isolating and appropriately providing care for that patient. If you’ re a lab, that means having policies and procedures and protocols about specimen collection and containment and transport back to the lab. And each program has its very own infection control assessment tool. These tools are designed to help bring a little more granularity to the standards and elements of performance, which as we discussed, were written to be very broad, so that every organization has the ability to tailor them to their specific organization and needs.”
Wiksten addressed the elements that surveyors are examining when they come to an organization.“ These infection control assessment tools are important because you can use them like a checklist to ensure you have the basic things that surveyors are going to look for. Just remember that the assessment tools are not all-encompassing.”
Next, Wiksten reviewed the frequently scored and high-risk IPC findings.“ We see the same things year after year after year,” she remarked.“ This year, I’ m going to focus on those things that are going to land you with a condition-level deficiency, which means we’ re going to be coming back
We still see a significant number of observations related to not having foundational elements in place for your infection prevention and control program. This puts not only your patients at risk, but staff at risk as well.”
to visit you in 45 days for an immediate threat to health or safety, which nobody likes to hear. These are all implementation standards, so that means surveyors are observing staff implement manufacturers’ instructions for use and the organization’ s policies, procedures and processes. When you have processes with multiple steps, such as in sterile processing, every defect that you identify increases the risk that a device or instrument is not going to be sufficiently cleaned, high-level disinfected and / or sterilized. How do we improve our processes because we also have to account for humans being human. We must give them the best foundation we can to make them a successful as they can be.”
Wiksten reported that surveyors are seeing bigger infection prevention and control issues for home health, nursing care center and behavioral health categories of facilities.“ We still see a significant number of observations related to not having foundational elements in place for your infection prevention and control program,” she observed.“ This puts not only your patients at risk, but staff at risk as well. We have standards that support implementation like human resources and leadership, and then we also have standards that support quality improvement and performance improvement processes. So, when you use them all together, you get more reliable processes. Successful implementation of activities is multi-factorial. If you write the policy, are they automatically going to follow it? Probably not. If you write the policy and you tell them about it, are they going to follow it? Probably not. So, you have to make sure you’ re identifying your infection control risks, you’ re developing your activities – the activities that every organization has in every setting where healthcare is
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