CMS developed optional toolkits to aid nursing home teams with reducing adverse events and improving dementia care. These toolkits were the result of CMS work with nursing home Breakthrough Communities—a learning collaborative design where a subset of nursing homes joined learning sessions and team calls to learn about quality improvement concepts.

Memorandum Summary

The Centers for Medicare & Medicaid Services (CMS) is announcing the release of two toolkits that align with the CMS strategic initiative to Ensure Safety and Quality in Nursing Homes.

• Developing a Restful Environment Action Manual (DREAM) Toolkit – CMS has created a toolkit that offers education and person-centered, practical interventions that nursing home administrators, directors of nursing, and bedside staff can implement to promote high-quality sleep for residents living with dementia.

• Head-to-Toe Infection Prevention (H2T) Toolkit – CMS has created a toolkit that offers educational materials and practical interventions for bedside staff designed to prevent common infections by improving activities of daily living (ADL) care.

Infections comprise a large share of adverse events in nursing homes. The Head to Toe Infection Prevention Toolkit contains educational materials and practical tools to support the clinical team in providing person-centered care that helps prevent and control common infections like pneumonia, skin infections, and urinary tract infections. The Toolkit aims to educate licensed nurses and nurse aides on infection prevention practices and provide tools that can be integrated into their daily work.

The H2T Toolkit consists of the following components:

1) Implementation Guide

2) Infection Prevention Handbook

3) Staff Presentation

4) Resource for Residents and Loved Ones

5) Observation Guide

6) Customizing Care Tool

7) Suspected Infection Investigation Tool

Changes in the 2020 Adult Immunization Schedule

Changes in the 2020 adult immunization schedule for persons aged ≥19 years include new or revised recommendations for hepatitis A vaccine (HepA) (2); human papillomavirus vaccine (HPV) (3); influenza vaccine (4); serogroup B meningococcal vaccine (MenB); pneumococcal vaccine (5); and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) (6). Following are the changes to the cover page, Table 1, Table 2, and Notes.

Cover page

• Trademark symbols (®) were added to all vaccine trade names.
• PedvaxHIB was added to the table of trade names for Haemophilus influenzae type b vaccine.
• The footnote on the cover page has been edited and now reads “Do not restart or add doses to vaccine series if there are extended intervals between doses.”

Table 1

• Age ranges: The columns for age groups 19–21 years and 22–26 years have been combined, thereby reducing the number of columns for age ranges from five to four. This change was made because of the change in recommendation for catch-up HPV vaccination for all adults aged ≤26 years.
• Tetanus, diphtheria, pertussis row: This row has been edited to state that tetanus and diphtheria toxoids (Td) or Tdap may be used for the decennial tetanus booster.
• Human papillomavirus (HPV) row: The rows for males and females have been combined, reflecting that catch-up vaccination is now recommended for all adults aged ≤26 years. In addition, a blue box has been added for persons aged 27–45 years to indicate that shared clinical decision-making regarding vaccination is now recommended for this group.
• Pneumococcal conjugate (PCV13) row: The box for persons aged ≥65 years who do not have an additional risk factor or another indication has been changed to blue to indicate that shared clinical decision-making regarding vaccination is now recommended for this group.
• Meningococcal B (MenB) row: A blue box has been added for persons aged 19–23 years who are not at increased risk for meningococcal disease, indicating that shared clinical decision-making regarding vaccination is now recommended for this group.
• Legend: A blue box has been added to indicate that shared clinical decision-making is recommended regarding vaccination. The text defining the gray box has been edited and now reads “No recommendation/not applicable.”

Table 2

• Tdap or Td row: This row has been revised to read that Td or Tdap may be used for the decennial tetanus booster.
• Human Papillomavirus (HPV) row: This row has been combined into a single row including both males and females, reflecting that HPV vaccine is now recommended for all adults aged ≤26 years.
• Hepatitis A (HepA) row: The box for persons living with human immunodeficiency virus (HIV) infection (regardless of CD4 count) is now yellow, reflecting the new recommendation that previously unvaccinated persons in this group should be vaccinated.
• Legend and bar text: The gray box in the Legend has been edited and now reads “No recommendation/not applicable.” The red box has been edited and now reads “Not recommended/contraindicated — vaccine should not be administered.” The text appearing in the red bars has been changed from “Contraindicated” to “Not Recommended.”

Memo #20-09-ALL

Posting Date 2020-02-06

Fiscal Year 2020

Summary

• Information Regarding Patients with Possible Coronavirus Illness: the U.S. Centers for Disease Control and Prevention (CDC) has issued information on the respiratory illness caused by the 2019 Novel Coronavirus (2019-nCoV). Links to these documents are provided.
• Healthcare Facility Expectations: CMS strongly urges the review of CDC’s guidance and encourages facilities to review their own infection prevention and control policies and practices to prevent the spread of infection.

The Centers for Disease Control and Prevention (CDC) continues to closely monitor an outbreak of respiratory illness caused by a novel coronavirus (2019-nCoV) that was initially detected in Wuhan City, Hubei Province, China in December 2019.

This CDC Health Alert Network (HAN) Update provides a situational update and interim guidance to state and local health departments that supersedes guidance in CDC’s HAN 426 distributed on January 17, 2020.

CDC Emerging Infection Diseases Volume 26, Number 2—February 2020

Research

Unique Clindamycin-Resistant Clostridioides difficile Strain Related to Fluoroquinolone-Resistant Epidemic BI/RT027 Strain

Andrew M. Skinner , Laurica Petrella, Farida Siddiqui, Susan P. Sambol, Christopher A. Gulvik, Dale N. Gerding, Curtis J. Donskey, and Stuart Johnson 

Abstract

During a surveillance study of patients in a long-term care facility and the affiliated acute care hospital in the United States, we identified a Clostridioides difficile strain related to the epidemic PCR ribotype (RT) 027 strain associated with hospital outbreaks of severe disease. Fifteen patients were infected with this strain, characterized as restriction endonuclease analysis group DQ and RT591. Like RT027, DQ/RT591 contained genes for toxin B and binary toxin CDT and a tcdC gene of identical sequence. Whole-genome sequencing and multilocus sequence typing showed that DQ/RT591 is a member of the same multilocus sequence typing clade 2 as RT027 but in a separate cluster. DQ/RT591 produced a similar cytopathic effect as RT027 but showed delayed toxin production in vitro. DQ/RT591 was susceptible to moxifloxacin but highly resistant to clindamycin. Continued surveillance is warranted for this clindamycin-resistant strain that is related to the fluoroquinolone-resistant epidemic RT027 strain.

This 2019 Nursing Home Infection Control Worksheet (ICWS) is a collaborative effort by CMS and CDC and meant to be used by facilities as a self-assessment tool. It comprises both regulatory requirements and best practices in infection prevention and control. A facility that uses this ICWS will identify gaps in practice and have a “roadmap” that can lead to an improved infection prevention and control program. The assessment reviews the following domains:

• Infection Control program infrastructure and Infection Preventionist
• Infection Preventionist relationship to Quality Assurance Committee
• Infection surveillance and outbreak response.
• Influenza and pneumococcal Immunization
• Linen management
• Infection prevention during transitions of care
• Water Management Program

A key problem in many nursing homes is inadequate infection surveillance. The written standards, policies, and procedures for an infection prevention and control program (IPCP) must include “a system of surveillance designed to identify possible communicable diseases or infections before they can spread to other persons in the facility,” according to §483.80(a)(2)(i) of the Code of Federal Regulations.

"The Centers for Medicare & Medicaid Services (CMS) wants providers to have a more formalized surveillance program, says Deb Patterson Burdsall, PhD, RN-BC, CIC, FAPIC. “You have to understand the epidemiological concepts of incidence and prevalence rates; how to calculate infection rates; and how to feed that information back in a feedback loop to the frontline providers—the people who can actually do something about what is going on with infection data.”

At the conclusion of the session, the participant will be able to accomplish the following:

• Describe the burden of multidrug-resistant organisms (MDROs).
• Describe challenges to preventing MDRO transmission in nursing homes.
• Define Standard Precautions, Enhanced Barrier Precautions, and Contact Precautions.
• Identify which residents and activities meet criteria for Enhanced Barrier Precautions.
• Discuss best practices for implementing Enhanced Barrier Precautions.

Unrecognized spread of germs from healthcare personnel (HCP) contamination occurs every day in healthcare settings, posing a risk to patients and HCP alike. Recent Ebola virus outbreaks demonstrated that the potential for transmission of any pathogen in healthcare settings poses an immediate and serious threat. 

 Preventing the spread of germs in healthcare is essential to protecting the health of patients and HCP. This International Infection Prevention Week, the CDC Prevention Epicenters Program is pleased to announce a groundbreaking new journal supplement, “Personal Protective Equipment for Preventing Contact Transmission of Pathogens: Innovations from CDC’s Prevention Epicenters Program,” composed of 14 in-depth studies, published in this month’s Clinical Infectious Diseases. This research provides insights from recent personal protective equipment (PPE) work in U.S. healthcare settings. It provides evidence to improve routine use of PPE, and to prevent contact transmission of Ebola and other infectious diseases in healthcare settings.

All healthcare settings can benefit from improvements in PPE use and design. PPE plays an important role in preventing the spread of infectious diseases in healthcare settings, but its optimal design and use need to be informed by dedicated research to achieve the reliability and effectiveness needed to protect patients and HCP.