Apply to become a member of the Healthcare-Associated Infections Advisory Committee

 

The Colorado Department of Public Health and Environment (CDPHE) is recruiting four new members of the Healthcare-Associated Infections Advisory (HAI) Committee. Currently, the committee is requesting applicants for the following positions Medical statistician OR clinical microbiologist with an advanced degree, Representative from a health insurer, Infection control practitioner from a long-term care setting, Representative from a rural hospital. Applicants must be a resident of Colorado and must be able to contribute objectively to committee meetings from the perspective of the position. All interested and qualified individuals should apply. This position will be appointed by the Executive Director of CDPHE for a term of three years. The HAI Advisory Committee was established under Colorado Revised Statute (C.R.S.) 25-3-602 to provide oversight to CDPHE for the collection and public reporting of data on HAI infection rates from health facilities. The committee typically meets every other month on the fourth Tuesday of the month from 2 - 4 p.m. CDPHE facilitates committee meetings using video conferencing. There are 11 members who represent a variety of stakeholders. Membership is voluntary. Participation on the HAI Advisory Committee is a great way to learn about HAIs and play an important role in state public health! We appreciate a diversity of input. Membership is not labor intensive, apart from participating in committee meetings. CDPHE invites qualified persons to complete and submit the fillable application with a resume or curriculum vitae by email to cdphe_hai_ar@state.co.us. You may submit additional pages with the application if needed to answer the “additional questions.” The deadline for submission is October 31, 2025. The CDPHE Healthcare-Associated Infections and Antimicrobial Resistance Program will review applicants internally before making a recommendation to the Executive Director for appointment. For more information, please see the HAI Advisory Committee Website or contact Chris Czaja MD, DrPH at christopher.czaja@state.co.us or 303-692-2700.

Request for documentation timelines

 

Dear Licensed Healthcare Entities, The department is dedicated to improving the survey process. However, we have encountered a consistent challenge: receiving the requested documentation in a timely manner during surveys or complaint investigations. This delay prolongs the survey and extends the time surveyors need to spend on-site. To improve this process, your cooperation is crucial. Chapter 2 states: 6 CCR 1011-1, Chapter 2, part 2.10.5, the licensee is required to provide, upon request, access to or copies of the following to the Department to facilitate regulatory oversight: (A) Individual client records.   (B) Reports and information required by the Department, which may include staffing reports, census data, statistical information, and any other records specified by the Department. To ensure a smooth process, the department requests that all documentation be provided within 2 hours of the request. If any mitigating circumstances prevent you from meeting this timeline, please communicate this to the surveyors promptly. Thank you for your attention and cooperation.

Chapter 24, Section 5 5.1: QMAP Must Be 18 Years of Age

To: All facilities with QMAPs From: The Health Facilities Education and Quality (HFEQ) Branch of the Health Facilities and Emergency Medical Services Division (HFEMSD) The Health Facilities and Emergency Medical Services Division would like to remind providers who use QMAPs in their facilities that QMAPs must be 18 years of age to work as a QMAP (Chapter 24, Section 5, 5.1). We encourage you to review the QMAP regulations in Chapter 24.  Other questions? Contact tonie.miller@state.co.us or cdphe_hfemsd_qmap@state.co.us .

Changes to the approach to public health surveillance for healthcare-associated invasive Group A Streptococcus infections

 

Key points Starting May/June 2024, the Colorado Department of Public Health and Environment’s (CDPHE) Healthcare-Associated Infections and Antimicrobial Resistance (HAI/AR) Program will only routinely review medical records of reported cases of invasive Group A Streptococcus (iGAS) infection in patients 55 years and older to identify healthcare exposures. CDPHE will no longer review medical records for patients younger than 55 years old for this purpose. This approach will allow CDPHE to identify and respond to 95% of long-term facility cases of iGAS, as well as allow for more efficient use of public health resources to respond to healthcare-associated iGAS infection in people at greatest risk of severe disease. The Vaccine Preventable and Invasive Disease Program will continue laboratory-based surveillance for iGAS in the five-county Denver metro area without changes. Background Healthcare-associated iGAS can cause severe disease and death. A single case of iGAS in a healthcare setting can be an indicator of an outbreak. Most healthcare-associated iGAS outbreaks occur in long-term care facilities, frequently skilled nursing facilities. Approximately 30% of cases of iGAS in residents of long-term care facilities reported to CDPHE from 2020-2023 were associated with an outbreak. Long-term care facility staff may not be aware of an iGAS outbreak because iGAS infection may be diagnosed in a hospital and cases may occur weeks or months apart. In contrast to long-term care facility outbreaks of iGAS, postpartum and postsurgical infections are less common and more readily identified by hospital providers.  CDPHE’s HAI/AR Program conducts active surveillance for iGAS in healthcare settings. GAS identified from a normally sterile site or from a non-sterile site in the presence of streptococcal toxic shock syndrome or necrotizing fasciitis is a four-day laboratory-reportable condition for patients residing in Arapahoe, Adams, Denver, Douglas, and Jefferson counties as part of CDC’s Emerging Infections Program - Active Bacterial Core Surveillance project. Currently, the HAI/AR Program reviews the medical records associated with all reported cases in order to identify healthcare exposures, including recent surgery, delivery, and long-term care facility residency. The HAI/AR Program investigates single cases and clusters of cases with healthcare exposures, in order to identify and respond to outbreaks and prevent additional cases of iGAS in healthcare settings. Between 2020 and 2023, reports of iGAS in the catchment area increased from fewer than 500 to greater than 1,000 per year. The proportion of iGAS reports with long-term care facility exposure was 1% among patients aged 0-54 years and 15% among patients aged 55 years and older. Medical record review for reports in patients 55 years and older will capture 95% of long-term facility cases of iGAS while reducing the volume of medical record review by 50%. Passive surveillance through provider reports will capture the remaining 5% of long-term care facility-associated cases, cases of iGAS in younger postpartum and post-surgical patients, and healthcare-associated cases outside the Denver metro area.  Health care providers statewide should contact the HAI/AR Program for technical assistance with the evaluation and management of single cases of iGAS in healthcare settings. Outbreaks of any kind, including suspected outbreaks of iGAS in healthcare settings, are immediately reportable. Contact the HAI/AR Program at 303-692-2700 or (cdphe_hai_ar@state.co.us). .

NHSN Reporting

 

To: Administrators, Executive Directors, Chief Clinical Officers, Directors of Nursing and others who are responsible for NHSN reporting From: Acute Care and Nursing Facilities Section Managers       Please review the linked document for NHSN information for reporting deadline reminders for the CMS Quality Reporting Programs. The National Healthcare Safety Network (NHSN) encourages facilities to enter data in a timely manner ahead of the prescribed deadlines to ensure data completion and accuracy. .

Norovirus season 2023-2024

 

To: Colorado Long Term Care Facility Partners From: CDPHE’s Foodborne, Enteric, and Waterborne Disease Program Colorado is currently experiencing a higher than usual number of norovirus outbreaks. Between Sept. 1 - Dec. 22, 2023, 94 outbreaks caused by norovirus were reported, with 15 in long-term care facilities, 42 in schools, and 34 in child care facilities. While norovirus incidence is highest between the months of November to April, the number of outbreaks so far this season is more than this same time frame in previous years. 2019 – 81 outbreaks  2020 – Five outbreaks 2021 – 41 outbreaks 2022 – 47 outbreaks  Norovirus is highly contagious, and while it is often referred to as the “stomach flu,” it is not influenza. Norovirus sheds in the stool of people who are ill and spreads via fecal-oral route. Common symptoms include vomiting, diarrhea, nausea, and stomach pain. While less frequent, people who are ill can also experience fever, headache, and body aches. There is no treatment for norovirus. Due to the loss of fluids through vomiting and diarrhea, dehydration is a common complication of norovirus and can require hospitalization. Norovirus’ low infectious dose, high environmental stability, prolonged and profuse shedding, and potential for asymptomatic infection make it challenging to control. Outbreaks of any illness in any setting are immediately four (4) hours reportable to state or local public health per Colorado regulation 6 CCR 1009-1. Suspected and confirmed norovirus outbreaks can be reported to your local public health agency or CDPHE. Call 303-692-2700 or email  cdphe_food_enteric_water_diseases@state.co.us. You can prevent norovirus by:  Frequently washing your hands with soap and water for at least 20 seconds. Alcohol-based hand sanitizers are not effective against norovirus. This is especially important after using the toilet or changing diapers, before preparing or handling food, and prior to giving yourself or others medication. Not handling or preparing food for others when experiencing symptoms of norovirus, especially diarrhea.  Using a disinfectant that is effective against norovirus. A list of effective disinfectants can be found on EPA’s List G or a solution of one cup unscented household bleach mixed with10 cups of water can be used. This solution must remain wet on a surface for at least one minute to be effective.  Laundering soiled linens with detergent and hot water for the maximum available cycle length and machine drying on the highest heat setting.  Norovirus resources for prevention and guidance: CDPHE: Communications toolkit  CDC: Norovirus CDPHE: Norovirus bleach guidance  CDPHE: Outbreak report form - Long-term care facilities, health care facilities, and similar settings CDPHE: Guidelines for norovirus outbreaks in health care facilities For further information, please email: cdphe_food_enteric_water_diseases@state.co.us

Clarification on FGI Guidelines Edition Being Utilized in Colorado

TO: Facility administrators and building operations managers   FROM: CDPHE HFEMS Division, FGI Plan Review & Safety Services Unit   As most of you are aware, the CDPHE licensing rule 6 CCR 1011-1, Chapter 2, Part 3 requires a Facility Guidelines Review and subsequent approval for all newly licensed health care facilities, as well as any qualifying renovations and/or additions to existing licensed health care facilities.   The Facility Guidelines Institute (FGI) updates their Guidelines books every four years. Although FGI has published the 2022 edition of the Guidelines, the Colorado Board of Health has not yet approved the 2022 edition as the edition being utilized in Colorado. Currently, CDPHE still enforces the 2018 edition of the Guidelines for our architectural plan review process. The update process for adoption of the 2022 Guidelines is scheduled to begin sometime in early 2024. At this time, we are unsure how long that update process will take. Until that time comes, we will continue to review all licensed health care projects to the 2018 edition of the Guidelines.   We would also like to remind you that our FGI team conducts an on-line quarterly news/Q&A presentation. This allows us to provide you all with any new Colorado FGI-related news and information as well as an opportunity for you to ask us questions in a forum where numerous people can learn at the same time. If you would like to have your email address added to our notification list, please email our team at the address below and we’ll happily include you. You may also forward this invite to any other parties that you feel may have interest.   If you have any questions or need further information, please see our FGI team web page at    https://cdphe.colorado.gov/facility-guidelines-institute-fgi   You can also email the FGI Plan Review and Safety Services team at FGIreview@state.co.us. 

Behavioral Health Entity Implementation & Advisory Committee: Application Now Available

 

To: Behavioral Health Providers, Consumers of Behavioral Health Services, Advocates, and Interested Parties From: The Health Facilities and Emergency Medical Services Division of the Colorado Department of Public Health and Environment (CDPHE) is currently accepting applications for the Behavioral Heath Entity Implementation and Advisory Committee (BHE-IAC) for the role of: A Mental Health provider (not a Community Mental Health Center) Per statutory requirements with the passage of House Bill 19-1237, specifically addressing the development of a licensing structure for Behavioral Health Entities (BHE), the Colorado Department of Public Health and Environment has a responsibility to establish, facilitate and streamline minimum standards and regulations for BHE’s in the State of Colorado. The intent of creating the Behavioral Health Entity License was to: Provide a single, flexible license category under which community-based behavioral health service providers can provide integrated mental health disorder, alcohol use disorder, and substance use disorder services and meet a consumer’s continuum of needs, from crisis stabilization to ongoing treatment; Provide a regulatory framework for innovative behavioral health service delivery models to meet the needs of both individuals and communities; Increase parity in the oversight and protection of consumers’ health, safety, and welfare between physical health and behavioral health regardless of the payment source; and to lastly, Streamline and consolidate the current regulatory structure to enhance community providers’ ability to deliver timely and needed services, while ensuring consumer safety.   In order to accomplish such a charge, HB 19-1237 established the Behavioral Health Entity Implementation and Advisory Committee. The BHE-IAC is responsible to: Offer advice to CDPHE and the State Board of Health concerning the phased-in implementation of the BHE license, rules promulgated by the State Board pursuant to C.R.S. 25-27.6-101 et seq., and the implementation of the BHE licensing transition; Provide ongoing advice to CDPHE regarding Behavioral Health Entities and Behavioral Health Entity licensing; and Identify a coordinated and aligned process of sharing information across state departments to ensure behavioral health services are available to all residents of Colorado.  The BHE-IAC meetings will occur on a recurring basis, taking place on the second Thursday of every other month, with the remaining meetings scheduled to occur in July 2023, September 2023, and November 2023. Meetings are anticipated to be one to two hours in duration. If you are interested in serving as a committee member, please complete the application and supplemental documents located here:  Behavioral Health Entity Implementation & Advisory Committee Application For additional information about the Behavioral Health Entity license, please visit: CDPHE's BHE Website All applications are due no later than close of business Friday, August 25, 2023. Any questions may be directed to Jane Flournoy at either 303.910.6348 or jane.flournoy@state.co.us.  Thank you in advance for your interest!

Precautions for Extreme Heat in Colorado: Ensure Your Residents, Clients, and, Patients Are Safe

 

To: Healthcare Providers (Please share widely with your teams) As summer in Colorado is bringing some extreme heat in recent days, we are sharing some information to help you in keeping your residents, clients, and patients safe. Extreme heat risk is affected by: exposure to high temperatures sensitivity of population to adverse health effects of heat events; and adaptive capacity of the population to reduce exposure (i.e., the ability to prepare for, respond to, and cope with heat events) We encourage you to review the following links: CDPHE heat infographic 7/11/2023 US News and World Report article on impacts of extreme heat on persons with dementia  7/26/2022 Yale School of the Environment article on the impact of certain medications on heat. Health Facilities Preparation for Extreme Heat: Recommendations for Retirement and Care Facility Managers 7/8/22 article, Alzheimer’s and Extreme Heat: Exercise Caution CDC Article, Warning Signs and Symptoms of Heat-Related Illness Tips for People Who Take Medication: Coping With Hot Weather Stay safe during these warm summer months!

Proposed Changes to 6 CCR 1009-1

 

To: Healthcare Stakeholders    From: Chris Czaja, Medical Epidemiologist, Program Manager    Please see the attached information. Announcing another opportunity to review and provide feedback to the proposed Board of Health rules for communicable disease control.  Memo 6 CCR1009-1 Draft rule text only 6 CCR 1009-1

Reminder: Colorado Hazardous and Medical Waste Regulations Training for Healthcare Facilities

 

To: Hospital, long-term care, and ambulatory surgical facility administrators   From: Colorado Hazardous and Solid Waste Programs   This is a reminder that the Colorado Department of Public Health and Environment will host a virtual training for healthcare facilities in Colorado that generate hazardous waste subject to 6 CCR 1007-3, Part 267, Subpart P of the Colorado hazardous waste regulations. The training will provide an overview of the main hazardous waste topics - such as generator requirements through Subpart P and information on what to expect during an inspection - and will allow time for attendees to ask questions of division staff.   The training will take place on Wednesday, April 12 from 8:00 a.m. to 4:00 p.m. Please see the Hazardous and Medical Waste Regulations Training for Healthcare Facilities Invitation to register and for more information.   With regards, Laura Gurule Notification Coordinator Hazardous Waste Compliance Assurance Unit laura.gurule@state.co.us | 303.692.3360 

March 2, 2023— Stakeholder Meeting Concerning The House Bill 1294 & House Bill 22- 1401

 

To: All Stakeholders  From: HFEMSD  The next House Bill (HB) 1294 Stakeholder Forum Meeting is scheduled for March 2, 2023, from 2:00 to 3:00pm. For this meeting, we will continue our conversation regarding rule changes in 6 CCR 1011-1, Chapter 2 as it relates to the passage of House Bill 22-1401- Hospital Nurse Staffing Standards. We will focus on the Stakeholder process for reviewing the proposed updated rule language.   The rule changes for 6 CCR 1011-1 Chapter 2 – General Licensure Standards have two parts. The first part affects all licensed health facilities, and brings into rule the requirement from Public Health Order 20-20 that facilities maintain an infectious disease, vaccine, and mitigation plan. The second part affects the following residential care facility types: All facilities licensed under 6 CCR 1011-1 Chapter 7, e.g. Assisted Living Residences All facilities licensed under 6 CCR 1011-1 Chapter 5, e.g. Skilled Nursing Facilities All facilities licensed under 6 CCR 1011-1 Chapter 8, e.g. Facilities for Persons with Intellectual and Developmental Disabilities, Group Homes, and Intermediate Care Facilities This second part brings into rule the requirement from Public Health Order 20-20 that requires those facilities to appoint an infection control officer, and that appointee’s duties related to infection control and the mitigation of infectious diseases. To participate, we have a number of resource links below.  HB 22-1401 Meeting Folder (includes meeting information  and invite/communication sign-up)  HB 1294 Stakeholder Forum Website (includes meeting information  and invite/communication sign-up)  Agenda Item Request Form   When:  Thursday, March 2, 2023, from 2:00- 3:00 p.m.  Where: This meeting will be held remotely via Zoom Join Zoom Meeting  https://us02web.zoom.us/j/83216415362 Meeting ID: 832 1641 5362 One tap mobile +17193594580,,83216415362# US +16694449171,,83216415362# US Find your local number: https://us02web.zoom.us/u/k9HAnr6w5 If you have any further questions or comments prior to the meeting please contact Tonie Miller at tonie.miller@state.co.us For more information on the purpose and function of the HB 1294 Stakeholder Forum:  The House Bill 1294 Stakeholder Forum is an opportunity to promote dialogue and transparency for all licensed healthcare facilities' issues of interest and concern. This forum is statutorily required for such purpose and had been postponed since the onset of the COVID pandemic.  During this time a smaller, Subject Matter Expert (SME) group members wishing to have ongoing discussions with the department about policy-level questions, issues regarding the financial impact of the pandemic, reimbursement rates for Medicaid providers, long-term planning to deal with healthcare worker shortages, and how to bring more people into the workforce was established.  Members of this group are encouraged to continue these discussions through the re-establishment of the HB 12-1294 Stakeholder Forum. Additionally, pursuant to C.R.S 25-3-113, the Stakeholder Forum consists of representatives from various types of provider facilities licensed by the department along with consumers, consumer advocates, ombudsmen, and other interested parties which meet at least four times each year for the Department to discuss and take into consideration the concerns and issues of interest to the forum members and other attendees regarding the development and implementation of rules and other matters that affect all licensed health care facilities.  Meetings are generally held virtually monthly, on the 1st Thursday of each month.

Resources to Help Providers Plan for the End of the COVID-19 National Emergency Declarations

 

To: All Health Care Providers From: Greg Schlosser, Branch Chief, Health Facility Education and Quality On January 30, 2023, the Biden-Harris Administration announced its intent to end the national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic on May 11, 2023. To help you prepare for the end of the PHE and the flexibilities enabled during the COVID-19 pandemic, the Centers for Medicare & Medicaid Services (CMS) has resources available, some of which have been updated based on recent action by Congress.  The following materials reflect recent changes and are currently available on the CMS Emergencies Page: Provider-specific fact sheets for information about COVID-19 Public Health Emergency(PHE) waivers and flexibilities: https://www.cms.gov/coronavirus-waivers CMS 1135 Waiver / Flexibility Request and Inquiry Form: https://cmsqualitysupport.servicenowservices.com/cms_1135 Acute Hospital At Home: https://qualitynet.cms.gov/acute-hospital-care-at-home Please note that two programs initiated during the PHE have been extended through 2023, thanks to Congress’s passage of the Consolidated Appropriations Act for Fiscal Year 2023: these extensions include the major telehealth waivers and the Acute Hospital Care at Home (AHCaH) individual waiver that was initiated during the PHE. CMS will continue to provide updates in upcoming months, and we encourage you to regularly visit the CMS Emergencies Page for the most up-to-date information. If you have any questions, please contact Melanie.Roth-Lawson@state.co.us.