appropriate.
  • Items taken into the dialysis station should either be disposed of, dedicated for use only on a single patient, or cleaned and disinfected before being taken to a common clean area or used on another patient. Waiting areas should be organized to separate patients with symptoms from patients without symptoms.
  • Patients with confirmed or suspected SARS-CoV-2 infection should maintain at least six feet of separation from other patients at all times in the dialysis facility, e.g., waiting area, treatment area.
  • Patients with confirmed or suspected COVID-19 should be dialyzed in a separate room or area. If a separate room or area is not available, patients with confirmed or suspected COVID-19 may be dialyzed in the general treatment area; however, they should be separated by at least six feet from the nearest patient (in all directions).
  • A negative COVID-19 test result is not a requirement for discontinuing isolation precautions. Surveyors should verify that facilities are adhering to the Centers for Disease Control and Prevention’s most recent guidance for discontinuing transmission-based precautions.

REFERENCES

  1. Centers for Medicare & Medicaid Services. Revised COVID-19 focused infection control survey tool for acute and continuing care. Dec. 30, 2020. https://www.cms.gov/files/document/qso-21-08-nltc.pdf
  2. Environmental Protection Agency. List N: Disinfectants for coronavirus (COVID-19). https://www.epa.gov/pesticide-registration/list-n-disinfectants-coronavirus-covid-19