With the release of the CMS mandate requiring the use of EBP in certain circumstances, we offer information related to common questions.
Regulation and Guidance for F880
- §483.80 Infection Control The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.
- §483.80(a) Infection prevention and control program. The facility must establish an infection prevention and control program (IPCP) that must include, at a minimum, the following elements.
- §483.80(a)(1) A system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, visitors, and other individuals providing services under a contractual arrangement based upon the facility assessment conducted according to §483.70(e) and following accepted national standards.
While the regulation is not new, there are new questions surrounding the correlation between F880 and Enhanced Barrier Precautions (EBP). Since the release of the CMS mandate effective April 1, 2024, requiring the use of EBP in certain circumstances, we offer information related to commonly asked questions.
Six most common questions asked and answered by Polaris Consultants during mock surveys since April 1.
- Yes, EBP is required for all residents with chronic wounds or indwelling medical devices, regardless of whether they have an MDRO.
- Yes, residents with targeted CDC MDROs but without chronic wounds or indwelling medical devices will require the use of EBP.
- No, EBP is not required in addition to Contact Precautions. EBP is considered a practice within the guidance of the Contact Precaution protocol.
- No, relocation of resident rooms is not required or advised when EBP protocol is initiated.
- Yes, residents with MDROs and/or chronic wounds and/or indwelling devices will need EBP protocol for the duration of their stay in the facility.
- Yes, Therapy team members will need to utilize EBP during treatment in the therapy gym but not during transfers from one chair to another outside the gym area.
Two questions Surveyors have been given guidance from CMS to ask facility staff when looking at F880 Infection Prevention and Control issues, related to the use of EBP.
- Is your staff aware of which residents require EBP before high-contact care activities?
- Is PPE readily available to staff?
If you find yourself struggling with proper and consistent implementation of EBP requirements and staff education, schedule a mock survey with Polaris Group. Our team of Nurse Consultants will customize training and on-going education for your employees and offer real-time teaching opportunities during the mock survey. Contact us today to learn more about our healthcare solutions.
