As widely reported in the media, an outbreak of a new strain of coronavirus — 2019-nCoV — presents an ongoing threat across the globe. The Joint Commission supports the Centers for Disease Control and Prevention (CDC) and other public health partners as being the appropriate source of information and guidance for health care organizations and providers regarding the virus.
Because this situation is changing rapidly and advice may change, all organizations are recommended to have someone assigned to actively review information and guidance as it becomes available and to evaluate the need to modify current practices and communications within their organization. Organizations also are encouraged to review their internal and external communication systems to ensure that those responsible know how to contact their local health authority during the day or night in the event of a suspect case.
The CDC’s Infection Control webpage for health care professionals addresses several important areas, including:
- Minimizing the chance of exposure by working to identify patients before arrival (e.g., asking screening questions for patients calling for appointments) and as early as possible upon arrival (e.g., place signs for patients advising them to put on a mask if they have respiratory symptoms).
- Implementing triage procedures to detect 2019-nCoV during or before patient triage or registration (e.g., at the time of patient check-in) and ensuring that all patients are asked about the presence of symptoms of a respiratory infection and history of travel to areas experiencing transmission of 2019-nCoV or contact with possible 2019-nCoV patients.
- If screening at triage is positive and the patient becomes a “person under investigation” (PUI), this should be communicated directly to the clinicians who will care for the patient, prevention and control services, and other health care facility staff according to a standard protocol.
- Adhering to standard contact and airborne precautions, including eye protection.
- Monitoring stock and the supply chain of personal protective equipment.
- Managing visitor access and movement within the facility.
- Implementing mechanisms and policies to promptly alert key facility staff — including infection control, health care epidemiology, facility leadership, occupational health, clinical laboratory and frontline staff — about known or suspected 2019-nCoV patients.
- Identifying specific staff to communicate and collaborate with state or local public health authorities.
- Reminding staff that some patients infected with 2019-nCoV will present with atypical symptoms — such as nausea, diarrhea, or abdominal pain (Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. Published online February 07, 2020. doi:10.1001/jama.2020.1585.)
- Patients who have recently visited China with symptoms whose etiology remains unknown should still be evaluated for 2019-nCoV.
Also, organizations are reminded of these currently required routine practices that will decrease the risk of transmission of any infectious agent:
- Have a clear system notifying patients of their role in preventing the transmission of communicable diseases. Most organizations do this by posting materials provided through the CDC, such as respiratory etiquette and providing access to hand hygiene products and masks.
- Ensure that staff at points of entry and intake know how to screen and respond to patients or visitors who may be infectious. Symptoms may include cough, fever, rash, diarrhea and vomiting.
- Implement all elements of standard precautions as outlined in the CDC Core Practices, including:
- Hand hygiene
- Environmental cleaning and disinfection
- Risk assessment with use of appropriate personal protective equipment (e.g., gloves, gowns, face masks) based on activities being performed
- Reprocessing of reusable medical equipment between each patient and when soiled
- Hand-off communications should include notification of colonization or infection with a potentially transmissible pathogen.
- Organizations should implement a system for evaluation and management of exposed or ill health care workers and support staff that could expose patients, visitors or other staff.
Joint Commission standards require health care organizations to have a plan for dealing with a surge of infectious patients — scored at Infection Control (IC) 01.06.01. With the incidence of the coronavirus being low — as well as it being flu season — now might be a good time for organizations to perform a drill to test their procedures.
The Joint Commission’s standards were developed with an emphasis on decreasing risk and preparing organizations to respond to this type of emergency. The Joint Commission is confident that accredited organizations who follow routine practices and follow evolving CDC guidance can continue to provide for the safety of their patients, visitors and staff.
Building on the release of the Accelerate PI Dashboard Report last year for accredited home health and hospice organizations, The Joint Commission will launch supportive educational webinars in March.
Two webinars — one focusing on topics related to home health and the other on topics related to hospice — will be available to all accredited home health and hospice organizations. Complementary to the dashboard reports, these webinars are intended to be a springboard for conversations on data, performance measures and quality improvement — especially for organizations that may be struggling in these areas.
Accredited home health and hospice organizations will serve as speakers for the webinars to provide lessons learned and best practices.
Registration is open for the hourlong webinars:
Just in time for American Heart Month, Texas Health Harris Methodist Hospital Fort Worth, Texas, has been awarded the first Primary Heart Attack Center (PHAC) certification by The Joint Commission and the American Heart Association.
PHAC certification is one of The Joint Commission’s four advanced cardiac certification programs offered in collaboration with the American Heart Association. The certification standardizes and improves coordinated systems of care across settings regarding identification, assessment, monitoring, management, data sharing and performance improvement for multidisciplinary ST-elevation myocardial infarction (STEMI) heart attack care.
PHAC certification allows hospitals to be able to reassure their patients that their emergency care providers are highly prepared, experts on best practices and effective coordinators of care — from the ambulance ride and admission to discharge from the hospital.
“The PHAC certification journey helped Texas Health Fort Worth highlight the process leading to a positive outcome for the patient,” said Susan Frugè, MHA, BSN, RN, chest pain coordinator, Cardiovascular Quality Outcomes, Texas Health Harris Methodist Hospital Fort Worth. “By adopting the metric guidelines and The Joint Commission’s PHAC standards, we have benchmarks to guide our process improvement plans. The metric guidelines encouraged Texas Health Fort Worth to break down the process to reach the goal and maintain the goal [of quality heart attack care].”
The advanced cardiac certifications also include:
- Acute Heart Attack Ready
- Advanced Heart Failure
- Comprehensive Cardiac Center
Learn more about The Joint Commission cardiac certification programs.
Leading Hospital Improvement — Most Challenging Standards for Advanced Cardiac Certified Hospitals: Joint Commission surveyors have identified the most commonly cited standards for organizations in their first year of certification. The most commonly cited standards from the Comprehensive Certification Manual for Disease-Specific Care is the subject of a recent blog post by Zach George, MBA, CPA, associate director of business development for hospital certification; Antigone Kokalias, MBA, MSN, RN, project director-clinical; Angela Murray, MSN, RN, project director-clinical; and Robin S. Voss, RN, MHA, TNCC-I, surveyor and field director, Disease-Specific Care.