CMS provides yet a little more flexibility for the management of the physical environment

By Steve MacArthur, Hospital Safety Consultant

In the ever-unfolding saga of pandemic response, the folks at CMS have issued another couple of waivers relating to the physical environment. Of course, these continue to be published with rest of the granted waivers, so I’ve copied and pasted the new stuff here:

• Alcohol-based Hand-Rub (ABHR) Dispensers: We are waiving the prescriptive requirements for the placement of alcohol based hand rub (ABHR) dispensers for use by staff and others due to the need for the increased use of ABHR in infection control. However, ABHRs contain ethyl alcohol, which is considered a flammable liquid, and there are restrictions on the storage and location of the containers. This includes restricting access by certain patient/resident population to prevent accidental ingestion. Due to the increased fire risk for bulk containers (over five gallons) those will still need to be stored in a protected hazardous materials area. Refer to: 2012 LSC, sections 18/19.3.2.6.  In addition, facilities should continue to protect ABHR dispensers against inappropriate use as required by 42 CFR §482.41(b)(7) for hospitals; §485.623(c)(5) for CAHs; §418.110(d)(4) for inpatient hospice; §483.470(j)(5)(ii) for ICF/IIDs and §483.90(a)(4) for SNF/NFs.
• Fire Drills: Due to the inadvisability of quarterly fire drills that move and mass staff together, we will instead permit a documented orientation training program related to the current fire plan, which considers current facility conditions. The training will instruct employees, including existing, new or temporary employees, on their current duties, life safety procedures and the fire protection devices in their assigned area. Refer to: 2012 LSC, sections 18/19.7.1.6.
• Temporary Construction: CMS is waiving requirements that would otherwise not permit temporary walls and barriers between patients.

I’m going to guess that some folks have already “taken advantage” of these items (with the possible exception of the fire drills, more on that in a moment). It would seem more than likely that some additional hand sanitizer dispensers have sprouted up all over your facility (hopefully you’ve been keeping reasonable track on these locations). Once this is over, you’ll probably need to either do an analysis of how much you’ve got floating around or remove them before you run afoul of allowable amounts. I also can’t imagine that temporary walls haven’t sprouted up (lots of sprouts this week!) in all sorts of spots. Those are probably a little simpler to track, but there is one instructive element to this allowance, that being the interpretive difference between TJC and CMS when it comes to temporary barriers: While TJC allows them to be smoke-tight, the feds are really looking for temporary barriers to be fire-rated, particularly for construction separations. Something about which to be mindful when things get back to “normal.”

As to the fire drill waiver, I absolutely understand the first part of the statement—inadvisable is as good a descriptor for trying to conduct fire drills at the moment, particularly as a function of moving and massing staff together. But I’m not exactly sure what they mean by the latter portion, but I think we can parse this for a bit. Especially if the physical space has been altered in efforts to provide “new” pressure relationships for some units, then, in all likelihood, there are elements of egress that have been impacted and, in some instances, that impact is to a degree that probably requires modification of existing unit-based fire response plans. I think it’s good to be able to alert folks to the “reality” that if the alarm goes off “this is not a drill,” but how do we make sure that folks can take full advantage of the compartmentalization features of our facilities? And then, how do we “document” that education? I don’t think it needs to be particularly complex (in fact, I suspect the less complex, the better) and could perhaps be communicated through whatever lines of communication are in place with your incident command structure. If anyone has any thoughts they’d be inclined to share, that would be delightful.

And for you folks who might be interested in what’s happening in the fulcrum of state and federal response, you can find your state’s waiver requests, etc., here.

I won’t say it’s good reading, but one can never have too much insight into the process during times of chaos.

Stay well and take care!

About the Author: Steve MacArthur is a safety consultant with The Greeley Company in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is also a contributing editor for Healthcare Safety Leader. Contact Steve at stevemacsafetyspace@gmail.com.