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Take a close look at your infection control program

Staff Development Weekly: Insight on Evidence-Based Practice in Education, February 7, 2008

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Joint Commission (formerly JCAHO) surveyors are looking more closely at infection control (IC) programs as of late. The new Joint Commission survey approach, which uses tracer methodology to follow a selected patient through the entire continuum of care, is very different in scope than surveys from the old days. Surveyors seem to go off and follow whatever lead they find. Because of this new and unpredictable format, it's more important than ever to ensure that your facility is ready when The Joint Commission pays a visit. Below are some tips to give you a starting point to make preparations.

• Examine your processes and look for potential holes. Never assume staff members are following your policies. Confirm it periodically with spot checks.
• Rehearse with staff members. Even the most competent and knowledgeable staff member can turn into a deer in headlights when approached by a surveyor. Have staff members role-play, write scripts, or otherwise practice explaining how the department implements your IC program, so they can respond capably when called upon.
• Ensure proper and thorough documentation. Keep on top of your processes to ensure that your staff members appropriately document everything your department does.
• Ensure facility cleanliness. One aspect to monitor is the cleaning and disinfection of portable medical equipment. Establish systems to identify how, when, and where staff members will clean the units to prevent lapses.

To get more information, go to Briefings on Infection Control (BOIC). For the cost of just three stories, you can get the entire February issue of BOIC. Click here to choose between the PDF and HTML versions for just $30. Subscribers to the online version of BOIC have free access to this article. Subscribers to the print newsletter can find this article in their February issue.

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