The 2024 Joint Commission Infection Prevention and Control Chapter - The Role of Cleaning Surfaces in Close Proximity to the Patient

Author: J. Darrel Hicks

Effective July 1, 2024, a fully revised Infection Prevention and Control (IC) chapter, including new and revised requirements, has been approved for all Joint Commission-accredited critical access hospitals and hospitals. The goal of the IC chapter rewrite was to help organizations develop a strong framework for their IC programs, while aligning requirements more closely to law and regulation and the U.S. Centers for Medicare & Medicaid Services (CMS) Conditions of Participation (CoPs).

In keeping with the ongoing initiative to simplify standards content and structure, The Joint Commission eliminated requirements that do not add value to accreditation surveys so that organizations can focus on the structures that support IC quality and safety. The rewrite resulted in a 70% reduction of EPs in the chapter.

After a review of the literature and consultation with a technical advisory panel, The Joint Commission decided to introduce new Standard IC.07.01.01 and two new elements of performance (EPs) to enhance hospitals’ and critical access hospitals’ preparedness for high-consequence infectious diseases or special pathogens.

The recent history of infectious disease outbreaks, including severe acute respiratory syndrome (SARS), H1N1 influenza, Middle East respiratory syndrome (MERS), Ebola, and the COVID-19 pandemic, has clearly demonstrated that emerging infectious diseases pose a real threat to human health and can cause significant disruptions in health care delivery systems on local, national, and global scales.

A standardized approach to preparedness for high-consequence infectious diseases or special pathogens is intended for emergency care areas but would also serve to strengthen basic infection control protocols and processes for routine, non–special pathogen infectious agents.

In addition, The Joint Commission created a new IC Assessment Tool that details the IC practices and structures needed to meet the IC requirements. The tool was developed using regulations, CMS survey procedures, the CMS Hospital Infection Control Worksheet, the US Centers for Disease Control and Prevention (CDC) Core IC Practices, and Category IA recommendations from CDC guidelines.

The new tool is posted to the Joint Commission Connect® extranet site (Go to “Survey Process” tab, under “Pre-Survey” menu, click on "Survey Activity Guide" and scroll down to "Additional Resources") for accredited critical access hospitals and hospitals; it will be added to the Critical Access Hospital and Hospital Organization Survey Activity Guides in spring 2024.

Here is the New Element of Performance pertaining to cleaning and disinfection of hospitals,

Element(s) of Performance for IC.06.01.01

1. “To prioritize the program’s activities, the hospital identifies risks for infection, contamination, and exposure that pose a risk to patients and staff based on the following: - Its geographic location, community, and population served - The care, treatment, and services it provides - The analysis of surveillance activities and other infection control data - Relevant infection control issues identified by the local, state, or federal public health authorities that could impact the hospital
2. Note: Risks may include organisms with a propensity for transmission within health care facilities based on published reports and the occurrence of clusters of patients (for example, norovirus, respiratory syncytial virus [RSV], influenza, measles, and organisms with antimicrobial resistance such as Carbapenem-resistant Enterobacterales [CRE], Candida auris).‍
3. The hospital implements activities for the surveillance, prevention, and control of health care–associated infections and other infectious diseases, including maintaining a clean and sanitary environment to avoid sources and transmission of infection, and addresses any infection control issues identified by public health authorities that could impact the hospital.”

The proper cleaning and disinfection of hospital surfaces is critical to keeping patients safe from HAIs.

Environmental Services leaders and staff deal with tough issues on a daily basis that create roadblocks to doing their job effectively. Topping the list of concerns:

• Pressure to speed up room turns
• Unclear responsibility for who cleans mobile patientcare equipment
• High staff turnover, absenteeism, unfilled vacant positions, scheduled PTO, injured on the job, etc.

Multiple studies have shown that less than half of hospital room surfaces are adequately cleaned and disinfected;

The "CDC’s Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings” states in section 5b. Environmental Cleaning and Disinfection, References and resources: 5.1.a

• ‍Require routine and targeted cleaning of environmental surfaces as indicated by the level of patient contact and degree of soiling.
• Clean and disinfect surfaces in close proximity to the patient and frequently touched surfaces in the patient care environment on a more frequent schedule compared to other surfaces.

The New and Revised 2024 TJC Infection Control Chapter Requirements reference the need for healthcare facilities to follow the CDC's guidance in respect to the frequent cleaning of those surfaces "in close proximity to the patient and frequently touched surfaces."

Those surfaces include but are not limited to:

• Privacy curtains are porous surfaces that cannot be disinfected; instead, the curtain must be exchanged for a clean, fresh curtain according to the facility protocol for the frequency of curtain exchanges.
• The patient’s overbed table.
• Bed rails including TV controls and nurse call button
• Phone
• Bedside table
• Bedside commode
• Walker or wheelchair
• IV pole and pump
• Furniture
• Wastebasket
• Restroom toilet, grab-bar, sink, light switch

TJC surveyors will likely ask questions of the EVS and nursing staff about the hospital disinfectant they use. “What is the contact or dwell time?” They need to verbalize or read from the product label, “It says right here __ minutes.” That is demonstrating they are following label instructions.

Or they might ask the same staff members about donning and doffing PPE. Hospital workers should never leave the patient’s room while wearing isolation gowns or gloves.Staff should perform hand hygiene before donning gloves and after removing gloves.

With these new Infection Control standards, the Joint Commission is judging a healthcare facility’s ability to protect patients from HAIs today, tomorrow and for the long-term future.

If it was 7/1/24 would your facility be ready for a TJC survey under the new Standard IC.07.01.01 and two new elements of performance (EPs) to enhance hospitals’ and critical access hospitals’ preparedness for high-consequence infectious diseases or special pathogens?