F UNDAMENTALS O CTOBER , 2014 R OXANNE P ERRY, RN, MS M ANAGER I NTEGRATED P ROGRAMS MANAGEMENT S ECTION Regulations for an Infection Prevention and Control Program

Department of Community Health Medical Services Administration Bureau of Medicaid Policy and Health Systems Integrated Care Division Integrated Programs Management Section 2

3 Objectives List at least 3 purposes for developing an effective infection prevention and control program. List and describe Federal and State Infection Prevention & Control Regulations for different types of health care facilities.

4 Historical Events  AD: Constantine the Great  1843: Oliver Wendell Holmes  1846: Ignaz Semmelweis  1860: Louis Pasteur  1867: Joseph Lister

5 Historical Events  1800’s: Florence Nightingale 1837 – Committed herself to nursing 1845 – Entered nursing – cared for poor/indigent population 1851 – Official training/nursing career

6 Historical Events 1854 – Crimean War – cleaned hospital equipment and reorganized patient care 1855 – Concluded that hospital deaths were due to poor living conditions  1950’s: Staphylococcal era  1959: First Infection Control Nurse

7 Historical Events  Change from Universal Precautions to Standard Precautions  Isolation Practices – least restrictive  Hepatitis B Vaccine  HIV/AIDS

8 Historical Events  MSIPC from MSIC  Influenza Vaccine  Pneumococcal Vaccine

9 Why have an Infection Prevention & Control Program? Prevent and protect residents, employees, volunteers & visitors from infections Maximize quality of care Avoid legal issues Avoid adverse publicity Comply with regulations and accreditation

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11 Regulations/Guidelines for the Prevention & Control of Infections Federal Government Centers for Medicare and Medicaid Services (CMS) Center for Disease Control (CDC) Occupational Safety and Health Administration (OSHA)

12 Regulations/Guidelines for the Prevention & Control of Infections State Government Michigan Public Health Code Licensing Rules Communicable Disease Rules Medical Waste Regulatory Program MIOSHA

13 Regulations/Guidelines for the Prevention & Control of Infections Accreditation Entities Association for Professionals in Infection Control and Epidemiology

14 Federal and State Regulations Long Term Care – State and Federal ICF/MR - Federal Acute Care – State and Federal CLIA Laboratories – State/Federal

Federal and State Regulations Home Health – Federal Ambulatory Surgical Clinics(ASC)/Freestanding Surgical Outpatient Facilities(FSOF) – State and Federal End Stage Renal Disease - Federal 15

Federal and State Regulations Outpatient Physical/Speech Therapy Centers- Federal Rural Health Clinics – Federal Critical Access Hospitals – State and Federal Comprehensive Outpatient Rehab Facilities - Federal 16

Federal and State Regulations Portable X-Ray Units – Federal Hospice Residences – State and Federal Hospice Agencies– State and Federal Psychiatric Hospitals- State and Federal 17

18 Long Term Care Infection Prevention/Control Federal Regulations

Long Term Care Infection Prevention/Control F441 § 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. 19

Long Term Care Infection Prevention/Control F441 continued §483.65(a) Infection Control Program §483.65(b) Preventing Spread of Infection §483.65(c) Linens 20

Long Term Care Infection Prevention/Control F334 §483.25(n) Influenza and pneumococcal immunizations--- (1) Influenza. The facility must develop policies and procedures that ensure that— (2) Pneumococcal disease. The facility must develop policies and procedures that ensure that— 21

Long Term Care Infection Prevention/Control F (k)(3) The services provided or arranged by the facility must— (i) Meet professional standards of quality... 22

23 Long Term Care Infection Prevention/Control F (o) Quality Assessment and Assurance (1) A facility must maintain a quality assessment and assurance committee consisting of- (i)The director of nursing services; (ii)A physician designated by the facility; And (iii)At least 3 other members of the facility’s staff.

24 Long Term Care Infection Prevention/Control F520 continued (2) The quality assessment and assurance committee- (3) State or the Secretary may not require disclosure of the records of such committee except insofar as such disclosure is related to the compliance of such committee with the requirements of this section. (4) Good faith attempts by the committee to identify and correct quality deficiencies will not be used as a basis for sanctions.

25 Long Term Care Infection Prevention/Control F520 continued Summary Identifies quality issues Establishes protocols Develops and implements corrective actions Evaluate response

26 Long Term Care Infection Prevention/Control Michigan Licensure Regulations

27 Michigan Licensure Regulation Rule 507 R Infection Control A written policy shall govern the control of communicable disease and infections in the nursing home and shall require the establishment and operation of an Infection Control Committee, which shall include at least the director of nursing and representatives of administration, dietary, housekeeping, and maintenance services.

28 Michigan Licensure Regulation Rule 402 R Health of Employees and Others Providing Care An employee on duty in the home shall be in good health and free from communicable disease. An employee shall have an intradermal test for tuberculosis at the beginning of employment and annually thereafter. If at any time the skin test is positive, the local health department shall be notified and the employee shall have a chest x- ray to determine the presence of disease.

29 Michigan Licensure Regulation Rule 506 R Tuberculosis Testing The facility shall develop and implement policies governing the periodic intradermal tuberculin testing of patients in addition to the requirement for a chest x-ray on admission.

30 Hospital Infection Prevention/Control Federal Regulations

31 Hospital Infection Prevention/Control A Condition of Participation: Infection Control The hospital must provide a sanitary environment to avoid sources and transmission of infections and communicable diseases. There must be an active program for the prevention, control, and investigation of infections and communicable diseases.

32 Hospital Infection Prevention/Control A (a) Standard: Organization and Policies A person or persons must be designated as infection control officers to develop and implement policies governing control of infections and communicable diseases….

33 Hospital Infection Prevention/Control A (a)(1) The infection control officer or officers must develop a system for identifying, reporting, investigating, and controlling infections and communicable diseases of patients and personnel.

34 Hospital Infection Prevention/Control A (a)…. The infection control officer or officers must maintain a log of incidents related to infections and communicable diseases.

35 Hospital Infection Control A (b) Standard: Responsibilities of Chief Executive Officer, Medical Staff, and Director of Nursing Services The chief executive officer, the medical staff, and the director of nursing must—

Hospital Infection Control (1) Ensure that the hospital-wide quality assessment and performance improvement (QAPI) program and training programs address problems identified by the infection control officer or officers; and (2) Be responsible for the implementation of successful corrective action plans in affected problem areas. 36

37 Hospital Infection Prevention/Control Michigan Licensure Regulations (Minimum Standards for Hospitals)

Hospital Infection Prevention/Control R (Rule 21) Compliance with law and regulations R (Rule 22) Water and ice supply R (Rule 23) Sewage, garbage, and waste disposal 38

39 Hospital Infection Prevention/Control R (Rule 24) Laundering and sterilization of linens; Sterilization of instruments and utensils R (Rule 25) Heating and ventilating

40 Hospital Infection Prevention/Control R (Rule 26) General maintenance. R (Rule 27) Patient Care.

41 Infection Control References Federal Regulations Guidance/Guidance/Manuals/downloads/som107_Appe ndixtoc.pdf State Regulations MSIPC