JCAHO Update for Infection Control

Joint Commission Infection Control Conference

ICPs have skills to expand job; do they have resources?

Meeting bioterrorism, new infection challenges

Infection control professionals have the expertise to handle a rapidly expanding job definition, but must have the resources and staff to accomplish the new demands on the profession, a leading ICP recently said in Chicago at a conference held by the Joint Commission on Accreditation of Healthcare Organizations.

The Joint Commission held the Nov. 17-18, 2003, meeting to discuss the future of infection control and release its new 2005 standards for the field.

Effective Jan.1, 2005, the new infection control standards describe a facilitywide program that enjoys both administrative support and staff collaboration. 

Whether such a vision truly becomes a reality may well depend on how serious the Joint Com-mission is about the infection control revolution it appears to be trying to start.

Right now, as evidenced by the meeting in Chicago, the bulk of the preaching still is being done to the choir. "People who have the power to allocate resources are not necessarily [ICPs], and we need something that’s validated to take to those people who allocate resources," Barbara M. Soule, RN, MPA, CIC, the 2003 president of the Association for Professionals in Infection Control and Epidemiology, told conference attendees.

"We need to develop a deep culture of infection control and prevention in our organizations. That is the challenge that we have ahead of us. How can we accomplish that so we are prepared for whatever comes?" she asked.

And whatever comes appears to be on its way. Bioterrorism, emerging infections, and patient safety issues are exploding on all fronts, and ICPs find their job responsibilities broadening out across the continuum of care. But their epidemiologic skills put ICPs in an excellent position to meet the challenge, Soule emphasized.

"New knowledge and core skills will continue to evolve," she said. "These new skills do not fundamentally define who we are, but they add to our role, scope and complexity. [But], we need some assistance in terms of resources so we can accomplish all of our goals."

While some attendees questioned whether the Joint Commission put enough emphasis on those needed resources in the 2005 standards, Soule noted the importance of the longstanding partnership between ICPs and the nation’s leading accreditation organization.

"The Joint Commission can be a powerful ally because our missions are right in line," she said. "They really care about the quality and safety for patients and so do we. We need their help to be fairly persuasive with the administrators and other folks. Not just in the hospitals, but out among the federal agencies. So I am hoping that they will take that challenge on."

Knowledge must expand

The current skill base of ICPs, the knowledge of infectious disease detection and prevention has to expand with every new pathogen such as severe acute respiratory syndrome (SARS). ICPs must not only know how to prevent transmission, they must master teaching abilities, use available research, and ensure they know the employee health ramifications, she said.

"As each new pathogen or disease presents itself, we need to understand the epidemiology of the organism," Soule said. "Is it the same challenges in new clothes, or do we need a whole new wardrobe? Obviously, we can’t focus on bioterrorism and emerging pathogens to the exclusion of preventing health care-related infection."

Battle in the balance

The ongoing battle against old enemies still is in the balance. While it is well and good to look to future challenges, Soule pointed to a recently published study that tallied the extraordinary costs of infections resulting in postoperative sepsis.1

"You can see we still have a lot of work do," she said. "If you look at post-op sepsis, excess days are almost 11, excess charges close to $60,000, and attributable mortality close to 22%."

With such issues still ongoing, the field must hold its current focus while expanding to meet the new challenges, she said. "I don’t believe we need a bioterrorism and emerging infections section [in Joint Commission standards]. New knowledge and skills essential for bioterrorism and emerging pathogens expand the scope and complexity of infection control practice."

But again, that begs the question of resources and staffing. Concerning the latter, Soule noted that a recent study confirmed that the old ratio of one ICP per 250 beds is insufficient for today’s demands.2

"[That] study that showed that 0.8 to one ICP per 100 occupied beds — based on current practice today — was more in line with resources needed for effective programs," she told attendees. That same study found that 100% of participants agreed that identifying the occurrence of infectious diseases and assessing patients were critical functions, but 10% said they did not have time to do such tasks.

"The primary factors influencing nonperformance were competing priorities and responsibilities for traditional and nontraditional infection functions," Soule said. Competing issues cited included bioterrorism, workers’ compensation, and latex allergies. In addition, staffing and lab support often was lacking.

The price for undersupporting infection control programs already has been exacted on Toronto, Soule reminded, citing the comments of Canadian clinicians that directly linked some of their considerable problems with SARS to reduced infection control resources.

References

1. Zhan C, Miller MR. Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA 2003; 290:1,868-1,874.

2. O’Boyle C, Jackson M, Henly SJ. Staffing requirements for infection control programs in U.S. health care facilities: Delphi project. Am J Infect Control October 2002; 30(6):321-333.