Key Takeaways from “The Joint Commission, PPE, and Me” Webinar
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The recent NETEC webinar on The Joint Commission (TJC) standards and personal protective equipment (PPE) generated many insightful questions from participants. Below, we’ve highlighted some of the key topics to help healthcare facilities better understand TJC’s special pathogen preparedness requirements.
Who must meet the new TJC standard for special pathogen preparedness?
- Acute care and critical access facilities accredited by The Joint Commission.
- It does not currently apply to stand-alone surgery centers, psychiatric facilities, or long-term care facilities.
What special pathogens should facilities prepare for?
While there is no definitive list, most Regional Emerging Special Pathogens Treatment Centers (RESPTCs) categorize them into broad groups based on transmission and risk factors, and consider these categories when selecting PPE:
- Novel Respiratory Pathogens: Includes highly pathogenic influenzas, MERS (Middle East Respiratory Syndrome), SARS (Severe Acute Respiratory Syndrome), and other new respiratory viruses that may emerge.
- Viral Hemorrhagic Fevers (VHFs): Includes Ebola, Marburg, and Lassa fever. VHFs are further categorized based on patient condition and risk of exposure to infectious bodily fluids:
- Dry or Suspect VHF: No bleeding, vomiting, or diarrhea; clinically stable.
- Wet or Confirmed VHF: Potential exposure to blood and body fluids or clinically unstable.
What PPE should be used for these patients?
PPE selection depends on the pathogen category:
- Novel Respiratory Pathogens:
- Eye protection: Goggles or face shield (may be integrated into a powered air-purifying respirator or PAPR)
- Respirator: N95 or similar, elastomeric half-mask, and/or PAPR
- Isolation gown
- Gloves
- Note: The recommendations for novel respiratory pathogens are based on the current understanding of transmission and risk factors. However, the emergence of new pathogens may lead to updates in guidance. Healthcare workers should always follow the latest CDC recommendations
- Dry or Suspect VHF:
- Eye protection: Goggles or face shield
- Mask
- Fluid-resistant gown (AAMI level 3) or coverall
- Gloves (recommend double layer of gloves, outer pair extended cuff)
- Wet or Confirmed VHF (Total skin coverage required):
- Eye protection: Goggles or face shield (may be integrated into PAPR)
- Head and neck cover
- Respirator: N95 or similar or PAPR
- Fluid-impermeable gown (AAMI level 4) or coverall
- Gloves (double layer of gloves, outer pair extended cuff)
- Shoe or boot covers
- Optional: Apron or cover gown, third pair of gloves
How can small facilities prepare with limited resources?
Smaller facilities that may not have full PPE inventories can take a look at what supplies they have available and identify items that could be sourced from somewhere else in the facility:
- If only a lower-level gown is available, layer it with something more fluid-resistant, such as a plastic-sleeved apron, which might already be stocked for food or custodial services.
- Surgical gloves (which have extended cuffs) can be substituted for non-sterile extended-cuff gloves.
- Check other departments (e.g., operating room, maintenance, or environmental services) for shoe covers.
What are the training requirements for PPE? Who has to be trained and how often? What counts as “PPE competency”?
There is no universal rule, but facilities should develop a sustainable training approach that fits their needs. Competency is not defined by TJC but should align with your facility’s existing standards for high-risk, low-frequency skills.
- Some may integrate high-level PPE training into new staff onboarding of annual competencies for the Emergency Department.
- Others may train and maintain a strike team or list of super-user staff available on demand.
- It may take several training sessions for staff to feel comfortable – and reach competency – in a complex PPE ensemble. Each facility should include re-training or a refresher course in its plans.
- While online education can supplement training, hands-on practice is necessary to ensure staff can don (put on) and doff (remove) PPE safely.
Watch the webinar recording and stay tuned for more NETEC resources, including upcoming webinars, podcasts, and additional tools. If you have specific questions about implementing these standards in your facility, don’t hesitate to reach out—we’re here to help!
About the Experts
Brooke Henriksen, BSN, RN, CCRN, is the Training and Education Coordinator for the Special Pathogens Program in Region 10 at Providence Sacred Heart Medical Center and Children’s Hospital (PSHMC&CH) in Spokane, Washington. She is a co-chair for the National Emerging Special Pathogens Training and Education Center (NETEC) Personal Protection Equipment (PPE) work group. Brooke is also a member of the NETEC Biocontainment Unit (BCU) work group.
Sarah Haroth, MSN, RN, PHN, has been an RN for 18 years with a background that includes MICU, SICU, Neuro ICU, primary care, and nursing education. She obtained her Masters in Nursing Education as she has a passion for teaching others. Sarah currently works as the Patient Care Supervisor and Unit Educator for the M Health Fairview University of Minnesota Medical Center Special Pathogen Unit, which is one of 13 Regional Emerging Special Pathogens Training & Education Centers in the nation.
Dr. Colleen S. Kraft, MD, MSc, is a Professor in the Department of Pathology and Laboratory Medicine as well as a Professor in the Department of Medicine Division of Infectious Diseases at Emory University School of Medicine. Dr. Kraft was the Associate Chief Medical Officer of Emory Hospital from 2020-2023 and is currently the Associate Chief Research Informatics Officer for the Woodruff Health Sciences Center. Dr. Kraft served as the President-Elect, President and Past President of the American Society for Microbiology from 2021-2024. Dr. Kraft was one of the infectious disease physicians at Emory Hospital in 2014 to receive and care for patients who had contracted Ebola virus disease and Lassa fever in West Africa. Dr. Kraft is a clinical consultant for the Emory Healthcare Human Factors Lab, and a director in the Healthcare Test Kitchen Lab, both of which were in response to the desire for high reliability after the care of patients with highly contagious infectious diseases.
Dr. Corri Levine, PhD, MS, MPH, is an Assistant Professor at the University of Texas Medical Branch (UTMB) in the Department of Internal Medicine – Division of Infectious Diseases. She is also the Associate Director for the Special Pathogens Excellence in Clinical Treatment, Readiness, and Education program (SPECTRE), and the Director of the Biorepository for Severe Emerging Infections (BSEI). Dr. Levine received her doctorate in Human Pathophysiology and Translational Medicine from UTMB focusing on high consequence infectious diseases such as Ebola virus, Lassa virus, and Nipah virus, and concurrently earned a Master’s of Public Health. She chairs the Basic and Translational State of the Science Workgroup for the national Special Pathogens Research Network (SPRN) and is a subject matter expert for the National Emerging and Special Pathogens Treatment and Education Center (NETEC). In her role at UTMB, Dr. Levine is focused on strengthening the healthcare system’s response to infectious diseases and increasing public awareness of infectious threats.
Jill Morgan, RN, is a nurse at Emory University Hospital. She has been on Emory’s biocontainment team for over 15 years where she has cared for patients with Ebola virus disease and Lassa fever. Jill is co-lead for the PPE working group for NETEC, the National Emerging Special Pathogens Training and Education Center and has recently been appointed to the National Academies Committee on Personal Protective Equipment and Workplace Safety and Health.