The Joint Commission Update for Infection Control

Proposed safety goals call for specific practices

The Joint Commission's proposed 2009 National Patient Safety Goals include the following new emphasis on infection prevention:

  • Requirement 7C:Implement best practices to facilitate the prevention of multiple drug resistant organisms (MDRO) infections in acute care hospitals, focusing on methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile-associated disease (CDAD).
  1. Educate health care workers about MDRO and the necessity for prevention.
  2. Measure MRSA and CDAD infection rates, monitor compliance with best practices, and evaluate the effectiveness of prevention efforts.
  3. Provide MRSA and CDAD infection rate data and prevention outcome measures to key stakeholders including senior hospital leadership, physicians, nursing staff, and other clinicians.
  4. Educate patients and their families about MRSA and CDAD prevention.
  5. Conduct a risk assessment for MRSA incidence, prevalence, acquisition, and transmission.
  6. Implement hand hygiene practices.
  7. Use contact precautions for patients with MRSA to reduce patient-to patient spread of infection.
  8. Effectively clean and disinfect patient care equipment and the patient care environment based on standards identified by the organization.
  9. Implement a MRSA surveillance program to identify and track patients with clinical or active surveillance culture/testing specimen positive results for MRSA.
  10. Implement a laboratory-based alert system that identifies new patients with MRSA.
  11. Implement an alert system that identifies readmitted or transferred MRSA-positive patients.
  • CDAD
  1. Conduct a risk assessment for CDAD incidence, prevalence, acquisition, and transmission.
  2. Implement hand hygiene practices.
  3. Use contact precautions for patients with CDAD to reduce patient-to patient spread of infection.
  4. Effectively clean and disinfect patient care equipment and the patient care environment.
  5. Implement a CDAD surveillance program.
  • Requirement 7D: Implement best practices for prevention of catheter-associated bloodstream infections (CABSI).
  1. Educate health care workers about CABSI and the necessity for prevention.
  2. Measure CABSI rates, monitor compliance with best practices, and evaluate the effectiveness of prevention efforts.
  3. Provide CABSI rate data and prevention outcome measures to key stakeholders including senior leadership licensed independent practitioners, nursing staff, and other clinicians.
  4. Educate patients and their families about CABSI prevention.
  • Before insertion
  1. Reinforce the education of health care personnel about CABSI prevention and the care of central venous lines.
At insertion
  1. Use a catheter checklist and a standardized protocol for central venous catheter insertion.
  2. Perform hand hygiene prior to catheter insertion or manipulation.
  3. Avoid using the femoral vein, if possible, for central venous access in adult patients.
  4. Use a standardized supply cart or kit that is all inclusive for the insertion of central lines.
  5. Use a standardized protocol for maximum sterile barrier precautions during central venous catheter insertion.
  6. Use a chlorhexidine-based antiseptic for skin preparation in patients older than 2 months of age.
  • After insertion
  1. Use a standardized protocol to disinfect catheter hubs and injection ports before accessing the ports.
  2. Evaluate all central lines daily and remove nonessential catheters.
  • Requirement 7E: Implement best practices for prevention of surgical site infections (SSI).
  1. Educate health care workers about SSI and the necessity for prevention.
  2. Measure SSI rates, monitor compliance with best practices, and evaluate the effectiveness of prevention efforts.
  3. Provide SSI rate data and prevention outcome measures to key stakeholders including senior leadership, licensed independent practitioners, nursing staff, and other clinicians.
  4. Implement policies and practices aimed at reducing the risk of SSI that meet regulatory and accreditation requirements and are aligned with evidence-based standards.
  5. Educate patients and their families about SSI prevention.
  6. Administer antimicrobial agents for prophylaxis with a particular procedure or disease according to standards and guidelines for best practices:
    1. Deliver intravenous antimicrobial prophylaxis within one hour before incision [two hours are allowed for the administration of vancomycin and fluoroquinolones].
    2. Discontinue the prophylactic antimicrobial agent within 24 hours after surgery [within 48 hours is allowable for cardiothoracic procedures].
  7. Shaving is an inappropriate hair removal method. When hair removal is necessary, use clippers or depilatories.
  8. Maintain optimal control of blood glucose levels (as defined by the organization) with standardized protocols during the perioperative period for surgical procedures.