JCAHO to add examples to existing health standards

By Geoff Kelafant, MD, MSPH, FACOEM

The Joint Commission on Accreditation of Health care Organizations (JCAHO) has decided not to create separate health standards for hospital employees. (See Hospital Employee Health, June 1999, pp. 70-71.) However, it does plan to add specific employee health examples to existing standards in its 2000 accreditation manuals.

Though not a regulatory agency, the Joint Commission, which tries to mirror standards of various regulatory agencies and professional organizations, has been working closely with the Occupational Safety and Health Administration (OSHA) in an effort to enhance employee health and safety. The Joint Commission devotes a section of its standards to the "environment of care" that exists in health care facilities, which states, "the goal of this function is to provide a safe, functional and effective environment for patients, staff members and other individuals in the hospital."

When the standards were reformulated several years ago, they were intended to be all-inclusive. There is general consensus within the Joint Commission that employee health and safety is important in any health care organization and that existing standards already apply.

Although various health and safety standards have long applied to health care, the health care industry has until recently been spared the same level of scrutiny as other industries. As HIV/AIDS focused attention on health care workers, OSHA’s bloodborne pathogen standard marked a radical change, with the health care industry finally being targeted for hazards associated with significant morbidity and mortality. An OSHA tuberculosis standard is pending, and latex allergy recently has attracted a great deal of regulatory attention.

Many of the challenges currently in the spotlight involve biologic hazards. The Joint Commis sion devotes an entire section of its guidelines to infection control standards. How those standards should be implemented, however, is left up to the individual organization. There are examples in the accreditation manuals, but there is an overall dearth of specific recommendations regarding infrastructure and essential activities for infection control and epidemiology programs.

An article that appeared in a recent issue of Infection Control and Hospital Epidemiology (1998; 19:114-24) and the American Journal of Infection Control (1998; 26:47-60) addresses infection control and epidemiology in detail, with specific cross-referencing to pertinent JCAHO standards. Numerous anecdotal reports indicate that at least some surveyors are familiar with the information discussed in the article. Although the article provides an instructive example of how to comply with some JCAHO standards effectively, it deals only with a subset of employee health issues. The infection control standards do not deal with physical, chemical, or psychological hazards, or any of the multiple challenges that confront hospital employee health professionals on a daily basis.

Despite the lack of a Joint Commission standard written specifically to address employee health, there are numerous standards and parts of standards that directly or indirectly indicate the need for a coordinated, comprehensive, and active employee health program. The table accompanying this article (see table, p. 116) lists key concepts and existing standards that may already apply. As examples are added and surveyors are trained, it is reasonable to expect that questions regarding employee health will surface in many parts of the survey process, especially with regard to the environment of care.

[Editor’s note: Kelafant is medical director of Occu pational Health Services at Sarah Bush Lincoln Health Center in Mattoon, IL. He serves as vice-chairman of the Medical Center Occupational Health Section of the American College of Occupational and Environmental Medicine, edits the Guidelines for Employee Health Services in Health Care Facilities listed above, and serves as a consultant to the JCAHO Committee on Healthcare Safety. He can be contacted at 1000 Health Center Drive, Mattoon, IL 61938. Telephone: (800) 500-2178. E-mail: kelafant@occenvmed.net. More information regarding medical center occupational health can be found at www.occenvmed.net.

The material presented in Kelefant’s article is the opinion of the author and does not necessarily represent the views of either JCAHO or ACOEM.]