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Some thoughts about The Joint Commission’s new EPs

Regarding these new EPs The Joint Commission released this week, I’d say fortunately, at least on the EC side of things, this is all stuff that is already (or should already be) in place by any organization that can be surveyed directly under the Conditions of Participation (COPs).

For instance, the expansion of consideration of radiation as a hazardous materials under EC.02.02.01 is a direct reflection of section 482.53(c) under the physical environment section of the COPs.

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Research contends PPE use may be vastly underestimated during a disaster

Hi everyone, it’s Scott Wallask. Hope everyone enjoyed their New Year’s celebrations, however loud or quiet they may have been.
One of HCPro’s free e-newsletters, Infection Control Weekly Monitor, recently published information about a study that surprised me.
The research, published in the Journal of Infection Control, made some stark conclusions regarding personal protective equipment use during a disaster. The study involved a 24-hour flu pandemic exercise in a British hospital.
According to researchers, in the worst-case scenario during the height of a flu pandemic, a ward with patients experiencing the same symptoms could expect to use:
  • 5,250 plastic aprons per week (compared to normal use of 400)
  • 8,400 pairs of gloves per week(compared to normal use of 850)
  • 4,550 surgical masks per week(compared to normal use of less than 10)
  • 100 respirators equivalent to an N99 model per week, a higher protection than common N95 respirators (compared to a normal use of 0)
The surgical mask use represents a 450-fold increase. “This has significant implications not only for cost and procurement, but also for storage. Accommodating supplies on the ward for the 24 hours of the exercise was difficult,” researches wrote in the Journal of Infection Control.
Why did this increase happen? One idea floated by researchers was that staff members lacked confidence in using personal protective equipment during a pandemic response and found the items uncomfortable to wear for long periods, which in turn dragged out the time needed to complete even basic duties.

Get IC involved early with construction and renovation projects

When it comes to addressing infection control concerns during construction and renovations, my experience has been that while organizations usually do a pretty good job of managing large projects, when it comes to the IC/facilities collaboration on smaller projects, frequently the IC coordinator doesn’t find out what’s going on until the work is underway or, in some cases, completed.
EC.02.06.05 is specific about conducting preconstruction risk assessments. My personal philosophy has been that the assessment piece of this is the key, no matter how large or small the project, especially if there is any chance of impacting an immunocompromised patient population.
If you don’t have a solid, proactive assessment process, then you’re leaving yourself not only open to Joint Commission scrutiny (for not having reduced risk to the lowest potential), but also from CMS as a function of whether they’d be inclined to pay for patients that acquire an infection during their stay that could have been the result of dust migration, airborne contaminants, etc.

Using alcohol-based hand sanitizers in psychiatric areas

Someone on HCPro’s Patient Safety Talk listserv recently asked about using alcohol-based hand sanitizers in psych units.
The key here is whether the results of your organization’s risk assessment indicate that you can safely place the dispensers in that particular care environment. A psych patient population is absolutely unique to a given organization, and when it comes to matters of safety as a function of medical condition/diagnosis, you really need to use that uniqueness (uniquity?) as the basis of the evaluation.
Also, consider these concerns:
  • What product do you use? Foam-based products might be a little safer in a psych application than a liquid.
  • How is the psych environment configured? Is there a safer way to install the dispensers?
Particularly with the likely scrutiny of this type of a thing as a function of The Joint Commission’s National Patient Safety Goals, there will be any number of folks who will take issue with whatever you end up doing. The psych safety zealots will condemn you for using the alcohol-based hand rubs and the infection control zealots will chastise you for not using the product.
I’d work the process through and base the decision on what will work for your patient population.

Construction scrutiny will move to EC.02.06.05

When it comes to managing construction and renovation projects, Joint Commission standard EC.8.30 will soon transition to EC.02.06.05.
The key process that surveyors look for is the risk assessment. Many of you probably use the infection control risk assessment, or ICRA, form that was developed by the Centers for Disease Control and Prevention and the Association of Professionals in Infection Control and Epidemiology.
(As an aside, platinum subscribers to the Hospital Safety Center site that you’re on right now can use our Infection Control Risk Assessment Workstation.)
Surveyors employ a very liberal interpretation of the need for risk assessments for all projects great and small, including projects like patching and painting walls, etc.–pretty much anything that can generate dust.
That’s not to say that one would have to issue permits for each instance. It is possible to establish the infection control protections as a function of the standard operating procedure for the task and go from there.
Part of the concern in this area revolves around the possibility (and in some cases likelihood) of these smaller projects growing in scope over time and creating an increased risk in the environment. Traditionally, hospitals do a pretty good job with the big projects (primarily because there is more scrutiny) but not so much with the smaller projects which, depending on where they are, can become very intrusive on the more immunocompromised patient populations.

The debate over storing cardboard boxes

There are really no standards for dealing with the storage of cardboard boxes on wooden pallets. Much as it is with the storage of materials under sinks, the expectation is that each organization will conduct a risk assessment relative to the practice in question.

For instance, while there are certainly going to be containers [more]

Tackle healthcare construction worries before the wall gets knocked in

In the 2009 EC standards, EC.02.06.05 deals with concerns surrounding construction, renovation, and demolition.
The standard’s provisions haven’t changed from earlier versions. However, I want to impress upon you the need for construction management to begin as a proactive pursuit–which means before the infection control coordinator discovers the facilities folks have knocked down a wall. I’ve been running into this problem with increasing frequency.
I would ask pointed questions to your infection control professionals and see how much squirming occurs. This is not a process for which the forgiveness versus permission equation can be applied.

Wrapping nurse call cords around hand rails

Someone asked me recently about whether nurse call pull cords could be wrapped around the handrails in patient bathrooms.
The consensus on these pull cords is that they need to extend down to a point just off the floor so if a patient falls to the floor, he or she can still summon assistance. The cord shouldn’t touch the floor so it doesn’t get all scuzzy–generally speaking, hanging the cord to the top of the baseboard is a good guide.
As far as the wrapping the cord around the handrail, it’s as much a performance issue as it is anything else. If the alarm still works as intended (meaning it activates with the same amount of downward pressure), then it should be fine.
That said, I’ve never really been clear on why folks felt that they had to do “the wrap.” If the cord is too long, then it should be trimmed to the appropriate length and that would do it.

New isolation guidelines are out

Don’t know if anyone else heard this yet, but maybe it’s of interest–the CDC released its updated isolation precautions guidelines, which you can view here:

http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007.pdf