Agency for Healthcare Research and Quality, US Department of Health and Human Services
This agency works in numerous areas including healthcare-acquired infections. They provide funding for special research projects to determine how best to prevent and then control healthcare- acquired infections. Examples of the grant topics include Barriers and Challenges for Preventing HAIs in 34 Hospitals; Initiative Examines Tools and Interventions to Assist Hospitals in Reducing HAIs; Hand Hygiene is Important for Preventing HAIs; Testing Spread and Implementation of MRSA-Reduction Practices; etc. (See endnote 57.)
Centers for Disease Control and Prevention
Healthcare-associated infections monitoring systems and specialized training materials from the CDC are essential to the work of the modern environmental health and infection control specialists, since they provide rapid information on disease problems. They are as follows:
- • Active Bacterial Core Surveillance, ABCs (cdc.gov/abcs/index.html). This surveillance system is used to determine and record invasive bacterial pathogens of public health importance.
- • Emerging Infections Program, EIP (cdc.gov/hai/eip/). This surveillance system and research network made up of 10 state health departments and academic units works with CDC in developing innovations in surveillance, evaluating epidemiology techniques, and evaluating practices in all areas of health care.
- • The Healthcare Infection Control Practices Advisory Committee is a federal advisory committee whose function is to advise and guide the CDC and the Secretary of the US Department of Health and Human Services on Best Practices for surveillance, prevention, control of healthcare-associated infections, and antimicrobial resistance.
- • The National Healthcare Safety Network, NHSN (cdc.gov/nhsn/). This very secure internet public health surveillance system is very frequently used by all types of healthcare facilities in all 50 states, collecting data on patient safety and employee safety including injuries and infections to: help establish appropriate surveillance techniques; determine the amount and type of healthcare-associated infections in the healthcare facility, similar types of healthcare facilities, state or region and the epidemiological pattern of the causative agents; see the facilities healthcare-associated infection data in real time; use appropriate measures to reduce the problems; establish priorities for eliminating these infection problems; comply with the state and federal reporting rules. The CDC through the National Healthcare Safety Network provides a series of training modules relating to Best Practices for various procedures, use and cleaning of medical devices, antimicrobial use and resistance including C. difficile. It provides an in-depth series of reports from current and previous data. This network provides information for healthcare personnel on problems related to blood/body fluids exposure and management of body fluids, as well as influenza exposure and vaccination. It provides modules for insertion practices and bloodstream infections as well as discussions on problems of infections related to ventilators, catheters, dialysis treatments, surgery, and anti-microbial use and multidrug resistance.
- • Surveillance for Emerging Antimicrobial Resistance Connected to Healthcare (S.E.A.R.C.H.). This surveillance system is made up of a group of voluntary participants from hospitals, state health departments, professional organizations, and clinical microbiology laboratories that are reporting the isolation of S. aureus which is suspected of being resistant to vancomycin.
- • CDC Healthcare Infection Control Practices Advisory Committee General Guidelines provides internet sites for specific guidelines on: disinfection and sterilization in healthcare facilities; isolation precautions; environmental infection control; hand hygiene; public reporting of healthcare-associated infections; device-associated infection prevention; procedure-associated infection prevention; prevention and control of drug-resistant organisms; a norovirus prevention toolkit; multi-drug-resistant organisms; and healthcare personnel guidelines.
- • CDC Healthcare Infection Control Practices Advisory Committee General Guidelines presents resources on: Biological Hazards and Control; Physical Hazards and Controls; Safety; Slips, Trips, and Falls; Violence; Reproductive Health; Dentistry; Emergency Preparedness and Response; CDC Emergency Preparedness and Response; and Surveillance and Statistics.
- • The National Health Worksite Program helps employers implement science-based Best Practices in prevention and control of chronic illnesses and disabilities due to employment.
• Emergency Department Ebola Preparedness Training Videos include specialized modules: Considerations for Preparedness; Screening Patients for Ebola Risk Factors and Symptoms; Isolation of a Patient with Ebola Risk Factors and Symptoms; and Evaluate and Briefly Manage Patients: Ebola Assessment Hospitals.
The Office of Public Health Preparedness and Response, which is part of the CDC, is the lead agency working with local and state health departments to save lives and protect communities from public health threatening situations. It operates the CDC Emergency Operations Center. It provides strategic direction, teams of experts, support services, coordination of all activities at the local, state, tribal, national, and international levels, funding, and technical assistance. It is involved in the strategic national stockpile preparedness system, and works with select agents and toxins. It helps with emergency operations, education, and training. (See endnote 45.)
The National Institute for Occupational Safety and Health (NIOSH) provides a website (cdc.gov/niosh/) with a variety of topics including biological, chemical, and physical hazards, and controls, etc. The latest information in these areas, and rules and regulations are presented.
The Occupational Safety and Health Administration (OSHA) mission is to save lives, prevent injuries, and protect the health of the workers of the United States. It is involved in every workplace within the country. Hospitals have to meet a large number of standards established by OSHA covering: hospital investigations: health hazards; blood-borne pathogens standard; healthcare-wide hazards—electrical; fire prevention plans; use of fire extinguishers; cardiopulmonary resuscitation (CPR) and self-contained breathing apparatus; chemical spill control procedures; search and emergency rescue procedures; hazardous materials emergency response; emergency communications; communication programs for employers using hazardous chemicals; etc.
Along with the standards that are issued are numerous documents in Best Practices in all areas within healthcare institutions. Some of these documents cover the following departments: administration, central supply, clinical services, dietary, emergency, engineering, housekeeping, ICU, laboratory, laundry, pharmacy, and surgical suite. Common topics and potential solutions are given for the following areas: ergonomics (reaching, lifting, repetitive motions, etc.); equipment and machine guards; tire safety; hazardous chemicals; healthcare-associated infections and infectious diseases; slips, trips, and falls; electrical safety; and infectious materials.
The European Agency for Safety and Health at Work has produced a document entitled “Occupational Health and Safety Risks in the Healthcare Sector-Guide to Prevention and Good Practice” (see endnote 63) which discusses the following six major topics: management’s role in health prevention and promotion; how to perform a risk assessment; biological risks; musculoskeletal risks; psychosocial risks; and chemical risks. This guide presents up-to-date technical and scientific knowledge concerning the prevention and control of various occupational risks.
The Society for Healthcare Epidemiology of America provides a compendium of a variety of strategies used to prevent healthcare-associated infections. The document is entitled, “Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals.” (See endnote 17.)
The Joint Commission is a not-for-profit independent agency that accredits more than 20,500 healthcare organizations throughout the country. Without this accreditation hospitals and other healthcare facilities have great difficulty in operating. Their mission is to improve health care for the public by evaluating healthcare organizations and providing a variety of training modules and Best Practices papers to improve quality of care. Healthcare facilities must receive on-site evaluations every 3 years and laboratories every 2 years. Many of the documents and standards established by The Joint Commission are available for use by healthcare facilities to upgrade their existing protocols and practices.
The Joint Commission establishes health and safety standards based on OSHA requirements. These standards are in several categories: management leadership; employee involvement; worksite analysis; hazard prevention and control; safety and health training; and annual evaluation.
The Institute for Healthcare Improvement of Cambridge, Massachusetts, has three critical objectives: improving the health of certain populations, enhancing patient care, and reducing or controlling the cost of health care. They work in conjunction with numerous other health organizations including the CDC, Association for Professionals in Infection Control and Epidemiology, public health systems, healthcare delivery systems, the community, the state, universities, and private organizations to improve health care including the control of healthcare-associated infections as is shown in their “How-to Guide: Improving Hand Hygiene.” (See endnote 64.)