Infection Control Professionals must stay informed about regulatory issues related to the prevention and control of infectious disease. This tab will contain links to pertinent new or pending legislation, information from the National Office about regulatory issues, changes in the CMS Conditions of Participation or grass roots efforts.

As many of you are aware, Illinois was one of the first states to require nosocomial infection information to be posted electronically in a consumer report card. The rules for implementation of that requirement are currently in development. Information relevant to the Illinois Hospital Report Card Act will also be posted here.

From AHANewsNow August 9, 2005
NFPA decision allows use of alcohol skin preps in the OR
The National Fire Protection Association, which sets national fire safety standards, has agreed to lift its restrictions on the use of alcohol-based surgical preparation solutions in operating rooms, as advocated by the AHA™s American Society for Healthcare Engineering. In an Aug. 8 advisory to members, ASHE said the NFPA Standards Council has accepted an ASHE-proposed amendment to its 2005 standards that include provisions to minimize the potential for fire in procedures involving a potential ignition source, while allowing the use of these critical infection control products. Appropriate skin antisepsis before surgery is critical to preventing surgical site infections, the society notes. The tentative interim amendment to the 2005 edition of the Standard on Health Care Facilities takes effect Aug. 18, 2005, and will be subject to review and approval by the full NFPA for the 2009 edition of the standard. The amendment and background information will be available soon at the ASHE Web site.

From the AHA News Now June 23, 2005
Project reduces hospital surgical infections, study finds
Hospitals participating in a Centers for Medicare & Medicaid Services demonstration project increased their use of several practices proven to prevent surgical infections and reduced their surgical site infection rate by 27%, according to a study published today in the American Journal of Surgery. Working with their associated Quality Improvement Organizations, the 56 hospitals focused on administering antibiotics within 60 minutes of surgical incision, using appropriate antibiotics, and discontinuing antibiotics within 24 hours after surgery, among other practices. Their overall surgical infection rate fell from 2.3% in the first three months of the one-year project to 1.7% in the last three months. "These are landmark achievements in getting individuals in hospitals to work with one another and with other hospitals to share their data and good ideas," an accompanying editorial notes.

Joint Statement from CMS and JCAHO
Below is a link to the official joint notice suspending the National Quality Hospital Measure SIP-2 issued by CMS and JCAHO late on Tuesday afternoon, June 21, 2005.

Recent Amendments to Illinois Statutes
SB59 (Hospital Report Card Act) was recently revised (SB1862) and sent to the Governor for signature on June 24, 2005. The proposed revisions provide that the hospital reports to the Department shall include information on infection-related measures for the facility (now, information on nosocomial infection rates for the facility). Changes the categories of infection-related information that the hospitals must report on. Requires the Department to base its infection-related measures upon those developed by other specified health care organizations. Provides that the Department shall include interpretive guidelines for infection-related indicators and, when available, shall include relevant benchmark information published by national organizations.

HB2343 Signed by the Governor June 14, 2005
Amends the Illinois Health Finance Reform Act. Provides that the Department of Public Health must require ambulatory surgical treatment centers licensed to operate in the State of Illinois to adopt a uniform system, based on certain federal laws, for submitting patient charges for payment from public and private payors. Requires the Department to evaluate additional methods for comparing the performance of hospitals and ambulatory surgical treatment centers and report its findings and recommendations on its Internet website and to the Governor and General Assembly no later than January 1, 2006. Requires the Department to study methods to collect and report data on mortality and nosocomial infection rates from hospitals and ambulatory surgical treatment centers for outpatient services and report its findings and recommendations on its Internet website and to the Governor and General Assembly no later than January 1, 2006.

To view the full text of either of these recent changes, visit http://www.ilga.gov/ and type in SB1862 or HB 2343 in the search by number browser.

APIC Position Paper on Mandatory Reporting of Healthcare-Associated Infections (HAIs)

CMS Interim Final Rule Regarding Placement of Alcohol-Based Hand-Rub Dispensers
March 25, 2005

From the National Office
The Public Policy Team is continuing to work with our partners and congressional champion on OSHA's annual fit-testing requirement for occupational exposure to M. tuberculosis. The current house appropriations bill contains language extending the moratorium on enforcement of the annual fit testing requirement for occupational exposure to M.tuberculosis.

The Senate and House Labor-HHS bills will eventually go to conference committee where the bill is finalized prior to submission to the President for signature. In August, the Congress traditionally goes into recess. So, the soonest this bill will be considered in conference is in September.
To the best of our knowledge, if a bill has not been finalized by September 30th, OSHA will continue to function under a continuing resolution. Therefore, we believe that OSHA will not be able to enforce the annual fit-testing requirement. At this time, we cannot guarantee the outcome and therefore, must leave the final decision with regard to instituting annual
fit-testing up to each facility.

Sincerely,

Mary Ellen Bennett, RN, MPH, CIC
2005 APIC Public Policy Chair
Shannon Oriola, RN, CIC
2005 APIC Public Policy Vice-Chair

The APIC Public Policy Team would like to alert you of the recent decision from the National Fire Protection Association (NFPA) to approve ASHE’s Tentative Interim Amendment (TIA) to NFPA 99 – Standard for Health Care Facilities – 2005 Edition. The language will now go to the Centers for Medicare and Medicaid Services (CMS) for its interpretation.

In a letter dated March 31, 2005, the Nebraska State Fire Marshall instructed the state’s hospitals and ambulatory surgery centers that the use of alcohol-based surgical prep solutions on patients in an oxygen-enriched atmosphere with cautery or electrosurgery violates NFPA 99.

ASHE responded with the development of this amendment to NFPA 99 to provide additional guidance to health care facilities on effectively managing the risk of fire when alcohol based surgical prep solutions are used in the presence of an ignition source (laser, ESU, cautery, etc.). This proposal was in response to enforcement of existing NFPA 99 language which prohibited the use of alcohol skin prep when use of ignition source was contemplated. ASHE felt this potential risk should be considered in light of the potential risk of banning or restricting use of these products in operating rooms.

On March 18, ASHE provided a Regulatory Advisory to ASHE members containing recommendations for the safe usage of alcohol surgical prep solutions, to minimize the potential for fire while continuing to allow the use of these critical infection control products. That alert emphasized the need to use skip prep solutions according to manufacturer instructions and introduction of a “time-out” before initiating activation of the ignition source to assure that there was no pooling of fluid or soaking of drapes and that the solution had fully dried. That alert was the basis of the TIA.

APIC commends both NFPA and ASHE for their hard work on this important patient safety issue. ASHE has publicly noted the role of clinical groups, including APIC in particular, for provision of evidence-based information and public support of the TIA. Infection Prevention and Control Professionals represented a large group of respondents commenting on the TIA and the success of this change is due in no small part to APIC's voice. Please go to www.apic.org, click on Advocacy, then CMS and then About the Issue to learn more and for updates.

For any additional information, please feel free to contact Denise Graham, Director of Public Policy, at dgraham@apic.org or (202) 454-2617.

Sincerely,
Mary Ellen Bennett, RN, MPH, CIC
2005 APIC Public Policy Chair
Shannon Oriola, RN, CIC
2005 APIC Public Policy Vice-Chair