CMS Manual System

CMS Manual System

Pub. 100-07 State Operations Provider Certification

Transmittal 55

Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS)

Date: December 2, 2009

Transmittal 54, dated November 30, 2009, is being rescinded and replaced by Transmittal 55 dated December 2, 2009. The C. difficile can survive in the environment (e.g., on floors, bed rails or around toilet seats) in its spore form for up to 6 months. Rigorously cleaning the environment removes C. difficile spores, and can help prevent transmission of the organism.i Cleaning equipment used for residents with C. difficile with a 1:10 dilution of sodium hypochlorite (nine parts water to one part bleach) will also reduce the spread of the organism. Once mixed, the solution is effective for 24 hours. Previously, a portion of this information was incorrectly stated and is now corrected. All other information in this instruction remains the same.

SUBJECT: Revisions to Appendix PP ? "Interpretive Guidelines for Long-Term Care Facilities," Tag F441"

I. SUMMARY OF CHANGES: This instruction combines F Tags 441, 442, 443, 444 and 445, and incorporates the guidance into Tag F441. This was done to bring everything that relates to infection control into one location to best utilize the surveyors time and resources.

NEW/REVISED MATERIAL - EFFECTIVE DATE*: September 30, 2009 IMPLEMENTATION DATE: September 30, 2009

Disclaimer for manual changes only: The revision date and transmittal number apply to the red italicized material only. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.

II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual not updated.) (R = REVISED, N = NEW, D = DELETED) ? (Only One Per Row.)

R/N/D R R R D D D D

CHAPTER/SECTION/SUBSECTION/TITLE Appendix PP/?483.65(a)/Infection Control/Tag F441 Appendix PP/?483.65(b)/Preventing Spread of Infection/Tag F441 Appendix PP/?483.65(c)/Linens/Tag F441 Appendix PP/?483.65(b)/Preventing Spread of Infection/Tag F442 Appendix PP/?483.65(b)(2)/Tag F443 Appendix PP/?493.65(b)(3)/Tag F444 Appendix PP/?493.65(c)/Linens/Tag F445

III. FUNDING: No additional funding will be provided by CMS; contractor activities are to be carried out within their operating budgets.

IV. ATTACHMENTS:

Business Requirements X Manual Instruction

Confidential Requirements One-Time Notification One-Time Notification -Confidential Recurring Update Notification

*Unless otherwise specified, the effective date is the date of service.

i Mayfield, J.L., Leet, T., Miller, J., and Mundy, L.M. (2000, Oct. 25). Environmental control to reduce transmission of Clostridium Difficile. Clinical Infectious Disease. 2000;31. Pp.998

F441

(Rev.55, Issued: 12-02-09 Effective: 09-30-09, Implementation: 09-30-09)

?483.65 Infection Control

The facility must establish and maintain an Infection Control Program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of disease and infection.

?483.65(a) Infection Control Program

The facility must establish an Infection Control Program under which it ?

(1) Investigates, controls, and prevents infections in the facility; (2) Decides what procedures, such as isolation, should be applied to an

individual resident; and (3) Maintains a record of incidents and corrective actions related to infections.

?483.65(b) Preventing Spread of Infection

(1) When the Infection Control Program determines that a resident needs isolation to prevent the spread of infection, the facility must isolate the resident.

(2) The facility must prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food, if direct contact will transmit the disease.

(3) The facility must require staff to wash their hands after each direct resident contact for which hand washing is indicated by accepted professional practice.

?483.65(c) Linens

Personnel must handle, store, process and transport linens so as to prevent the spread of infection.

INTENT: (F441) 42CFR 483.65 Infection Control

The intent of this regulation is to assure that the facility develops, implements, and maintains an Infection Prevention and Control Program in order to prevent, recognize, and control, to the extent possible, the onset and spread of infection within the facility. The program will:

? Perform surveillance and investigation to prevent, to the extent possible, the onset and the

spread of infection;

? Prevent and control outbreaks and cross-contamination using transmission-based

precautions in addition to standard precautions;

? Use records of infection incidents to improve its infection control processes and outcomes

by taking corrective actions, as indicated;

? Implement hand hygiene (hand washing) practices consistent with accepted standards of

practice, to reduce the spread of infections and prevent cross-contamination; and

? Properly store, handle, process, and transport linens to minimize contamination.

DEFINITIONS

Definitions are provided to clarify terminology or terms related to infection control practices in nursing homes.

? "Airborne precautions" refers to actions taken to prevent or minimize the transmission

of infectious agents/organisms that remain infectious over long distances when suspended in the air. These particles can remain suspended in the air for prolonged periods of time and can be carried on normal air currents in a room or beyond, to adjacent spaces or areas receiving exhaust air.1

? "Alcohol-based hand rub" (ABHR) refers to a 60-95 percent ethanol or isopropyl-

containing preparation base designed for application to the hands to reduce the number of viable microorganisms.

? "Antifungal" refers to a medication used to treat a fungal infection such as athlete's

foot, ringworm or candidiasis.

? "Anti-infective" refers to a group of medications used to treat infections.

? "Antiseptic hand wash" is "washing hands with water and soap or other detergents

containing an antiseptic agent."2

? "Cohorting" refers to the practice of grouping residents infected or colonized with the

same infectious agent together to confine their care to one area and prevent contact with susceptible residents (cohorting residents). During outbreaks, healthcare personnel may be assigned to a cohort of residents to further limit opportunities for transmission (cohorting staff).

? "Colonization" refers to the presence of microorganisms on or within body sites without

detectable host immune response, cellular damage, or clinical expression.

? "Communicable disease" (also known as [a.k.a.] "Contagious disease") refers to an

infection transmissible (as from person-to-person) by direct contact with an affected individual or the individual's body fluids or by indirect means (as by a vector).

? "Community associated infections" (formerly "Community Acquired Infections") refers

to infections that are present or incubating at the time of admission, or generally develop within 72 hours of admission.

? "Contact precautions" are measures that are "intended to prevent transmission of

infectious agents, including epidemiologically important microorganisms, which are spread by direct or indirect contact with the resident or the resident's environment."3

? "Droplet precautions" refers to actions designed to reduce/prevent the transmission of

pathogens spread through close respiratory or mucous membrane contact with respiratory secretions.4

? "Hand hygiene" is a general term that applies to washing hands with water and either

plain soap or soap/detergent containing an antiseptic agent; or thoroughly applying an alcohol-based hand rub (ABHR).

? "Hand washing" refers to washing hands with plain (i.e., nonantimicrobial) soap and

water.

? "Health care associated infection [HAI]" (a.k.a. "nosocomial" and "facility-acquired"

infection) refers to an infection that generally occurs after 72 hours from the time of admission to a health care facility.

? "Infection" refers the establishment of an infective agent in or on a suitable host,

producing clinical signs and symptoms (e.g., fever, redness, heat, purulent exudates, etc).

? "Infection prevention and control program" refers to a program (including

surveillance, investigation, prevention, control, and reporting) that provides a safe, sanitary and comfortable environment to help prevent the development and transmission of infection.

? "Infection preventionist (IP)" (a.k.a. infection control professional) refers to a person

whose primary training is in either nursing, medical technology, microbiology, or epidemiology and who has acquired additional training in infection control.

? "Isolation" refers to the practices employed to reduce the spread of an infectious agent

and/or minimize the transmission of infection.

? "Isolation precautions" see "Transmission-Based Precautions"

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