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Pending legislation, standards on HAIs
With the STAAR bill, which in part would establish an Office of Antimicrobial Resistance under the auspices of the Department of Health and Human Services, pending in Congress, what other regulations and requirements could be part of the future for hospital-acquired infection prevention?
The National Quality Forum-endorsed 2009 Safe Practices are currently being updated, with final practices to be published the first week of January. According to Charles Denham, co-chairman of the NQF's Safe Practices group, "there will be 34 practices. They're being updated from the 2006 update, and there will be eight new ones, and all of the health care-associated infections will be included. They also will align with the [Centers for Medicare & Medicaid Services] health care-associated infections so I think that's big news."
"Clearly evidence-based," Denham says, the practices have been reviewed by the Infectious Disease Society of America and numerous other organizations and will be further reviewed and refined until they are voted on in December.
The NQF also has been working with a lineup of other health care agencies — among those The Joint Commission, CMS, ARC, The Leapfrog Group, the Institute for Healthcare Improvement, and the Centers for Disease Control and Prevention — to develop what Denham refers to as "the most harmonized, synchronized set of activities and steps taken to reduce infections that has ever been put out. All of these organizations have come to agreement about what works," Denham says.
Though each agency will pursue its own areas, the collaboration's efforts on this front will be revealed this month. And Denham's excitement about it is palpable.
"The recommendations and, in some ways, requirements have been harmonized in a way that has never been done before," he says, "and a synchronized road map has been developed to help hospitals reach the goal of dramatic reductions in infections."
The work to avoid HAIs has just begun in earnest for some hospitals, and how close to "never" they can get remains to be seen. Health care lawyer and blog writer David Harlow recalls a law passed about 20 years ago in reference to nursing homes and certain deficiencies in care. The law, like the CMS never-event policies, had a zero tolerance approach.
After many years of comments from industry, Harlow says, the final regulations adopted a "substantial compliance approach even though the statue required 100% compliance. The regulatory agency eventually realized that that was completely impossible and unrealistic." In that case, he says, the zero tolerance policy was deemed "unadministratable."