Regulation change also affects medication management training options. The Board of Health has approved regulations related to Alzheimer's and related dementia in residential facilities for groups. The changes include:
Regulation changes also affect the application and approval of medication management training programs. Generally, the change requires a person or entity that proposes to offer a course of training in the administration of medication to apply to the Division of Public and Behavioral Health (DPBH). The regulation also authorizes DPBH to approve a nationally recognized organization to offer a course without an application if it determines that the course meets the applicable requirements. Find full information at the Medication Management for Licensed Health Facilities web page. Refer to LCB File No. R043-22 linked here for full text of the approved regulations described above. For overall information about residential facilities for groups licensing, visit dpbh.nv.gov/assistedliving.
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Reduce exposure to bloodborne pathogens by following best practices. Regulators with the Division of Public and Behavioral Health (DPBH) would like to provide a reminder on the use of needles, syringes and fingerstick devices and single -dose/single-use medication vials.
According to Centers for Disease Control and Prevention (CDC), needles, syringes and fingerstick devices are to be used per the manufacturer’s instructions that notes they are for single use only. The reuse of these devices is prohibited as it can lead to the spread of bloodborne pathogens such as hepatitis B, hepatitis C and HIV. When using fingerstick devices, changing the lancet does not make the pen portion of the fingerstick device reusable even if the pen is disinfected between uses. This concept is the same for changing the needle on a syringe. These devices can retain small portions of blood unseen by the naked eye and therefore have the potential to spread disease if reused. The shared use of these devices is one of the common root causes of exposure and infections in health care settings. The same practice should be used with single-dose medication vials. A single-dose/single-use vial is a vial of liquid medication intended for parenteral administration (injection or infusion) that is meant for use in a single patient for a single case/procedure/injection. Single-dose or single-use vials are labeled as such by the manufacturer and typically lack an antimicrobial preservative. According to CDC, even if a single-dose/single-use vial appears to contain multiple doses or contains more medication that is needed for a single patient, that vial should neither be used for more than one patient nor stored for future use on the same patient. If the single-dose or single-use vial will be entered more than once for a single patient as part of a single procedure, it should be with a new needle and new syringe, and the vial must be discarded at the end of the procedure and not stored for future use. To help your facility’s efforts toward education of safe injection practices and the prevention of exposing patients and health care personnel to avoidable risks, links are provided below to educational resources.
State regulators provide explanations to help with compliance. Changes to state regulations (Nevada Administrative Code 449) affecting home health agencies have been approved and are now in effect. To help agencies understand these changes, explanations are provided below.
R048-22 adds two new Nevada Administrative Code provisions, as described below (section and page numbers are within R048-22):
Section 55 (page 59) revises NAC 449.793
Section 57 (page 61) revises NAC 449.797 The following information must be included in each patient’s home health clinical record:
Section 58 (page 63) makes changes to NAC 449.800 Physician assistants and advanced practice registered nurses are now allowed to independently complete the face-to-face encounter and documentation, and to order, certify, and sign for home health care services and durable medical equipment. Everything else remains unchanged. (Cross reference NAC 449.800 with SOM Appendix B, G536, G574 through G598. Note: SOM Appendix B has not been updated to reflect the NAC 449.800 and corresponding G tag changes. However, the Medicare Benefit Policy Manual, Chapter 7 – Home Health Services and the Medicare General Information, Eligibility and Entitlement, Chapter 4 – Physician Certification and Recertification of Services have been updated to reflect the change. Once the updated SOM Appendix B becomes available, the OASIS Education Coordinator will notify you.) Repealed regulations As noted in the “Text of Repealed Sections” of LCB File No R048-22, a number of state home health regulations are no longer in effect. They have been removed to avoid duplication and/or conflict with the “Appendix B – Guidance to Surveyors: Home Health Agencies.” State experts will continue to provide consultations and support to help facilities mitigate infection With the end of the federally declared COVID-19 Public Health Emergency, there have been many questions from health facilities regarding required actions and measures for infection control and prevention.
In response, Bureau of Health Care Quality and Compliance (HCQC) infection prevention and control staff have drafted a technical bulletin to supply state-licensed health care facilities, including those that are CMS certified, with access to the updated CDC and CMS guidance. Visit the Division of Public and Behavioral Health Technical Bulletins web page and see the top of the COVID-19 section. The HCQC infection prevention and control team is available for consultations and risk assessment; onsite technical support; outbreak support; and questions about infection prevention and control issues. The team has also posted online general resources for health facilities. Email [email protected] regarding any of the services listed above; for questions regarding this technical bulletin; or other infection prevention and control issues. Document provides information about bacteria that can grow in water systems Infection prevention experts from the Bureau of Health Care Quality and Compliance (HCQC) have created a guidance document about Legionnaires’ disease, which is a very serious type of pneumonia (lung infection) caused by bacteria called Legionella.
This bacteria is of concern to residential facilities because it can grow in water systems, such as hot and cold tap water, in shower heads and sink faucets, whirlpool spas, cooling towers (structures that contain water and a fan as part of centralized air-cooling systems for buildings), decorative fountains and water features, hot water tanks and heaters, and large, complex plumbing systems. An outbreak could be potentially more dangerous at a facility populated by residents over age 65 with risk factors such as diabetes or other health issues. View or download the guidance document under the “Legionella Infection and Prevention” section at dpbh.nv.gov/assistedliving/. Technical bulletin provides background and details on symptoms, transmission, treatment and testing On April 6, 2023, the Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory to inform clinicians and public health departments in the United States about two confirmed outbreaks of Marburg virus disease (MVD): one in Equatorial Guinea and one in Tanzania. Currently, there is no evidence to suggest that these two outbreaks are related; most experts agree that these represent two independent animal-to-human spillover events. To date, no confirmed cases of MVD related to these outbreaks have been reported in the United States or other countries outside Equatorial Guinea and Tanzania.
The Division of Public and Behavioral Health has drafted a technical bulletin that provides information about these outbreaks to increase awareness of the risk of imported cases to the United States. It also summarizes CDC’s recommendations for case identification, testing and clinical laboratory biosafety considerations in the United States. Visit the DPBH Technical Bulletins web page and scroll to the “Other Topics” section. New federal guidance means there is additional information for facilities to include on reports .The Centers for Medicare/Medicaid Services (CMS) has revised the guidance in Chapter 5 of the State Operations Manual (SOM) to strengthen the oversight of nursing home complaints and facility-reported incidents (FRIs). The goal of the federal complaint/incident process is to establish a system that will assist in promoting and protecting the health, safety and welfare of residents, patients and clients receiving health care services.
Below is a summary of changes to the FRI form for skilled nursing facilities:
Dear Health Facility Licensee,
Since early 2021, many health facilities have been providing approved cultural competency training (CCT). By providing this training to your agents/employees who provide care to patients/residents, these trained staff may better understand the patients/residents who have different cultural backgrounds. The Division of Public and Behavioral Health (DPBH) is thankful and applauds these efforts. DPBH has received overwhelming feedback regarding the current approval processes for CCT programs, indicating that the approval process is burdensome. In reviewing the current regulations (LCB File No. R016-20), DPBH has determined these regulations have created unintended challenges for the health facility industry. With this in mind, the CCT approval process regulations have been included on a list in response to the Governor’s Executive Order #003, which requires state agencies (such as DPBH) to evaluate regulations that are overburdensome. In addition to the need to further evaluate the current CCT regulations, there are two bills (AB 267 and SB 365) being considered right now by the Nevada Legislature. If passed, these two bills may have significant impact on the CCT approval process, who is required to be trained, and the number of required training hours. Due to this pending legislation and the review of the current regulations, DPBH is putting a hold on the approval process of new CCT programs until after the 2023 legislative session ends. DPBH is committed to reworking the CCT regulations to ensure they include input from health facility industry members. We know that by working together and listening to you, the CCT requirements can be improved to reduce unnecessary burden while meeting the intent to protect patients’ rights. As such, we will engage with the health facility industry on the CCT requirements after the 2023 legislative session ends in June. In the meantime, health facilities must continue to train staff in accordance with the current non-discrimination requirements (NRS 449.101 – NRS 449.104). However, since these statutes do not require training to be repeated, once the training is received from an approved program, it results in compliance with these laws. Facility inspection processes will check to see that training is being accomplished and complaints will continue to be investigated where noncompliance with these laws is alleged. For facilities that choose to employ an approved third-party trainer, a list of such programs can be found at dpbh.nv.gov/culturalcompetency. If you have any questions, e-mail us at [email protected]. Sincerely, Cody L. Phinney, Deputy Administrator Division of Public and Behavioral Health, Regulatory and Planning Services A PDF copy of this memo is linked here for downloading/printing. Training and technical assistance are available from state health experts The Nevada Department of Health and Human Services’ Healthcare-Associated Infection (HAI) program has drafted a memo linked here with updated case counts and education information for C. auris. HAI and other health department staff to continue to be diligent about containing the spread of C. auris in Nevada. All known cases have originated in Southern Nevada; however, two now reside in Northern Nevada.
If C. auris cases have not been identified in your facility, the HAI Program encourages screening for colonized patients who have not been identified but can still spread C. auris in your building(s). To request screening supplies, email the HAI program at [email protected]. The program has several training tools and links to webinars with CEUs on containment of multidrug-resistant organisms (MDROs), if you or your staff need training or just a refresher. Facilities can also visit this web page for HAI program training and education. The Centers for Disease Control and Prevention (CDC) recommends use of an Environmental Protection Agency (EPA)-registered hospital-grade disinfectant effective against C. auris (EPA’s List P or EPA’s List K) for daily and terminal cleaning of patient environments. Be sure to clearly communicate prior to discharge a patient’s MDRO status when they are going to post-acute or acute care to ensure these patients are placed under the correct precautions when they arrive. The HAI website above includes tools for educating the patient and family when diagnosed and/or being discharged home. The HAI program is here to assist facilities as much as possible. HAI staff and state infection preventionists also provide non-punitive on-site assessments to help facilities identify and close gaps in infection prevention and control practices. If you would like training for your staff, please email us at the address above so that we can coordinate a date and time. Please feel free to forward this information to others who could benefit from it. Data reported by licensed health care facilities was used to create the report The State of Nevada Healthcare Associated Infections (HAI) Program has published the Community-Wide Surveillance for Carbapenem-Resistant Organisms (CROs) Report for 2019-2021. This report includes surveillance definitions, monthly case counts for each year, figures that depict the trend of CROs, descriptive statistics for reported CRO cases, case counts for carbapenemase-producing organisms (CPOs), characterization of CPO cases, annual rate of CPO/CRO in hospitals, links to antibiograms, infection prevention guidance, and reporting guidance. The data source that was used for this report comes from surveillance data for carbapenem-resistant organisms reported to the State of Nevada HAI Program by state-licensed health care facilities and the State Public Health Laboratory as mandated by Nevada Revised Statutes 441A.
To review the reports visit the HAI Program webpage at Healthcare Associated Infection Prevention and Control (HAI) – Publications web page. To report cases and for infection prevention guidance, email the HAI Program at [email protected]. |
AuthorThe Bureau of Health Care Quality and Compliance (HCQC) licenses medical and other health facilities, child care facilities and personnel, and medical laboratories and personnel in Nevada. HCQC also conducts compliance surveys and takes complaints. Archives
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