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Logic doesn’t always prevail…a luxury you can’t afford!

By my observations over time, I’ve found that, all-too-often, logic finishes a distant third behind self-interest (which sometimes manifests itself as crimes of convenience) and panic. Unfortunately, if you currently work in the healthcare industry, you must cling to the bastion of logic as those “other” winds threaten to pull you under.

But sometimes even bureaucracies manage to act judiciously; the good folks at the Centers for Medicare & Medicaid Services (CMS) have elected to curtail some of their “regular” survey activities to afford healthcare organizations the opportunity to focus on COVID-19 preparedness (you might want to bookmark the CMS FAQ page—they’ll be updating frequently). While this doesn’t mean CMS is going to halt all survey activity, it outlined how it would be prioritizing survey activities over the next little while:

Effective immediately, survey activity is limited to the following (in priority order):

  • All immediate jeopardy complaints (cases that represent a situation in which entity noncompliance has placed the health and safety of recipients in its care at risk for serious injury, serious harm, serious impairment, or death or harm) and allegations of abuse and neglect
  • Complaints alleging infection control concerns, including facilities with potential COVID-19 or other respiratory illnesses
  • Statutorily required recertification surveys (Nursing Home, Home Health, Hospice, and ICF/IID facilities)
  • Any revisits necessary to resolve current enforcement actions
  • Initial certifications
  • Surveys of facilities/hospitals that have a history of infection control deficiencies at the immediate jeopardy level in the last three years
  • Surveys of facilities/hospitals/dialysis centers that have a history of infection control deficiencies at lower levels than immediate jeopardy

While that does narrow down the field somewhat, those last two possibilities might be well-served by digging out any survey reports from the past couple of years to see if there are any IC-related issues lurking in the weeds.

According to the information provided to surveyors, the aim is to keep on-site survey time to no more than two days, with a particular focus on (you guessed it!) infection control, particularly as it relates to COVID-19 preparedness. You can see the meat and potatoes of the CMS memos to providers here:

https://www.cms.gov/files/document/qso-20-12-allpdf.pdf-1

https://www.cms.gov/files/document/qso-20-13-hospitalspdf.pdf-2

https://www.cms.gov/files/document/qso-20-14-nhpdf.pdf

As a final note for this week’s entertainment, our friends at ASHE have dedicated a webpage to provide COVID-19 information and resources; some of the materials require membership to access, but this is probably another page you’ll want to visit regularly as the next few weeks unfold.

If this isn’t a holdup, why are so many people wearing masks?

I suspect this is as much a confluence of any number of (seemingly/probably) unrelated elements, including a presidential election year in a certain North American nation, but it does seem to demonstrate, on a fairly significant scale, the power of fear to motivate folks to, and in some instances, past, the point of panic. There is no question that COVID-19 represents a significant turn of events in the epidemiological world and certainly has the potential to cause real havoc across the globe (I’ve always maintained that the bugs can evolve faster than we can). But it astonishes me the lengths to which folks will go to give in to their fears.

As I type this, I am sitting in an airport that serves a large area in the Northeast (euphemistically, the home of the New English), and I am quite taken aback by the number of folks wearing surgical masks for traveling. I will admit that I have not spent a lot of time recently (or, indeed, ever) watching the doom and gloom (or is it gloom and doom?) pronouncements of the various news organs—I tend to rely on the folks whose job/charge is to keep an eye on this type of stuff—folks like the CDC. I know that there are those for whom the CDC carries not much in the way of authority, but (being comprised primarily of human beings), perfection is the goal, but not necessarily the reality. But there are certain (to my mind) inescapably logical elements:

  • CDC does not recommend that people who are well wear a facemask to protect themselves from respiratory diseases, including COVID-19.
  • Facemasks should be used by people who show symptoms of COVID-19 to help prevent the spread of the disease to others.
  • The use of facemasks is also crucial for health workers and people who are taking care of someone in close settings (at home or in a healthcare facility).
  • Stay home except to get medical care.
  • Stay home: People who are mildly ill with COVID-19 are able to isolate at home during their illness. You should restrict activities outside your home, except for getting medical care.
  • Avoid public areas: Do not go to work, school, or public areas.
  • Avoid public transportation: Avoid using public transportation, ride-sharing, or taxis.

So, if you should only wear a mask if you are sick and if you are sick, you should stay home except to get medical care (a very reasonable chain of reasoning), then why am I seeing masks at the airport?

I do believe that everyone gets to make their own way in the world, at least to the degree that the impact of that “way” does not have a negative impact on everyone else’s “way.” But there are already reported shortages of supplies and it just seems to me that such actions are not (at least not yet) supported by the data. But there is something that can be done—and I’ve not seen enough of this CDC recommendation in action:

Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol. Always wash hands with soap and water if hands are visibly dirty.

As I think about it, wearing a mask doesn’t absolve anyone of the responsibility to wash their hands, but hand hygiene numbers in the public sector are not nearly where they should be. Which leads me to this question: What’s the best way of shaming the hand-hygiene deficient? I’d love to hear any stories you might have.