Friday, July 14, 2023

EPIC Offers Antibiotic Stewardship and

Clinical IP Support

Free of Charge

The Hazards of Wildfire Smoke

The CDC issued an official health advisory on Friday, June 30, 2023. Canadian wildfire smoke has been drifting into the United States over the past six weeks as hundreds of out-of-control wildfires have spread across Canada.

Wildfire smoke can affect people even if they are not near the fire source. Individuals especially at risk after exposure to wildfire smoke include people with asthma, COPD, or cardiovascular disease. The CDC recommends for the public to:

• Stay indoors and keep smoke outside.



• Limit your time outdoors or reduce your smoke exposure by wearing an N95 or P100 respirator.

• If you have a medical condition like asthma, COPD or metabolic and cardiovascular disease that puts you at risk for severe outcome from wildfire smoke exposure, monitor your symptoms, seek medical care when needed, and ensure that your prescriptions are up-to-date and that you have an adequate supply on hand.

For more information visit the link below. Also, ASPR TRACIE added an Air Quality Resources category to the Climate Change and Healthcare System Considerations Topic Collection to help health care planners and providers expect, understand, and communicate about health threats posed by poor air quality to community members. 

ADHS Announces Change in Bureau of Long Term Care

ADHS announced that Estrella Gies will be the Interim Bureau Chief for Long Term Care. Ms. Gies has been with the Department for almost nine years, having spent the last two years as team lead.

Should you have any questions for her please reach out to Estrella Gies Estrella.Gies@azdhs.gov or at 602-364-2690. Please know that you can always reach out to AHCA’s Kay Huff too. We’ll continue to keep you posted with any further changes.

Stay Current on Your COVID-19 Vaccines

Are you up to date with your own COVID-19 vaccine? What does “up to date” mean anymore? You are up to date with your COVID-19 vaccine if:

• Everyone aged 6 years and older are up to date when they receive 1 updated Pfizer-BioNTech or Moderna COVID-19 vaccine. 

• Children aged 6 months – 5 years who get the Pfizer-BioNTech COVID-19 vaccine are up to date if:

1. Aged 6 months - 4 years and they get 3 COVID-19 vaccine doses, including at least 1 updated COVID-19 doses.
2. Aged 5 years and they get 1 updated COVID-19 vaccine dose.

• Children aged 6 months – 5 years who got the Moderna COVID-19 vaccine are up to date when they get 2 Moderna COVID-19 vaccine doses, including at least 1 updated COVID-19 vaccine dose. 

• People who are unable or choose not to get a recommended mRNA vaccine are up to date when they get the Novavax COVID-19 vaccine dose when approved for the age group. 

• People who got the Johnson & Johnson/Janssen COVID-19 vaccine are up to date when they get 1 updated COVID-19 vaccine. 

Additionally, the CDC has recommendations for people who may get additional updated COVID-19 vaccines. Including:

• People aged 65 years and older may get 1 additional dose of COVID-19 vaccine 4 or more months after the 1^st updated COVID-19 vaccine. 

• People who are moderately or severely immunocompromised may get 1 additional dose of updated COVID-19 vaccine 2 or more months after the last updated COVID-19 vaccine. 

Talk to your health care provider about additional updated doses, and stay up to date with the COVID-19 vaccines here: Stay Up to Date with COVID-19 Vaccines | CDC

SNF Survey Scope and Severity Determination

Infection control deficiencies are commonly cited on SNF surveys. A question that we have been frequently receiving is how do surveyors determine the scope and severity (S/S) of a deficient practice? So, let’s review… surveyors determine the S/S of an identified deficient practice as part of the survey process. Once a surveyor/team identifies deficient practice they evaluate the impact it has had on the resident and the prevalence of the deficient practice in the facility by using the scope and severity grid below: 

The survey team will first identify the level of harm the deficient practice had on to the resident(s). The severity levels are on the left side of the grid and describe the harm levels. They are:

• Level 1 - no actual harm with potential for minimal harm.

• Level 2 - no actual harm with a potential for more than minimal harm that is not immediate jeopardy.

• Level 3 - actual harm that is not immediate jeopardy.

• Level 4 - immediate jeopardy to resident health or safety. Immediate jeopardy is a situation in which the facility’s noncompliance with one or more requirements of participation has caused, or is likely to cause, serious injury, harm, impairment, or death to a resident.

Next the survey team will determine the extent of the deficient practice in the facility. The scope of the deficient practice is listed across the top of the grid and is intended to identify the number of residents affected by the deficiency. There are three scope levels that can be assigned to a deficiency. They are:

• Isolated – one or a very limited number of residents were affected, or situation occurred only occasionally or in a very limited number of locations. 

• Pattern - when more than a very limited number of residents are affected, or the situation has occurred in several locations, and/or the same resident(s) have been affected by repeated occurrences of the same deficient practice.

• Widespread - the deficient practice is pervasive in the facility and/or represent systemic failure that affected or has the potential to affect a large portion or all of the facility’s residents. Widespread scope refers to the entire facility population, not a subset of residents or one unit of a facility.

Once both the harm level and the scope of the deficient practice are determined, the survey team will use the grid to identify the S/S letter of the deficient practice. The survey team’s determination on S/S is preliminary and will be reviewed and verified by a Supervisor at the ADHS bureau.

Just in case you are wondering, no, a surveyor cannot disclose the scope and severity of a tag, but they must inform the facility if they are in Immediate Jeopardy or Substandard Quality of Care. 

The Scope and Severity Grid can be found in the Survey Resources Folder. Please contact AHCA’s Kay Huff with further questions. 

Isolation Carts and

Life Safety Code Compliance

As the battle rages on in long term care facilities to safeguard residents from infections in compliance with Life Safety Code requirements, conflicts between the two disciplines often emerge. 

One such conflict involves isolation carts that are placed in the hallway outside of resident rooms on both sides of the hallway. A basic element of Life Safety Code compliance is that items in the hallway should only be placed on one side of the hallway or the other (not both). 

To help ensure positive infection control practices by placing isolation carts outside of residents' rooms on both sides of the hallway, an obvious Life Safety Code (LSC) conflict exists. The good news is that the LSC acknowledges special circumstances where deviation from the code is necessary as in the case where isolation carts are needed on both sides of the hallway.  The "work-around" is to add information to your facility's policies and procedures, including the Emergency Operations Plan (EOP) acknowledging the need for the carts in the hallways. 

Additionally, language needs to be added to the policies and procedures and EOP citing that during an emergency where the fire alarm activates or a smoke / fire condition is present in the building, these items will be immediately removed from the hallway and placed behind a closed door as part of emergency procedures. 

Not only is it critical to include this information in the EOP but all staff members should be trained on this procedure. Contact Stan Szpytek, Disaster Ready / EPIC / Life Safety Consultant with any of your questions at Stan@azhca.org or call him at (708) 707-6363.

Understanding

Tuberculosis Screening Rules 

The Arizona Department of Health Services requirement for TB screening was updated approximately a year ago and there seems to be some confusion regarding this requirement- as to whether or not annual TB screening is required. So, let’s review… an initial/baseline TB screening is required for individuals who are employed, volunteer, or who are admitted to a health care institution. The baseline screening must include a negative Mantoux skin test or other tuberculosis screening test recommended by the CDC and a TB signs and symptoms screening.

The facility will also need to conduct an annual assessment of its risk of exposure to infection TB. Part of the facility’s assessment would include obtaining documentation for each individual required to be screened for TB that indicates they are free from symptoms of infectious TB. It should be provided by a medical practitioner, occupational health provider or local health agency. This new rule also requires facilities to provide annual training/education about recognizing the signs and symptoms of TB to employees and volunteers. ADHS has provided a TB Screening Regulation Summary for better understanding of the requirement.  

Importance of the

Infection Preventionist Role

The SNF Infection Preventionist role is very important to a facilities infection prevention and control program. The intent of F882 Infection Preventionist regulation is to ensure that the facility has a qualified individual who is responsible for implementing programs and activities to prevent and control infections.

The importance of the infection preventionist role is also demonstrated by survey results. According to the CMS website 50% of the facilities cited for failing to have a trained infection preventionist were also cited at F880 Infection Prevention & Control and F883 Influenza and Pneumococcal Immunizations.

To help ensure compliance with the CMS infection prevention and control requirements facilities may want to have at least two individuals trained to be Infection Preventionists. Free training can be found at the CDC Nursing Home Infection Preventionist Training.

Facilities can also use the CMS Infection Prevention, Control & Immunizations CE Pathway to ensure compliance and identify areas that need improvement, which can be found in the Survey Resources Folder.

The complete CMS infection prevention and control requirements can be viewed in Appendix PP.