HICPAC is a federal advisory committee made up of 14 external infection control experts who provide advice and guidance to the Centers for Disease Control and Prevention (CDC) and the Secretary of the Department of Health and Human Services (HHS) regarding the practice of health care infection control, strategies for surveillance and prevention and control of health care associated infections in United States health care facilities.

One of the primary functions of the committee is to issue recommendations for preventing and controlling health care associated infections in the form of guidelines, resolutions and informal communications.

Healthcare-associated infections, or HAIs, are infections that people acquire while they are receiving treatment for another condition in a healthcare setting. HAIs can be acquired anywhere healthcare is delivered, including inpatient acute care hospitals, outpatient settings such as ambulatory surgical centers and end-stage renal disease centers, and long-term care facilities such as nursing homes and rehabilitation centers. HAIs may be caused by any infectious agent, including bacteria, fungi, and viruses, as well as other less common types of pathogens.

These infections are associated with a variety of risk factors, including:

·         The use of indwelling medical devices such as bloodstream, endotracheal, and urinary catheters

·         Surgical procedures

·         Injections

·         Contamination of the healthcare environment

·         Transmission of communicable diseases between patients and healthcare workers

·         Overuse or improper use of antibiotics

Magnitude of the Problem

HAIs are a significant cause of morbidity and mortality. At any given time, one in twenty hospital patients have an HAI. Hospital-acquired HAIs alone are responsible for $28 to $33 billion dollars in preventable healthcare expenditures every year.  

Over a quarter of all hospital-acquired HAIs are caused by four types of infections:

·         Urinary tract infections (34% of all hospital-acquired HAIs)

·         Surgical site infections (17%)

·         Bloodstream infections (14%)

·         Pneumonia (13%)

Call to Action

There is growing consensus that our ultimate goal should be the elimination of HAIs. To improve coordination and maximize the efficiency of prevention efforts across the U.S. Department of Health and Human Services (HHS), a senior-level Steering Committee for the Prevention of Healthcare-Associated Infections was established in 2008. Members include clinicians, scientists, and public health leaders who are high-ranking officials from HHS, the U.S. Department of Defense, and the U.S. Department of Veterans Affairs. The Steering Committee marshaled the extensive and diverse resources across the federal government, formed public and private partnerships, and initiated discussions that identified new approaches to HAI prevention and collaborations.

In 2009, the HHS Assistant Secretary for Health created the Office of Healthcare Quality (OHQ) to support and carry out the Steering Committee’s mandate to improve healthcare quality by preventing and eventually eliminating HAIs. The Steering Committee developed the HHS Action Plan to Prevent Healthcare-Associated Infections, providing a roadmap for HAI prevention. At a meeting held in late 2010, subject matter experts met to discuss strategies to accelerate the progress towards national infection reduction goals.

 CDC issues checklist for infection prevention in out-patient settings to accompany new guide, July 2011

The checklist to accompany the 2011 infection prevention guide can be used to proactively assess infection prevention and control practices. Checklist (2011)

Infection Prevention Checklist
Section I. Administrative Policies and Facility Practices
1. Facility Policies Practice Performed If answer is No, document plan for remediation
Written infection prevention policies and procedures are available, current, and based on evidence-based guidelines (e.g., CDC/HICPAC), regulations, or standards
(Note: Policies and procedures should be appropriate for the services provided by the facility and should extend beyond OSHA bloodborne pathogen training) Yes      No  
Infection prevention policies and procedures are re-assessed at least annually or according to state or federal requirements Yes      No  
At least one individual trained in infection prevention is employed by or regularly available to the facility Yes      No  
Supplies necessary for adherence to Standard Precautions are readily available
(Note: This includes hand hygiene products, personal protective equipment, and injection equipment.) Yes      No  

 
2. General Infection Prevention Education and Training1. Practice Performed If answer is No, document plan for remediation
Healthcare Personnel (HCP) receive job-specific training on infection prevention policies and procedures upon hire and at least annually or according to state or federal requirements
(Note: This includes those employed by outside agencies and available by contract or on a volunteer basis to the facility.) Yes      No  
Competency and compliance with job-specific infection prevention policies and procedures are documented both upon hire and through annual evaluations/assessments Yes      No  

 
3. Occupational Health Practice Performed If answer is No, document plan for remediation
HCP are trained on the OSHA bloodborne pathogen standard upon hire and at least annually Yes      No  
The facility maintains a log of needlesticks, sharps injuries, and other employee exposure events Yes      No  
Following an exposure event, post-exposure evaluation and follow-up, including prophylaxis as appropriate, are available at no cost to employee and are supervised by a licensed healthcare professional Yes      No  
Hepatitis B vaccination is available at no cost to all employees who are at risk of occupational exposure Yes      No  
Post-vaccination screening for protective levels of hepatitis B surface antibody is conducted after third vaccine dose is administered Yes      No  
All HCP are offered annual influenza vaccination at no cost Yes      No  
All HCP who have potential for exposure to tuberculosis (TB) are screened for TB upon hire and annually (if negative) Yes      No  
The facility has a respiratory protection program that details required worksite-specific procedures and elements for required respirator use Yes      No  
Respiratory fit testing is provided at least annually to appropriate HCP Yes      No  
Facility has written protocols for managing/preventing job-related and community-acquired infections or important exposures in HCP, including notification of appropriate Infection Prevention and Occupational Health personnel when applicable Yes      No  
For additional guidance on occupational health recommendations consult the following resource(s):

       Guideline for Infection Control in Healthcare Personnel   [PDF - 285 KB]

       Immunization of HealthCare Personnel

       Occupational Safety & Health Administration (OSHA) Bloodborne Pathogens and Needlestick Prevention Standards

 
4. Surveillance and Disease Reporting Practice Performed If answer is No, document plan for remediation
An updated list of diseases reportable to the public health authority is readily available to all personnel Yes      No  
The facility can demonstrate compliance with mandatory reporting requirements for notifiable diseases, healthcare associated infections, and for potential outbreaks. Yes      No  

 
5. Hand Hygiene Practice Performed If answer is No, document plan for remediation
The facility provides supplies necessary for adherence to hand hygiene (e.g., soap, water, paper towels, alcohol-based hand rub) and ensures they are readily accessible to HCP in patient care areas Yes      No  
HCP are educated regarding appropriate indications for hand washing with soap and water versus hand rubbing with alcohol-based hand rub
(Note: Soap and water should be used when bare hands are visibly soiled (e.g., blood, body fluids) or after caring for a patient with known or suspected infectious diarrhea (e.g., Clostridium difficile or norovirus). In all other situations, alcohol-based hand rub may be used.) Yes      No  
The facility periodically monitors and records adherence to hand hygiene and provides feedback to personnel regarding their performance Examples of tools used to record adherence to hand hygiene   [PDF - 165 KB] Yes      No  
For additional guidance on hand hygiene and resources for training and measurement of adherence, consult the following resource(s).

       Guideline for Hand Hygiene in Healthcare Settings   [PDF - 298 KB]

       Hand Hygiene in Healthcare Settings

       List of tools that can be used to measure adherence to hand hygiene   [PDF - 165 KB]

 
6. Personal Protective Equipment (PPE) Practice Performed If answer is No, document plan for remediation
The facility has sufficient and appropriate PPE available and readily accessible to HCP Yes      No  
HCP receive training on proper selection and use of PPE Yes      No  
For additional guidance on personal protective equipment consult the following resource(s):

       2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

 
7. Injection Safety Practice Performed If answer is No, document plan for remediation
Medication purchasing decisions at the facility reflect selection of vial sizes that most appropriately fit the procedure needs of the facility and limit need for sharing of multi-dose vials Yes      No  
Injections are required to be prepared using aseptic technique in a clean area free from contamination or contact with blood, body fluids or contaminated equipment Yes      No  
Facility has policies and procedures to track HCP access to controlled substances to prevent narcotics theft/diversion Yes      No  
For additional guidance on injection safety consult the following resource(s):

       2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

       CDC's Injection Safety Website

       Frequently Asked Questions (FAQs) regarding Safe Practices for Medical Injections

       CDC training video and related Safe Injection Practices Campaign materials

 
8. Respiratory Hygiene/Cough Etiquette Practice Performed If answer is No, document plan for remediation
The facility has policies and procedures to contain respiratory secretions in persons who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and continuing through the duration of the visit. Policies include: Yes      No  
Posting signs at entrances (with instructions to patients with symptoms of respiratory infection to cover their mouths/noses when coughing or sneezing, use and dispose of tissues, and perform hand hygiene after hands have been in contact with respiratory secretions.) Yes      No  
Providing tissues and no-touch receptacles for disposal of tissues Yes      No  
Providing resources for performing hand hygiene in or near waiting areas Yes      No  
Offering facemasks to coughing patients and other symptomatic persons upon entry to the facility Yes      No  
Providing space and encouraging persons with symptoms of respiratory infections to sit as far away from others as possible. If available, facilities may wish to place these patients in a separate area while waiting for care Yes      No  
The facility educates HCP on the importance of infection prevention measures to contain respiratory secretions to prevent the spread of respiratory pathogens when examining and caring for patients with signs and symptoms of a respiratory infection. Yes      No  
For additional guidance on respiratory hygiene/cough etiquette consult the following resource(s):

       2007 Guidelines for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings

       Recommendations for preventing the spread of influenza

 
9. Environmental Cleaning Practice Performed If answer is No, document plan for remediation
Facility has written policies and procedures for routine cleaning and disinfection of environmental services, including identification of responsible personnel Yes      No  
Environmental services staff receive job-specific training and competency validation at hire and when procedures/policies change Yes      No  
Training and equipment are available to ensure that HCP wear appropriate PPE to preclude exposure to infectious agents or chemicals (PPE can include gloves, gowns, masks, and eye protection) Yes      No  
Cleaning procedures are periodically monitored and assessed to ensure that they are consistently and correctly performed Yes      No  
The facility has a policy/procedure for decontamination of spills of blood or other body fluids Yes      No  
For additional guidance on environmental cleaning consult the following resource(s):

       Guidelines for Environmental Infection Control in Healthcare Facilities   [PDF - 285 KB]

 
10. Reprocessing of Reusable Instruments and Devices Practice Performed If answer is No, document plan for remediation
Facility has policies and procedures to ensure that reusable medical devices are cleaned and reprocessed appropriately prior to use on another patient (Note: This includes clear delineation of responsibility among HCP.) Yes      No  
Policies, procedures, and manufacturer reprocessing instructions for reusable medical devices used in the facility are available in the reprocessing area(s) Yes      No  
HCP responsible for reprocessing reusable medical devices are appropriately trained and competencies are regularly documented (at least annually and when new equipment is introduced) Yes      No  
Training and equipment are available to ensure that HCP wear appropriate PPE to prevent exposure to infectious agents or chemicals (PPE can include gloves, gowns, masks, and eye protection). (Note: The exact type of PPE depends on infectious or chemical agent and anticipated type of exposure.) Yes      No  
The above basic information allows for a general assessment of policies and procedures related to reprocessing of reusable medical devices. Ambulatory facilities that are providing on-site sterilization or high-level disinfection of reusable medical equipment should refer to the more detailed checklists related to sterilization and high-level disinfection in separate sections of this document devoted to those issues.

Critical items (e.g., surgical instruments) are objects that enter sterile tissue or the vascular system and must be sterile prior to use (see Sterilization Section).

Semi-critical items (e.g. , endoscopes for upper endoscopy and colonoscopy, vaginal probes) are objects that contact mucous membranes or non-intact skin and require, at a minimum, high-level disinfection prior to reuse (see High-level Disinfection Section).

Non-critical items (e.g., blood pressure cuffs) are objects that may come in contact with intact skin but not mucous membranes and should undergo cleaning and low- or intermediate-level disinfection depending on the nature and degree of contamination.

Single-use devices (SUDs) are labeled by the manufacturer for a single use and do not have reprocessing instructions. They may not be reprocessed for reuse except by entities which have complied with FDA regulatory requirements and have received FDA clearance to reprocess specific SUDs.

Note: Pre-cleaning must always be performed prior to sterilization and/or disinfection

For additional guidance on reprocessing of medical devices consult the manufacturer instructions for the device and the following resource(s):

       Guideline for Disinfection and Sterilization in Healthcare Facilities

       FDA regulations on reprocessing of single-use medical devices

 
11. Sterilization of Reusable Instruments and Devices Practice Performed If answer is No, document plan for remediation
All reusable critical instruments and devices are sterilized prior to reuse Yes      No  
Routine maintenance for sterilization equipment is performed according to manufacturer instruction (confirm maintenance records are available) Yes      No  
Policies and procedures are in place outlining facility response (i.e., recall of device and risk assessment) in the event of a reprocessing error/failure. Yes      No  
For additional guidance on sterilization of medical devices consult the manufacturer instructions for the device and the following resource(s):

       Guideline for Disinfection and Sterilization in Healthcare Facilities

 
12. High-Level Disinfection of Reusable Instruments and Devices Practice Performed If answer is No, document plan for remediation
All reusable semi-critical items receive at least high-level disinfection prior to reuse Yes      No  
The facility has a system in place to identify which instrument (e.g., endoscope) was used on a patient via a log for each procedure Yes      No  
Routine maintenance for high-level disinfection equipment is performed according to manufacturer instruction; confirm maintenance records are available Yes      No  
For additional guidance on reprocessing of high-level disinfection devices consult the manufacturer’s instructions for the device and the following resource(s):

       Guideline for Disinfection and Sterilization in Healthcare Facilities