INFECTION CONTROL NEWSLETTER

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May/June 2000
written by and for Long Term Care Infection Control Nurses

Broad Street Solutions
James Marx, RN, MS, CIC Editor
PO Box 16557
San Diego, CA 92176
(619) 656-7887 Voice/FAX
jmarx@BroadStreetSolutions.com

Surveillance System tune-up

While an infection surveillance system is not required in a skilled nursing facility, the Federal Survey requirements state that, "The facility must establish an infection control program under which it--(1) Investigates, controls and prevents infections in the facility." Most facilities accomplish this by implementing an infection surveillance program.

There is no specific requirement that all infections need to be investigated, however most facilities perform total house surveillance. This means that all residents are monitored at all times for infections at all body sites. This can become very time consuming and frequently results in information that is either old or incomplete.

You might consider limiting surveillance activities to infections that are most common, are most easily reduced, are most costly to treat, or cause the highest morbidity. The area of need will vary from facility to facility. For example, a skilled facility that is part of a hospital system and receives postoperative patients for rehabilitation may want to include a surgical site infection component to assist the hospital. In a free standing facility with many long term residents, surveillance of lower respiratory tract infections may be way to reduce morbidity and mortality associated with pneumonia and influenza. This monitor also is easy to influence with vigilant immunization programs, identifying residents at risk of aspiration and ambulating programs. Ask the following questions:

Do you understand why you perform surveillance, other than it is expected as part of your job?

Do you perform surveillance every day, or at least weekly?

Do you report surveillance data back to the direct care givers and others who help collect the information?

Do you have and are you using a written definition of infection for surveillance?

Is your surveillance report visually presented? Are you comparing your facility's infection rates against a known or targeted rate?

A variety of infection on surveillance is available on the internet. As a starting point, look at these web sites:

Lee TB, Baker OG, Lee JT, Scheckler WE, Steele L, Laxton CE, APIC Surveillance Initiative
Working Group. Recommended Practices for Surveillance. American Journal of Infection
Control 1998;26:277-288. http://www.apic.org/html/resc/surveill.html

McGeer A, Campbell B, Emori TG, Hierholzer WJ, Jackson MM, Nicolle LE, Peppler C,
    Rivera A, Schollenberger DG, Simor AE, Smith PW, Wang E. Definitions of Infection for
    Surveillance in Long Term Care Facilities. American Journal of Infection Control 1991;19(1):1-7.
    http://www.apic.org/html/pdf/ltcdefs.pdf

MedicareBiiling for Pneumococcal Vacciantion

Effective July 1, 2000 Medicare will no longer require a doctor's order for receiving the pneumococcal pneumonia vaccination (PPV). This according to Transmittal 363 of the Medicare Skilled Nursing Facility Manual. Medicare Part B pays 100 percent for PPV and influenza virus vaccines. Deductible and copayments do not apply. Beneficiaries may receive the vaccine upon request without a physician's order and without a physician's supervision. This is already the case with influenza virus vaccination.