We all know that Ben Franklin was a diplomat, scientist, inventor, publisher, and signer of the Declaration of Independence, but few recall that he was the co-founder of America’s first public hospital, which opened in 1751. Franklin’s most famous quote, “An ounce of prevention is worth a pound of cure,” still rings very true today.

An estimated 1.2 million infections occur annually in approximately 8 million adult and pediatric home health care patients in the United States. The predominant risk factor for a home health agency infection is the presence of a medical device such as a catheter, central venous catheter or access for parenteral nutrition. (Manangan, Lilia P., et al. Emerging Infectious Diseases, 2002; Vol. 8(3) pp. 233-236).

It goes without saying that medical devices are common in hospice care as well. Because hospice agencies must approach infection control with consideration to Medicare and Medicaid Hospice Conditions of Participation (CoPs), Centers for Disease Control and Prevention (CDC) and Occupational Safety and Health Administration standards, and North Carolina’s Communicable Disease Control regulations, it is important to review these important compliance areas.

In an effort to protect the public’s health, the North Carolina Communicable Disease Control regulations prescribe certain infection control measures for “health care organizations.” A health care organization is defined as a “hospital; clinic; physician, dentist, podiatrist, optometrist, or chiropractic office; home health agency; nursing home; local health department; community health center; mental health agency; hospice; ambulatory surgical center; urgent care center; emergency room; or any other health care provider that provides clinical care.”

The North Carolina Communicable Disease Control regulations require, in part, that “each health care organization that performs invasive procedures shall implement a written infection control policy. The health care organization shall ensure that health care workers in its employ, or who have staff privileges, are trained in the principles of infection control and the practices required by the policy; require and monitor compliance with the policy; and update the policy as needed to prevent transmission of HIV and hepatitis B from health care workers to patients. The health care organization shall designate a staff member to direct these activities. The designated staff member in each health care organization shall complete a course in infection control approved by the Department.” In addition, the CoPs require hospices to “maintain and document an effective infection control program that protects patients, families, visitors, and hospice personnel by preventing and controlling infections and communicable diseases.”

The Hospice Interpretive Guidance to the CoPs at L578 provides that the hospice’s infection control program may include but should not be limited to the following:

• Educating staff on the science of infectious disease transmission;
• Protocols for addressing patient care issues and prevention of  infections related to infusion therapy, urinary tract care, respiratory tract care, and wound care;
• Guidelines on caring for patients with multi-drug-resistant organisms;
• Policies on protecting patients, staff and families from blood- borne or airborne pathogens;
• Monitoring staff for compliance with hospice policies and procedures related to infection control; and
• Protocols for educating staff and families in standard precautions and the prevention and control of infection.

The CoPs require hospices to follow accepted standards of practice to prevent transmission of infections and communicable diseases, including the use of standard precautions. During certification surveys, your staff may be asked to explain the strategies they implement to prevent infections, which include educating patients and families about prevention and how they receive timely instruction relative to standard precautions. Accepted standards of practice are usually developed by government agencies, professional organizations and associations. Hospice staff, including volunteers, should be aware that during certification surveys, the infection control measures they utilize are being observed to ensure that best practices are actually being used in homes to prevent the spread of infection. The best example that comes to mind is utilizing proper hand-washing techniques.

Remember that hospice agencies must include infection control in their quality assessment performance improvement (QAPI) efforts with surveyors who will assess whether the agency is collecting infection control data and determining from the data opportunities for improvement. This data should help you identify infection trends within your agency and measures to decrease the risk of infection. Reviewing targeted infection rates, identifying practices and factors that contribute to infections, monitoring staff compliance with the agency’s infection control policies and procedures, and utilizing data from reportable staff or patient illnesses and infections are all appropriate measures to take in your QAPI efforts. Involving the hospice leadership in QAPI initiatives is also a CoP requirement and, to that end, the QAPI Committee should keep agency leaders informed through reports on the hospice’s infection control activities
and data collected through analysis and surveillance.

One last word on Ben Franklin that relates to our health care practices today. According to the Franklin Institute, in addition to his many other inventions, on behalf of his brother, he also invented the first flexible urinary catheter.

For more information about this article, please contact Cindy Morgan of AHHC of NC at 919.971.8731 or cindymorgan@homeandhospicecare.org.