EPIC Newsletter
For Arizona SNFs - Emergency Preparedness Infection Control
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REGISTER TODAY
AHCA Quality Forum
Managing the Survey Process
Thursday, September 15 |Marriott Phoenix Airport
Skilled nursing facilities are in a constant state of flux with the ever-changing regulatory environment. Staying abreast of the latest advances and regulatory changes can be challenging, to say the least. CMS released the interpretive guidance for the Requirements of Participation Phase II and Phase III in June 2022. These changes will go into effect on October 24, 2022, and with that comes the challenge of managing the survey process. This quality forum will address managing the survey process and will provide a high-level overview of the new regulatory interpretive guidance.
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Infection Preventionist Call this Month
The EPIC infection preventionist call will occur on Thursday, August 25 at 1:00 pm. Please email Kay Huff with any questions or to receive the zoom link. |
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Monkeypox Update
On Thursday, August 4, 2022, the Biden administration declared monkeypox a Public Health Emergency (PHE).
According to the CDC the total confirmed monkeypox cases in the US are over 7,100, the first case was identified in May. The PHE announcement will free up money and other resources to fight the virus, “We are prepared to take our response to the next level in addressing this virus, and we urge every American to take monkeypox serious,” said Xavier Becerra, head of the US Department of Health and Human Services.
The White House said it has made more than 1.1 million vaccine doses available and has helped to boost domestic diagnostic capacity to 80,000 tests per week.
The monkeypox virus spreads through prolonged skin-to-skin contact, including hugging, cuddling and kissing, as well as sharing bedding, towels and clothing. The people who have gotten sick so far have primarily been men that have sex with men.
However, health officials emphasize that the virus can infect anyone.
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CDC Updates Enhanced Barrier Precautions Guidance
The CDC has updated its guidance for nursing homes on enhanced barrier precautions (EBP) to help prevent the transmission of multi-drug resistant organisms (MDROs).
EBP requires the use of gown and gloves during high-contact resident care activities that provide opportunities for transfer of MDROs to staff hands and clothing. Use of eye protection may be necessary when splash or spray may occur but is not necessary in other situations.
High contact care actives include but are not limited to:
- Bathing/showering/hygiene
- Preforming wound care
- Changing briefs/toileting
- Caring for indwelling medical device
The updated guidance includes that EBP use is not limited to outbreaks or specific MDROs. It should be used for nursing home residents who are infected or are colonized with an MDRO and for any resident who has wounds or an indwelling medical device.
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CMS Updates
5-Star Rating
CMS launched its enhanced Nursing Home Five-Star Quality Rating System on July 27, 2022. CMS updated Five-Star ratings and incorporated PBJ staff turnover measures, which modified the scoring of Overall ratings. Click on this link to see the analysis.
The report emphasizes it’s a methodological change and not a change in care provided that causes nearly a third of centers to see a lower staffing rating and a quarter to see a lower Overall rating. The report also provides the context that facilities are in their worst labor shortage in 29 years. In the next couple of days LTC Trend Tracker will be releasing a Top-Line and resources to help members understand their new Five-Star rating, the scoring methodology, and what targets to set to improve their rating.
In Arizona, almost 36% of skilled nursing facilities scored 4 or 5 stars, while another 36% just received 1 or 2 stars and 27% of the state’s nursing homes scored 3-stars. The majority of Arizona SNFs are for-profit (121) with 18 held by non-profit organizations. Keep in mind this was prompted by CMS adding four new measures to the Nursing Home Five Star Quality Rating System effective with the July 27 release.
In addition to existing measures of RN and total nurse hours per resident per day, the new staffing rating methodology will include the following measures:
- Total nurse (RN, licensed practical nurses, and nurse aids) staffing hours per resident per day on weekends;
- Total nurse staff turnover within a given year;
- RN turnover with a given year; and
- Number of administrators who have left the nursing home within a given year.
Ratings are updated quarterly. A summary of the changes to the methodology is in the fact sheet link below.
Details of the methodology can be found in the link to the Technical Guide below.
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COVID-19 Boosters to be Updated with Omicron Variant
The US FDA's Vaccines and Related Biological Products Advisory Committee (VRBOAC) held a virtual meeting on June 28th, 2022, to discuss whether a change to the current vaccine strain composition of COVID-19 vaccine booster doses is necessary for the 2022 fall and winter seasons.
A majority of the committee voted in favor of including a SARS-CoV-2 Omicron component in COVID-19 vaccines that would be used for booster doses. The FDA has advised vaccine manufacturers seeking to update their COVID-19 vaccines to develop modified vaccines to add an Omicron BA.4/5 component to their current vaccine compositions to create two component (bivalent) booster vaccines. Please do not wait to get your COVID-19 booster, find a vaccine provider today.
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Revised Guidance for F563 Right to Receive /
Deny Visitors
CMS revised visitor restriction guidance in F563 to help protect the health and safety of residents and staff. The revised guidance indicates that the facility may need to modify their visitation practices during infectious outbreaks or pandemics to align with the current CMS guidance and CDC guidelines that enables maximum visitation. The guidance emphasizes the importance of adhering to the principles of infection prevention during visitation, the importance of educating visitors and contacting local health authorities for guidance during outbreaks.
The revised guidance also allows for the denial of access or allows for supervised visitation to individuals who have a history of bringing illegal substances into the facility which places residents’ health and safety at risk. It stresses the importance for facility staff to have knowledge of signs, symptoms, and triggers of possible illegal substance use such as changes in resident behavior, increased unexplained drowsiness, lack of coordination, slurred speech, mood changes, and/or loss of consciousness, particularly after interaction with visitors or leaves of absence.
Facilities should ensure their policies and procedures reflect the revised guidance and that residents, visitors and staff have been educated on the revised guidance. Please review the advanced copy of Appendix PP for the complete requirement at F563. The CMS new and revised guidance will go into effect on October 24, 2022, please see QSO-22-19-NH. Contact EPIC team member Kay Huff for further questions.
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ABHR Dispensers
and Carpeting
Alcohol-based hand rub (ABHR) dispenser are obviously common-place in all health care facilities and senior living communities as well as just about every place else in today's world. A hazard exists when these devices are placed over a carpeted area and the ABHR solution saturates the carpeting when solution drips out of the dispenser.
ABHR foam dispensers are specifically prohibited from being installed over carpeted areas and standard ABHR liquid dispensers should not be installed in these areas as a best practice.
Remember, ABHR solution can contain up to 95% alcohol which is a highly flammable liquid. Be sure to follow manufacturer's guidelines and code requirements when installing and utilizing ABHR dispensers in your facility.
Contact DR/EPIC Consultant Stan Szpytek with any questions at stan@azhca.org.
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Antibiotic Stewardship Materials Website Progress
During June and July, EPIC's Dr. Peter Patterson presented workshops to teams from facilities wishing to upgrade their existing antibiotic stewardship programs to a results-oriented uniform standard. A comprehensive set of materials was provided to the workshop registrants. These materials are now being compiled into a complete set to be posted on the EPIC website: https://epic.disasterreadyaz.org/.
A live link will be provided soon, linking these materials to the ADHS HAI stewardship website and a cross-link on the ADHS site will also be offered. Special thanks to Dr. Patterson and Dr. Mandana Naderi of ADHS for this collaboration. Stay tuned.
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NHSN Clarifies Definition of Up to Date Vaccination in COVID-19 Vaccination Modules
In June 2022, the National Healthcare Safety Network (NHSN) began using the updated definition of up-to-date COVID-19 vaccination issued by the CDC. All facility types reporting data through the COVID-19 Vaccination Module must use the updated definition.
Up-to-date COVID-19 vaccination includes:
- An individual who has received all doses in the primary series and all recommended booster doses, when eligible.
- Most individuals who are 50 years and older and have received a second booster dose
Reporting of up-to-date vaccination status is summarized in the table below.
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*Individuals with a moderately to severely immunocompromising condition are considered up to date in the following cases:
- Received an additional dose less than three months ago, if primary series was the Moderna or Pfizer-BioNTech COVID-19 vaccine; or
- Received an additional dose less than two months ago, if primary series was the Janssen COVID-19 vaccine; or
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Received an additional dose and one booster dose less than four months ago;
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Received a second booster dose.
If data does not reflect the updated definition, facilities are encouraged to go back into NHSN and update their data.
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Alphabet Soup: A Little-Known Acronym, the R95
The health care sector is no stranger to alpha-numeric abbreviations, acronyms, and nicknames for the tools of the trade. According to AIHA, in July 2022 NIOSH registered the certification mark “R95” with the U.S. Patent and Trademark Office (USPTO). With the sting of COVID-19 supply chain issues still impacting us, you should know about this potential personal protective equipment (PPE) option.
As you may recall from various EPIC, AHCA or Clark Seif Clark, Inc. (CSC) educational programs, the “N” in N95, N99, N100, means the devices are “not resistant to oil”, and the “P” in P95 and P100 indicate the filters are “strongly resistant” to oil (commonly referred to as oil proof). Well, there is also an “R95” filtering facepiece respirator, that filters at least 95 percent of 0.3 micron particles (the most difficult particle size to capture). The “R” designation means the devices are “somewhat resistant” to oil. This “R” designation is also used in R99 and R100 devices. Fortunately, for the skilled nursing facility (SNF) community, an N95, P95, or R95 will each suffice for your COVID-19 programs, and likely for most other airborne infection scenarios, since airborne oils are not present in these settings.
Please remember any of these respirators necessitate compliance with the federal respiratory protection standard, 29CFR 1910.134, which requires:
- A written Respiratory Protection Program (Your program may need to be modified to include the R95 designation),
- A medical eligibility release signed by a physician or licensed health care professional (PLHCP),
- Annual respirator training,
- Annual fit testing for each make, model and size of respirator an employee intends to wear.
For more information visit:
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Check out our DR EPIC Helpline!
To submit questions, email the DR EPIC online helpline at EPIC@azhca.org. You can also call the DR EPIC phone Helpline at 602-241-4644 and we will assist you. or valuable infection prevention resources! Go to: EPIC.DisasterReadyaz.org to explore these tools.
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Questions? Contact EPIC@azhca.org |This program is funded by ADHS
The Disaster Ready Emergency Preparedness Infection Control (DR EPIC) program provides education and technical assistance for skilled nursing providers throughout the state. Individual providers will need to exercise their independent discretion in how to apply this information and technical assistance to the unique operation of each facility. For that reason, a facility’s of its professional judgment and due diligence in utilizing the program for infection control and risk management practices is solely within the facility’s control for which it is entirely responsible.
Copyright 2022.
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