Meeting JCAHO’s new infection control standard

By Betty T. Dixon, RN, BSN

Home Care Consultant

Savannah, GA

The goal of any home care infection control program is the improvement of patient outcomes by identifying and reducing risks of infection in patients and staff. Some infections may be those the patient acquires as a result of services you provide. Other infections are a result of previous care in other settings, such as a hospital or outpatient diagnostic clinic. To be comprehensive and meet the Joint Commission’s intent as spelled out in its 1997-98 manual, your infection control program should include specific processes and activities that protect the patient and the staff from infection.

Special considerations for the patient at home must be weighed in any infection control program. Considerations include caregivers (e.g., family) who are not usually trained in medical procedures and may not understand basic infection prevention practices. There may also be a lack of adequate facilities to wash hands, store supplies, disinfect reusable items, or dispose of such items as contaminated needles.

In comparing the new 1997-1998 Joint Commission manual with the previous one, it is apparent the infection control chapter has been updated and streamlined. Standards have been combined and moved into the intent statements so that the number of standards in the chapter has decreased. A new introduction was added to help organizations better understand surveillance, prevention, and control of infections.

The level of overall staff knowledge is crucial to achieving compliance. Several agencies are currently employing either full-time or part-time Infection Control Practitioners (ICPs) to spearhead their programs. Unfortunately, the rest of the staff may assume the ICP is the infection control program. All care providers, such as homemaker aides and physical therapists, must know reportable signs and symptoms of infection in patients as well as themselves.

Usual reportable signs and symptoms of infection include:

• temperature greater than 100.6 degrees orally;

• positive culture;

• diagnosis of infection;

• antibiotic therapy.

There are occasions when your patient might be on antibiotic therapy as a prophylactic measure, such as patients who have recently had surgery. In this example, the patient does not fit the definition for having an infection as evidenced by placement on an antibiotic therapy.

Once everyone in the agency has been educated about the need for an infection control program and understands signs and symptoms indicating an infection, the next step is to institute practices to prevent the spread of infection. These steps include using proper bag technique, consistently applying universal precautions, and proper hand washing. All staff should report infections and identify the source of the infection, if possible.

While home care patients are not usually exposed to other patients who would be a source of infection to them, they are exposed to home care providers who may themselves be a source of patient-to-patient contamination. This is where proper hand washing and following your agency’s policies becomes paramount.

"We really hold agencies to their policies," says Bill Hansill, home care nurse surveyor for the Joint Commission on Accreditation of Healthcare Organizations. "If your policy states hands are to be washed every time gloves are removed, then that is what we expect to see. Make sure your policies are not so prescriptive and are realistic. Staff should have an understanding of infection control [and other policies] for a successful survey."

Consistently tracking infections is the key to any infection control program, says Sally Welsh, MSN, RN, CNAA, director of quality management at CareOne in Savannah, GA.

"Our agency has over 40 branches and covers several hundred miles, so it was imperative we develop an infection control surveillance report system to stay on top of what is going on."

CareOne uses two forms in its infection control program. (See surveillance, identification, and reporting form, p. 97, and form in Homecare Quality Management, April 1997, p. 48.)

"Once data is collected, we begin working on curing the infection. At our monthly meetings we search for ways to reduce infection rates," Welsh says.

The Joint Commission does not mandate how often your agency should review infection control practices. Some agencies hold quarterly meetings, and some monthly.

Meetings should include a review of infection control issues and actions taken by the agency to reduce the overall rate of infection. Accurate and complete minutes that include business discussed, trends, and infection rates must be kept.

Meetings may be used as a clearinghouse for reporting and tracking infections, such as HIV and methicillin-resistant Staphylococcus aureus, or for educating staff about the newly released OSHA infection guidelines. The Atlanta-based Centers for Disease Control and Prevention promulgates many hospital infection control guidelines that could also apply to home care.

Surveillance tends to consume more time than any other aspect of the infection control program. Yet it is critical to detect infection problems, document trends, implement control measures, and establish prevention measures to improve outcomes. Performance Improvement (PI) activities are part of any superior infection control program. Therefore, if your agency has separate committees for PI and infection control, a representative from PI should be on the infection control committee and the ICP should be on the PI committee. This representation will facilitate communication between the two groups, which frequently have common quality concerns. Both groups are involved in the problem-solving process — assessing quality issues, planning for improvement, implementing the improvement process, and evaluating resolution of the problem.