Joint Commission Approves Strengthened Infection Control Standards


OAKBROOK TERRACE, Ill. --The Joint Commission on

Accreditation of Healthcare Organizations (JCAHO) has approved revised

standards to help prevent the occurrence of deadly healthcare-associated


The standards retain many of the concepts embodied in existing standards,

but sharpen and raise expectations of organization leadership and of the

infection control program itself. The requirements for ambulatory care,

behavioral health care, home care, hospital, laboratory and long-term care

organizations will take effect January 2005.

Healthcare-associated infections constitute a significant safety risk for

individuals receiving care in a variety of settings. The Centers for

Disease Control and Prevention (CDC) estimates that 2 million

individuals acquire an infection each year while being treated in

hospitals for other illnesses or injuries, and that 90,000 people die as a

result. The Joint Commission accredits more than 16,000 healthcare

organizations, and healthcare-associated infections are a risk in all of

the care settings encompassed in this group.

The revised standards are the result of the work of an expert group of

infection-control practitioners, hospital epidemiologists, physicians,

nurses, risk managers and other healthcare professionals, along with

significant input from accredited organizations participating in a field

review. Since the work of these groups began, two new issues -- emerging

antimicrobial resistance and the management of epidemics and emerging

pathogens -- have been identified. Requirements addressing those topics

will be sent to all accredited organizations next month for field review.

The revised standards are designed to raise awareness that healthcare-associated infections are a national concern that can be acquired within

any care, treatment or service setting, and transferred between settings,

or brought in from the community. Therefore, prevention represents one of

the major safety initiatives that a healthcare organization can

undertake. The revised standards focus on the development and

implementation of plans to prevent and control infections, with

organizations expected to:

- incorporate an infection control program as a major component of safety

and performance improvement programs;

- perform an ongoing assessment to identify its risks for the acquisition

and transmission of infectious agents;

- effectively use an epidemiological approach which includes conducting

surveillance, collecting data, and interpreting the data;

- effectively implement infection prevention and control processes;

- educate and collaborate with leaders across the organization to

effectively participate in the design and implementation of the infection

control program;

The Joint Commission has long worked with experts in infection control to

set and maintain state-of-the-art standards. The current infection

control standards help accredited hospitals to identify and reduce the

risks of acquiring and transmitting infections among patients, employees,

physicians and visitors. The standards cover both direct patient care

activities and those used to support patient care. The Joint Commission

also requires accredited healthcare organizations to work with local,

state and federal agencies to prevent, monitor and control infections.

In addition to evaluating compliance with infection control standards

during triennial surveys, the Joint Commission has included infection

control as a special focus area during random, unannounced surveys for

hospitals in 2003. The Joint Commission also made the CDC's recently

updated handwashing guidelines a 2004 National Patient Safety Goal for all

accredited organizations in an effort to bring further attention to

infection control issues. Furthermore, the Joint Commission has advised

accredited organizations that health care-associated infections resulting

in death or serious injury should also be voluntarily reported to the

Sentinel Event database. The 2004 National Patient Safety Goals require

organizations to manage as sentinel events all healthcare-associated

infections that result in death or major permanent loss of function.

Source: JCAHO

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