Q&A With The Joint Commisson...Q&A With The Joint Commission. COVID-19 Webinar for Ambulatory Health...

Q&A With The Joint CommissionCOVID-19 Webinar for Ambulatory Health Care Accreditation

June 3, 2020

Herman A. McKenzie, MBA, CHSP Director of Engineering, Standards Interpretation Group (SIG) Division of Healthcare Improvement The Joint Commission

Linda Seager, RN, MSNDirector, Clinical Standards Interpretation GroupDivision of Healthcare ImprovementRPI Certified Yellow BeltThe Joint Commission

Sylvia Garcia-Houchins, MBA, RN, CIC Director, Infection Prevention and Control The Joint Commission

Kelly McCannAssociate Director AccreditationAccreditation and Certification OperationsThe Joint Commission

Stephanie CampbellField Director, Standards Interpretation GroupThe Joint Commission

Dana DunnField DirectorStandards Interpretation GroupThe Joint Commission

Pre-Submitted Questions

Are Respiratory Therapists among the eligible healthcare providers being included in telehealth service provision?

Ambulatory surgery changes in standards?

If a State Health Department has delayed renewing professional licenses for up to six (6) months following the close of the current Public Health Emergency, how should this be documented in Cred. & Privileging records?

If we need to lay-off medical providers for a period of 2-3 months, how do you manage credentialing when they return? New and/or renewal?

We have had to do some annual training virtually, will this be acceptable for sterilization training?

Can we expect to see COVID related inquiries during our next survey and how can we best prepare for that?

What will surveyors be looking for specifically on our next re-accreditation survey?

Please reinforce the timeframe that will NOT be surveyed. I understood just the pandemic period. Would you define pandemic timeframe?

Is there a requirement to document COVID related operational changes for the Joint Commission?

How thorough are our COVID-19 plans supposed to be?

How or will TJC be evaluating Ambulatory clinics and sites?

If the practice was closed to patients in 2Q20, is it okay if we cancelled fire drills and resume when operations ramp back up?

Is there a plan to update the instructions for the BBI?

Updates to Emergency Preparedness Plans?

When designing or renovating a hospital, what features should be considered to improve the hospital’s ability to COVID-19, or other pandemic emergency?

Is there a plan to push Joint Commission visits ahead due to the COVID pandemic?

How much virtual survey do you anticipate and which areas will be performed remotely? Are you looking for volunteers to test process?

How long will on-site surveys be delayed and what is the plan for extending the due date if it goes past, for reimbursement purposes?

Are surveys that are due in August-September 2020 going to be pushed back as the others for this year have been?

What is the likelihood of initial surveys resuming in June?

Is the TJC survey schedule for Mid-March 2021 going to be on schedule?

How will the pandemic affect deemed status surveys?

Question

Do ambulatory care settings have to have a respiratory fit program?

OSHA website: https://www.osha.gov/SLTC/respiratoryprotection/OSHA Small Entity Compliance Guide forthe Respiratory Protection Standard: https://www.osha.gov/Publications/3384small-entity-for-respiratory-protection-standard-rev.pdf

QuestionWe are having to reuse our N95 mask, and are now concerned about a gown shortage. Do you have any guidance on how/ what we can do to maintain safety?

FDA Medical Gowns (provides overview of gowns that may be helpful)https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/medical-gownsFDA Surgical Mask and Gown Conservation Strategies - Letter to Health Care Providershttps://www.fda.gov/medical-devices/letters-health-care-providers/surgical-mask-and-gown-conservation-strategies-letter-health-care-providersCDC Strategies for Optimizing PPE: Isolation Gownshttps://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/isolation-gowns.html

QuestionDo the OR's and pre-op/PACU bays need to be terminally cleaned after every patient, including ceilings and walls?

Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings Item number 10https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Finfection-control%2Fcontrol-recommendations.html#infection_control

Question

Source: https://www.cdc.gov/infectioncontrol/guidelines/environmental/appendix/air.html#tableb1

Can you review guidance how long an exam room must be “shut down” after caring for a COVID-19 patient? What if we obtained a specimen for COVID testing? How this will impact our ability to see patients?

Healthcare Infection Prevention and Control FAQs for COVID-19 Q: How long does an examination room have to remain vacant after being occupied by a patient with confirmed or suspected COVID-19?https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-faq.html

Question

Do you have to wash your bedding in chlorine bleach or can you wash it with a non chlorine bleach detergent?

EPA List of Disinfectantshttps://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2

Question

Do you recommend the use of HEPA filters or UV lighting to increase the number of air exchanges per hour in an operating room?

ASHE Filtration Sectionhttps://www.ashe.org/covid-19-frequently-asked-questions

QuestionHow do you foresee precautions in office based surgical centers to change in the post covid-19 world? Do you see any changes?

Webinars: Preventing Coronavirus Transmission in Ambulatory Surgery Centers https://www.jointcommission.org/resources/news-and-multimedia/webinars/coronavirus-webinar-replays/preventing-coronavirus-transmission-in-ambulatory-surgery-centers/Preventing Coronavirus Transmission in Ambulatory Health Care Settings https://www.jointcommission.org/resources/news-and-multimedia/webinars/coronavirus-webinar-replays/preventing-coronavirus-transmission-in-ambulatory-health-care-settings/

Question

Physicians would like to limit access to the center for the remainder of the year in case of a second wave and flu season. How long after we go green should we limit access to the center such as having the family drop off the patient in the front and pick up in the back?

Question

Does the Joint Commission have guidance regarding shortages in hand hygiene products, cleaning and disinfecting supplies?

Question

Is it recommended to test for Covid-19 on all procedures prior to day of service?

Question

If a patient tested positive for Covid-19 months prior to the date of surgery do they need to be retested?

Question

Is an N95 recommended for all aerosol generating procedures (e.g., endoscopy, intubation) procedures in ASC and AHC?

Question

There is a lot of content on testing when a person is suspected to have Covid-19, but what are the guidelines of routine Covid-19 testing for surgical patients?

Question

How often should Healthcare Professionals be tested and which test?

Question

Is there any expectation for continuous universal masking for HCWs? Specifically, are HCWs expected to wear a mask at all times while in the facility?

Question

Should the Circulator and Anesthesia provider be the only people in the room for intubation and extubation? Should they be wearing N95 masks?

Question

If N-95 are used, must staff be fit tested first?

Question

Is there any guidance for PPE use for elective procedures?

Question

Is there a sample policy available for a COVID assessment room with negative pressure in an ambulatory setting?

Question

How will the Joint Commission accreditation survey review the organization's infection control practices?

Question

What is the science of Covid19 being transmitted through the eyes? Should we require staff to wear eye protection?

Question

Are see through fabric masks as effective as material you cannot see thru?

Question

Should drinking fountains be closed in ambulatory care settings?

Question

What is your position on the use of plexi-glass sneeze guards? Is this a recommendation?

Question

Is it acceptable to disinfect/wash cloth face masks in a dishwasher?

Question

How do new recommendations to control COVID-19 impact universal precaution and standard precautions?

Question

Should people change from “home” clothes to work clothes when they arrive to work and leave work?

Question

What is acceptable patient waiting room occupancy?

Question

We are doing a phone screen, then screening them again prior to entering the center along with a temperature check and having them tested for COVID prior to coming in, do we still need to wear masks? If so, what type of masks should ASC staff be wearing in each area (Pre-op, PACU, OR and SPD)?

Question

Do you have any guidelines or recommendations on resuming/providing outpatient aquatic therapy services during this COVID 19 pandemic?

Question

What precautions should we take with therapists when they work in multiple settings daily (e.g. Inpatient, Outpatient and Home Care)

Question

Will TJC be revising IC standards (for multiple reasons) but specifically around air exchange and air quality in Dental Clinics to align with CDC recommendations or just reference those guidelines during survey? If yes, when can we expect to see revisions.

Thank You

We support your efforts in response to the COVID-19 pandemic and hope to provide helpful resources

Resources−COVID Resources− https://www.jointcommission.org/covid-19/

−Standards Interpretation− https://www.jointcommission.org/standards/standard-

Q&A With The Joint Commisson...Q&A With The Joint Commission. COVID-19 Webinar for Ambulatory Health...

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