Panel recommendations for infection control

The 23 recommendations from the consensus panel report1 on the infrastructure and essential elements of an infection control program are summarized as follows:

Managing critical data and information

1. Surveillance of nosocomial infections must be performed. (Category I)

The surveillance process should incorporate at least the following elements:

· identification and description of the problem or event to be studied;

· definition of the population at risk;

· selection of the appropriate methods of measurement, including statistical tools and risk stratifications;

· identification and description of data sources and data collection personnel and methods;

· definition of numerators and denominators;

· preparation and distribution of reports to appropriate groups;

· selection of specific events to be monitored should be guided by validated, nationally available benchmarks appropriately adjusted for patient risks, so that meaningful comparisons can be made.

2. Surveillance data must be analyzed appropriately and used to monitor and improve infection control and health care outcomes. (Category I)

3. Clinical performance and assessment indicators used to support external comparative measurements should meet the criteria delineated by SHEA and APIC. (Category II)

Specifically, these indicators and their analyses must address the following parameters:

· relation to outcome or process;

· ability to measure variation in quality;

· definition of numerators and denominators;

· reliability, completeness, and feasibility of data collection;

· appropriate risk adjustment;

· comparability of populations; severity and case-mix adjustments for external comparison;

· training required for indicator implementation;

· applicable benchmarks of standards of care.

Setting and recommending policies and procedures

4. Written infection prevention and control policies and procedures must be established, implemented, maintained, and updated periodically. (Both Categories II and III)

· The policies and procedures should be scientifically valid.

· The policies and procedures should be reviewed for practicality and cost.

· The policies and procedures should lead to improved prevention or improved patient outcomes.

5. Policies and procedures should be monitored periodically for performance. (Both Categories II and III)

Compliance with regulations, guidelines

6. Health care facilities should use infection control personnel to assist in maintaining compliance with relevant regulatory and accreditation requirements. (Category II)

7. Infection control personnel should have appropriate access to medical or other relevant records and to staff members who can provide information on the adequacy of the institution's compliance with regard to regulations, standards, and guidelines. (Category II)

8. The infection control program should collaborate with, and provide liaison to, appropriate local and state health departments for reporting of communicable diseases and related conditions and to assist with control of infectious diseases. (Both Categories II and III)

Employee health

9. The infection control program personnel should work collaboratively with the facility's employee health program personnel. (Category II)

· The infection control program should review and approve all policies and procedures developed in the employee health program that relate to the transmission of infections in the hospital.

· Infection control personnel should be available to the employee health program for consultation regarding infectious disease concerns.

10. At the time of employment, all facility personnel should be evaluated by the employee health program for conditions relating to communicable diseases. (Both Categories II and III)

The evaluation should include the following:

· medical history, including immunization status and assessment for conditions that may predispose personnel to acquiring or transmitting communicable diseases;

· tuberculosis skin testing;

· serologic screening for vaccine-preventable diseases if indicated;

· such medical examinations as are indicated by the above.

11. Appropriate employees or other health care workers should have periodic medical evaluations to assess for new conditions related to infectious diseases that may have an impact on patient care, the employee, or other health care workers, which should include review of immunization and tuberculosis skin-test status, if appropriate. (Both Categories II and III)

· All facilities should maintain confidential medical records on all health care workers.

· The employee health program should have the capability to track employee immunization and tuberculosis skin-test status.

12. Employees must be offered appropriate immunizations for communicable diseases. (Both Categories I and III)

· Immunizations should be based on regulatory requirements and CDC recommendations for health care workers.

13. The employee health program should develop policies and procedures for the evaluation of ill employees, including assessment of disease communicability, indications for work restrictions, and management of employees who have been exposed to infectious diseases, including postexposure prophylaxis and work restrictions. (Category I)

Intervening to prevent transmission

14. All health care facilities must have the capacity to identify the occurrence of outbreaks or clusters of infectious disease. (Category I)

· Infection control personnel should review microbiology records regularly to identify unusual clusters or a greater-than-usual incidence of certain species or strains of microorganisms.

· In patient areas of the health care facility in which active prospective surveillance is not conducted, infection control programs should maintain regular contact with clinical, medical, and nursing staff in order to ascertain the occurrence of disease clusters or outbreaks, to assist in maintenance and monitoring of infection control procedures, and to provide consultation as required.

15. All health care facilities must have access to the services of personnel trained and experienced in conducting outbreak investigations. (Category II)

16. When an outbreak occurs, the infection control team must have adequate resources and authority to ensure a comprehensive and timely investigation and the implementation of appropriate control measures. (Category II)

Education and training of health care workers

17. Health care facilities must provide ongoing educational programs in infection prevention and control to health care workers. (Both Categories II and III)

· Infection control personnel with a knowledge of epidemiology and infectious diseases should be active participants in the planning and implementation of the educational programs.

18. Educational programs should be evaluated periodically for effectiveness, and attendance should be monitored. (Both Categories II and III)

· Educational programs should meet the needs of the group or department for which they are given and must provide learning experiences for people with a wide range of educational backgrounds and work responsibilities.

Personnel resources

19. The personnel and supporting resources, including secretarial services, available to the hospital epidemiology and infection control program should be proportional to the size, complexity, and estimated risk of the population served by the institution. (Category II)

20. All hospitals should have the continuing services of a trained hospital epidemiologist(s) and ICP(s). (Category I)

21. ICPs should be encouraged to obtain Certification in Infection Control. (Category II)

Nonpersonnel resources

22. Health care facilities should provide or make available in a timely fashion sufficient office space and equipment, statistical and computer support, and clinical microbiology and pathology laboratory services to support the nosocomial infection surveillance, prevention, and control program of the institution. (Category II)

23. Resources should be provided for continuing professional education of hospital epidemiologists and ICPs. (Category II)

Reference

1. Scheckler WE, Brimhall D, Buck AS, et al. Requirements for infrastructure and essential activities of infection control and epidemiology in hospitals: A consensus panel report. Infect Control Hosp Epidemiol 1998; 19:114-126.