health care professionals for clinical resources section of web site

Infection Control & Prevention


Heroes, Handwashing and More: Infection Prevention F-Tags

July 19, 2021

Today we look at our healthcare workers as heroes! And, rightly so. They stepped up to the head of the bed when needed and treated an illness that had never been seen before. COVID-19 emerged as one of the most deadly viruses, surpassed only by the bubonic plague of the 14th century. And the healthcare workers of today met the challenge with aplomb and an amazing composure.

While most of the world’s population shielded away from the possibility of contracting this horrible virus, our healthcare workers stepped into the fray and saved thousands of lives in the process. We can never thank them enough! And, we owe the profession to one lady, Florence Nightingale, the founder of modern nursing. Often called “the Lady with the Lamp,” she was a caring nurse, statistician, and leader. Although she was born 200 years ago, her ideas for how to stay healthy still resonate today.

In the 1880s, Florence Nightingale was well aware of the importance of the simple act of hand washing. She encouraged hand hygiene and cleanliness, and tracked/trended one of the local hospitals to show that both actions decreased patient deaths from 42% to a resounding 2%. In 1843, Oliver Wendell Holmes jumped on board and concluded that “puerperal fever” was spread by the hands of health personnel. He is also considered one of the pioneers who laid the foundation that hand hygiene would prevent illness and/or death.

But it wasn’t until 1961 that the US Public Health Service produced a training film that demonstrated handwashing techniques recommended for use by healthcare workers (HCWs), who were directed to wash their hands with soap and water for 1 to 2 minutes before and after patient contact. In 1975 and 1985, the Centers for Disease Control (CDC) published formal written guidelines on handwashing practices using non-antimicrobial soap between patient contacts and antimicrobial soap before and after invasive procedures.

In 1995 and 1996, the Healthcare Infection Control Practices Advisory Committee (HICPAC) recommended that either antimicrobial soap or a waterless antiseptic agent (alcohol-based products) be used for cleaning hands upon leaving the rooms of patients with multi-drug resistant pathogens and for routine patient care. The alcohol-based products are more effective for standard handwashing or hand antisepsis by HCWs than soap or antimicrobial soaps. And the products are more likely to be used by the HCWs than traditional handwashing with plain soap and water since they require less time, act faster, are less irritatating, and are more convenient to access.

Unfortunately, despite the guidance, adherence of HCWs to recommended handwashing practices remained low. To address this issue, the Center for Medicare and Medicaid (CMS) implemented F-tag 444. This regulation stated very clearly that “the facility must require staff to wash their hands after each direct resident contact for which handwashing is indicated by accepted professional practice.” The intent of this regulation was to prevent the spread of infection and encourage facilities to follow the CDC’s guidelines for handwashing.

The F-tag, however, did not go far enough to adequately address an infection prevention infection control program (IPCP). Much more was needed to protect the residents in our long-term care facilities. CMS revisited the issue and developed a new set of regulations for Infection Control. These regulations are housed under F-880 and clearly define an Infection prevention and control program.

Hand hygiene is once again a hallmark for this program and requires staff to follow hand hygiene practices consistent with accepted standards of practice. Yet F-880 delves much deeper into infection control and sets the expectations for the long-term care facilities. It directs them “to establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment…to prevent the development and transmission of communicable disease and infections.” Hand hygiene is only one part of the new F-tag requirement

  • F-881 directed the facilities to “develop and implement and IPCP to prevent, recognize, and control the onset and spread of infection and to revise the IPCP as national standards change….and develop an antibiotic stewardship program to include antibiotic use protocols and a system to monitor antibiotic use.”
  • F-882 spelled out the qualifications and the role of an Infection Preventionist, a position that did not exist prior.
  • F-883 addressed influenza and pneumococcal immunizations for the long-term care resident population.

But then came COVID-19 and the long-term care world (indeed the entire world) was upended. More protocols and more actions were demanded from our healthcare systems. CMS stepped in again with new regulations for reporting, testing, and immunizations. We are not safe from COVID-19 yet, so we must continue to follow the guidance and direction of the CDC and CMS. And, as HCWs, we must continue to wash our hands and educate others to do the same. It’s the single most important action we can take as individuals to help prevent the spread of infection. Florence and Oliver would be proud of us!

The Nurse Consultant Services’ department at PharMerica is an value’added service for our customers. We can assist in helping to meet these new regulatory requirements being developed and implemented by CMS and mitigate the risks you face.

Stay tuned for my next blog, in which I will discuss F-887, COVID-19 Immunization and the jabs.

Submitted by:
Ramona Proctor, BA, RN, PHNC3
Manager Quality Nurse Consulting Services/PharMerica