The Lowdown
Summer 2021

An Educational Resource for Long-Term Care

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​​Welcome to the latest issue of The Lowdown. The Reduction and Prevention of Health Care-Associated Infection and Long-Term Care Nursing Facilities Act of 2007 (“Act 52”) requires long-term care facilities to report specific healthcare-associated infections (HAIs) to the Patient Safety Authority (PSA) and the Pennsylvania Department of Health (DOH) through the Pennsylvania Patient Safety Reporting System (PA-PSRS) using nationally recognized guidelines and definitions. This issue will clarify some common misconceptions concerning Act 52 and PA- PSRS reporting.

​About the PSA

Our Mission—Improve the quality of healthcare in Pennsylvania by collecting and analyzing patient safety information, and advising facilities through publication, education, collaboration, and issuing recommendations for improvement

Our Vision—Safe healthcare for all patients

Our Values—Safety, integrity, continuous improvement

One way the PSA accomplishes its mission is through its journal, Patient Safety. Its articles provide timely, original, scientific evidence that can be used to improve healthcare delivery systems and educate providers about safe healthcare practices. View the journal library here​.

It’s the Law!

Act 52 of 2007 is part of the Medical Care Availability and Reduction of Error (MCARE) Act of 2002 (“Act 13”). Act 52 requires long-term care facilities to conduct facilitywide surveillance and to report HAIs to DOH, the Pennsylvania Healthcare Cost Containment Council (PHC4), and PSA through PA-PSRS. The Act is part of the Governor’s Prescription for Pennsylvania plan to eliminate HAIs.1

What Are Those Numbers and Where Are They Found?

Along with the number of HAIs, facilities need to collect denominator data (e.g., resident days, device utilization days for central lines and foley catheters) to calculate infection rates. Denominator data is collected daily, aggregated, and reported monthly.

Central lines, defined as an intravascular catheter that terminates at or close to the heart, are inserted into one of the great vessels. These include peripherally inserted central catheter (PICC) lines, dialysis catheters, or mediports. Peripheral intravenous lines and midlines are not considered central lines and are not included in the daily count.2
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Urinary catheters are indwelling catheters that pass through the urethra (i.e., foley catheter). Suprapubic catheters and nephrostomy tubes are not included in the daily device count.2

Tips to make reporting easier:
  • Use PA-PSRS forms to collect event data and device days.
  • Have others assist in collecting device days at the same time daily. (Example: the charge nurse on each unit documents the device days each day at 2 a.m. on the collection form.)
  • Obtain resident days from the billing office for the month.

No One Reported for Months! Help!

Event reporting is mandatory in Pennsylvania. If reporting has not occurred, data will need to be recreated and entered into PA-PSRS. Some suggestions to assist in recreating data include:
  • Use ADT (admission, discharge, transfer) access to identify residents with a chronic foley catheter or central line. These residents would be your base number for the month.
  • After obtaining this base number, try to identify other residents with a catheter to add to that base number.
  • Ask your billing office for a list of residents billed for catheter care kits then review the record to determine the days the catheter was in place.​

Once the denominator data is collected to the best of your ability, review culture reports and any HAI sheets from that time frame. Look at the admission date to your facility and the date of symptoms or when the culture was obtained. Eliminate any that were within 48 hours of admission to your facility to try and narrow the list. Once you have identified potential infections, the only way to verify if they are an infection is to pull the record and apply the criteria. If it meets criteria, it is an infection and must be reported. Document and keep a record of the steps taken to obtain the data. Infection control surveillance is a lot of legwork and does take time.

​“It Takes a Village”

Certified nursing assistants (CNAs) play an important role in infection identification because they provide most of the hands-on care. CNAs typically have keen observational abilities, are attuned to the resident’s baseline status, and are likely to note subtle changes quickly. Educate your CNAs on the signs and symptoms of infection as defined in the revised McGeer criteria to leverage their often unique and important perspective.3,4,5

Environmental Services (EVS) personnel are also critical in preventing infection by maintaining a clean care environment.

Practicing good environmental hygiene:6
  • Will help your healthcare team win the battle of infection control.
  • Will help create a safe environment for patients and staff. The patient environment can facilitate transmission of bacteria and viruses. Enterococci and staphylococci can survive on surfaces for months!
Environmental cleaning tips to consider:6
  • ​Include policies and procedures for routine cleaning and disinfection in your facility’s infection prevention plan.
  • Place emphasis on high-touch surfaces.
  • Assign responsibility for cleaning to properly trained personnel.
  • Monitor cleaning practices to ensure they are performed correctly and consistently and provide timely feedback.
  • Use an Environmental Protection Agency (EPA) registered disinfectant labeled for use in healthcare and follow the manufacturer’s instructions for use (e.g., amount, dilution, contact time, safe use, disposal).
  • Label containers with date and time.
  • Document completion of terminal and scheduled cleanings using a standard checklist and/or log.
  • Avoid spray bottles which can aerosolize microorganisms and may not adequately wet the surface to allow the appropriate contact time.
​Additional environmental cleaning tools and resources are available from the Centers for Disease Control and Prevention (CDC) at https://www.cdc.gov/hai/ toolkits/appendices-evaluating-environ-cleaning.html.
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References
  1. Act of Jul. 20, 2007, Pa. Laws 331, No. 52. http://www.legis.state.pa.us/cfdocs/ legis/li/uconsCheck.cfm?yr=2007&sessInd=0&act=52#
  2. National Healthcare Safety Network (NHSN). Patient Safety Component Manual (2021) https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf
  3. Allemann H, Sund-Levander M. Nurses’ Actions in Response to Nursing Assis- tants’ Observations of Signs and Symptoms of Infections Among Nursing Home Residents. (2015). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5006863/
  4. Ball, W. (2020) Sweet Sixteen: Top Qualities of a Great CNA. https://cna.plus/cer- tified-nurse-assistant-top-qualities/
  5. Tingström P, Milberg A, Sund-Levander M. Early Nonspecific Signs and Symp- toms of Infection in Institutionalized Elderly Persons: Perceptions of Nursing Assistants. Scand J Caring Sci. 2010 Mar;24(1):24-31. doi: 10.1111/j.1471- 6712.2008.00680.x. Epub 2009 Nov 30. PMID: 19954493.
  6. Sehulster L, Chinn RYW, the Healthcare Infection Control Practices Advisory Com- mittee (HICPAC). Guidelines for Environmental Infection Control in Health-CaFe facilities. Atlanta (GA): Centers for Disease Control and Prevention, 2003.​​