Patterson C H
Department of Standards, Joint Commission on Accreditation of Healthcare Organizations, Chicago, IL 60611.
Am J Infect Control. 1989 Oct;17(5):231-40. doi: 10.1016/0196-6553(89)90168-5.
The Joint Commission recently has revised its hospital standards for infection control to reflect more accurately current state-of-the-art practices. In addition, the Joint Commission's Agenda for Change initiatives include the development of clinical indicators; one of the topics that will be included in those clinical indicator sets will be infection control. How the hospital chooses to organize itself to conduct the historically required monitoring and evaluation of clinical patient care currently required by the standards of the Joint Commission is at the option of the hospital. How the hospital will organize and collect data specific to infection control indicators yet to be developed by the Joint Commission has not been determined and will not be defined until specific research and development projects are completed. The hospital is expected to have in place infection prevention, surveillance, and control programs; it also is expected to have in place a quality assurance program that focuses not only on solving identified problems but also on the improvement of patient care quality. How the hospitals organize and/or integrate these activities is also at its option. It is expected that qualified professionals will direct and enforce infection prevention, surveillance, and control practices; indicators for infection control can provide data that will help assess the relative success of those practices and activities. The Joint Commission is not developing the capability to judge, on its own part, the actual quality of care provided by an organization seeking accreditation. Rather, the Joint Commission is committed to developing more accurate means to evaluate the structures, processes, and outcomes of diagnosis and treatment activities, as well as their interrelationships. Clinical excellence is supported by quality in the organizational environment and the managerial and leadership contexts within which patient care is delivered. Both clinical and organizational excellence are essential components of quality, and the Joint Commission is convinced that it is appropriate and timely to undertake more direct assessments of both.
联合委员会最近修订了其医院感染控制标准，以更准确地反映当前的先进做法。此外，联合委员会的“变革议程”倡议包括制定临床指标；这些临床指标集中将包括的一个主题将是感染控制。医院如何选择组织自身来进行联合委员会标准目前要求的对临床患者护理的历史性监测和评估，由医院自行决定。医院将如何组织和收集联合委员会尚未制定的感染控制指标的特定数据尚未确定，并且在特定的研发项目完成之前不会确定。预计医院将制定感染预防、监测和控制计划；还预计医院将制定一个质量保证计划，该计划不仅侧重于解决已发现的问题，还侧重于提高患者护理质量。医院如何组织和/或整合这些活动也由其自行决定。预计合格的专业人员将指导和执行感染预防、监测和控制措施；感染控制指标可以提供有助于评估这些措施和活动相对成效的数据。联合委员会本身并不具备判断寻求认证的组织所提供实际护理质量的能力。相反，联合委员会致力于开发更准确的方法来评估诊断和治疗活动的结构、过程和结果，以及它们之间的相互关系。临床卓越得到组织环境以及提供患者护理的管理和领导背景中的质量的支持。临床卓越和组织卓越都是质量的重要组成部分，联合委员会确信对两者进行更直接的评估是适当且及时的。
