The Joint Commission revises NPSGs

Performance elements for SSIs change

While The Joint Commission will have no new National Patient Safety Goals (NPSGs) for 2011, it has revised elements of performance (EPs) within those goals to remove specific requirements related to clinical practice. The changes to the EPs are effective immediately.

Those changes include the EPs for NPSG 07.05.01, implement evidence-based practice for preventing surgical site infection. The EP is applicable to ambulatory care, hospitals, critical access hospitals, and office-based surgery practices.

The NPSG requires accredited organizations to administer antimicrobial agents for prophylaxis for a particular procedure or disease according to methods cited in scientific literature or endorsed by professional organizations (no longer "evidence-based best practices").

The Joint Commission will not accept practices that are not supported by evidence or widespread consensus. "During the on-site survey, surveyors will explore the source of the practices the organization follows," it says.

The following EPs have been removed:

  • Facilities should administer intravenous antimicrobial prophylaxis one hour before incision. (Two hours are allowed for the administration of vancomycin and fluorquinolones).
  • They should discontinue the prophylactic antimicrobial agent within 24 hours after surgery. (Within 48 hours is allowable for cardiothoracic procedures).

The NPSG also says that when hair removal is necessary, use a method that is cited in scientific literature or endorsed by professional organizations ("Clippers or depilatories" has been removed).

The Joint Commission says that a limited number of NPSGs contain requirements for practices that reflect current science and medical knowledge. "In these cases, the element of performance refers to a practice that is cited in scientific literature or endorsed by professional organizations," it says. "This means that the practice used by the organization must be validated by an authoritative source. The authoritative source may be a study published in a peer-reviewed journal that clearly demonstrates the efficacy of that practice or endorsement of the practice by a professional organization(s) and/or a government agency(ies)."