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May 2014 VA Hep C Treatment Guidelines
UPDATE: Feb 26, 2016-
Funding and Prioritization Status Update

UPDATE: March 2016
VA Hep C Treatment Guidelines
VA to treat all vets in system
 

By Judith Graham
VA Extends New Hepatitis C Drugs to All Veterans in Its Health System

 
Orange Count Registry
Vietnam vets blame 'jet guns' for their hepatitis C
By Lily Leung Feb. 14, 2016 
 
CBS News Investigates
Congress outraged over hepatitis C treatment VA can't afford
Dr. Raymond Schinazi played a leading role developing a drug that cures hepatitis C while working seven-eighths of his time for the VA
 
ibtimes.com| By amynordrum
 


Hepatitis C drug costing VA, DoD millions
By Patricia Kime, Staff writer
We're looking at a company who is milking a cash cow for everything it's worth," Sanders said. 
 


VA to outsource care for 180,000 vets with hepatitis C
Dennis Wagner, The Arizona Republic 12:27 a.m. EDT June 21, 2015
 


VA to outsource care for 180,000 vets with hepatitis C
, The Republic | azcentral.com 11:51 a.m. MST June 19, 2015
Dr. David Ross, the VA's director public-health pathogens programs, resigned from the working group. "I cannot in good conscience continue to work on a plan for rationing care to veterans," he wrote.
 


VA Region Stops Referring Patients To Outside Hospitals Thanks To Budget Shortfall
Michael Volpe Contributor ...According to a memo — the entire region has been forced to stop all “non-VA care” referrals due to a budget shortfall.
 

DisabledVeterans.org
OIG INVESTIGATES VA CHOICE PROGRAM PROBLEMS
Sen. Mark Kirk admitted the VA Choice Program is a failed joke in a letter to Secretary Bob McDonald despite attempts to fix it.
 

 
Denied Hep C VA dental care?
Please click here

 
Dried Hepatitis C Blood Exposure 11/23/2013 Weeks later inconspicuous blood transmits virus and more likely to cause accidental exposures to Hep C
 

Lack of Standards for
Mass Vaccinations
1970 Jetgun Nursing Instructions
 

2014 AASLD Study Hepatitis C not an STD

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Help with VA Claims
 


 
Info: Plan Backfires-
VBA Fast Letter Boost Claims
 
Legal- Fed Regs state:
Judge decision may be relied upon
Cotant v. Principi, 17 Vet.App. 116, 134 (2003),
 
Service Connected Claims
# 1 Conclusion of Law 
# 2 Conclusion of Law 
 
More Claims
Jetgun Decisions
Hep C Decisions

BVA Granted Claims
Nexus Letters
Doctors Testimony

VA physicians
Private Physicians
 
Search Board of Appeals Website
BVA Jetgun Decisions
BVA Hepatitis C Decisions

Great Advice!  
After the jetgun win
What to do next

 

 

Extracted from http://www.cdc.gov/HAI/settings/outpatient/checklist/outpatient-care-checklist.html 09/17/2011

Note and compare the standards of care not in place during service.

CDC. Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care. July 12, 2011.

CDC Home

Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care

The Infection Prevention Checklist for Outpatient Settings: Minimum Expectations for Safe Care Adobe PDF file [PDF 538 KB] is a companion to the Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care. The checklist should be used:

  1. To ensure that the facility has appropriate infection prevention policies and procedures in place and supplies to allow healthcare personnel to provide safe care.
  2. To systematically assess personnel adherence to correct infection prevention practices.
    (Assessment of adherence should be conducted by direct observation of healthcare personnel during the performance of their duties.)

Facilities using this checklist should identify all procedures performed in their ambulatory setting and refer to appropriate sections to conduct their evaluation. Certain sections may not apply (e.g., some settings may not perform sterilization or high-level disinfection). If the answer to any of the listed questions is No, efforts should be made to correct the practice, appropriately educate healthcare personnel (if applicable), and determine why the correct practice was not being performed. Consideration should also be made for determining the risk posed to patients by the deficient practice. Certain infection control lapses (e.g., re-use of syringes on more than one patient or to access a medication container that is used for subsequent patients; re-use of lancets) can result in bloodborne pathogen transmission and should be halted immediately. Identification of such lapses warrants immediate consultation with the state or local health department and appropriate notification and testing of potentially affected patients.

Infection Prevention Checklist
Section I. Administrative Policies and Facility Practices

1. Facility Policies
Practice Performed
If answer is No, document plan for remediation
  1. Written infection prevention policies and procedures are available, current, and based on evidence-based guidelines (e.g., CDC/HICPAC), regulations, or standards
    (Note: Policies and procedures should be appropriate for the services provided by the facility and should extend beyond OSHA bloodborne pathogen training)
Yes No
 
  1. Infection prevention policies and procedures are re-assessed at least annually or according to state or federal requirements
Yes No
 
  1. At least one individual trained in infection prevention is employed by or regularly available to the facility
Yes No
 
  1. Supplies necessary for adherence to Standard Precautions are readily available
    (Note: This includes hand hygiene products, personal protective equipment, and injection equipment.)
Yes No
 
2. General Infection Prevention Education and Training1.
Practice Performed
If answer is No, document plan for remediation
  1. Healthcare Personnel (HCP) receive job-specific training on infection prevention policies and procedures upon hire and at least annually or according to state or federal requirements
    (Note: This includes those employed by outside agencies and available by contract or on a volunteer basis to the facility.)
Yes No
 
  1. Competency and compliance with job-specific infection prevention policies and procedures are documented both upon hire and through annual evaluations/assessments
Yes No
 
3. Occupational Health
Practice Performed
If answer is No, document plan for remediation
  1. HCP are trained on the OSHA bloodborne pathogen standard upon hire and at least annually
Yes No
 
  1. The facility maintains a log of needlesticks, sharps injuries, and other employee exposure events
Yes No
 
  1. Following an exposure event, post-exposure evaluation and follow-up, including prophylaxis as appropriate, are available at no cost to employee and are supervised by a licensed healthcare professional
Yes No
 
  1. Hepatitis B vaccination is available at no cost to all employees who are at risk of occupational exposure
Yes No
 
  1. Post-vaccination screening for protective levels of hepatitis B surface antibody is conducted after third vaccine dose is administered
Yes No
 
  1. All HCP are offered annual influenza vaccination at no cost
Yes No
 
  1. All HCP who have potential for exposure to tuberculosis (TB) are screened for TB upon hire and annually (if negative)
Yes No
 
  1. The facility has a respiratory protection program that details required worksite-specific procedures and elements for required respirator use
Yes No
 
  1. Respiratory fit testing is provided at least annually to appropriate HCP
Yes No
 
  1. Facility has written protocols for managing/preventing job-related and community-acquired infections or important exposures in HCP, including notification of appropriate Infection Prevention and Occupational Health personnel when applicable
Yes No
 
For additional guidance on occupational health recommendations consult the following resource(s):
4. Surveillance and Disease Reporting
Practice Performed
If answer is No, document plan for remediation
  1. An updated list of diseases reportable to the public health authority is readily available to all personnel
Yes No
 
  1. The facility can demonstrate compliance with mandatory reporting requirements for notifiable diseases, healthcare associated infections, and for potential outbreaks.
Yes No
 
5. Hand Hygiene
Practice Performed
If answer is No, document plan for remediation
  1. The facility provides supplies necessary for adherence to hand hygiene (e.g., soap, water, paper towels, alcohol-based hand rub) and ensures they are readily accessible to HCP in patient care areas
Yes No
 
  1. HCP are educated regarding appropriate indications for hand washing with soap and water versus hand rubbing with alcohol-based hand rub
    (Note: Soap and water should be used when bare hands are visibly soiled (e.g., blood, body fluids) or after caring for a patient with known or suspected infectious diarrhea (e.g., Clostridium difficile or norovirus). In all other situations, alcohol-based hand rub may be used.)
Yes No
 
  1. The facility periodically monitors and records adherence to hand hygiene and provides feedback to personnel regarding their performance

Examples of tools used to record adherence to hand hygiene Adobe PDF file [PDF - 165 KB]External Web Site Icon

Yes No
 
For additional guidance on hand hygiene and resources for training and measurement of adherence, consult the following resource(s).
6. Personal Protective Equipment (PPE)
Practice Performed
If answer is No, document plan for remediation
  1. The facility has sufficient and appropriate PPE available and readily accessible to HCP
Yes No
 
  1. HCP receive training on proper selection and use of PPE
Yes No
 
For additional guidance on personal protective equipment consult the following resource(s):
7. Injection Safety
Practice Performed
If answer is No, document plan for remediation
  1. Medication purchasing decisions at the facility reflect selection of vial sizes that most appropriately fit the procedure needs of the facility and limit need for sharing of multi-dose vials
Yes No
 
  1. Injections are required to be prepared using aseptic technique in a clean area free from contamination or contact with blood, body fluids or contaminated equipment
Yes No
 
  1. Facility has policies and procedures to track HCP access to controlled substances to prevent narcotics theft/diversion
Yes No
 
For additional guidance on injection safety consult the following resource(s):
8. Respiratory Hygiene/Cough Etiquette
Practice Performed
If answer is No, document plan for remediation
  1. The facility has policies and procedures to contain respiratory secretions in persons who have signs and symptoms of a respiratory infection, beginning at point of entry to the facility and continuing through the duration of the visit. Policies include:
Yes No
 
  1. Posting signs at entrances (with instructions to patients with symptoms of respiratory infection to cover their mouths/noses when coughing or sneezing, use and dispose of tissues, and perform hand hygiene after hands have been in contact with respiratory secretions.)
     
Yes No
 
  1. Providing tissues and no-touch receptacles for disposal of tissues
Yes No
 
  1. Providing resources for performing hand hygiene in or near waiting areas
Yes No
 
  1. Offering facemasks to coughing patients and other symptomatic persons upon entry to the facility
Yes No
 
  1. Providing space and encouraging persons with symptoms of respiratory infections to sit as far away from others as possible. If available, facilities may wish to place these patients in a separate area while waiting for care
Yes No
 
  1. The facility educates HCP on the importance of infection prevention measures to contain respiratory secretions to prevent the spread of respiratory pathogens when examining and caring for patients with signs and symptoms of a respiratory infection.
Yes No
 
For additional guidance on respiratory hygiene/cough etiquette consult the following resource(s):
9. Environmental Cleaning
Practice Performed
If answer is No, document plan for remediation
  1. Facility has written policies and procedures for routine cleaning and disinfection of environmental services, including identification of responsible personnel
Yes No
 
  1. Environmental services staff receive job-specific training and competency validation at hire and when procedures/policies change
Yes No
 
  1. Training and equipment are available to ensure that HCP wear appropriate PPE to preclude exposure to infectious agents or chemicals (PPE can include gloves, gowns, masks, and eye protection)
Yes No
 
  1. Cleaning procedures are periodically monitored and assessed to ensure that they are consistently and correctly performed
Yes No
 
  1. The facility has a policy/procedure for decontamination of spills of blood or other body fluids
Yes No
 
For additional guidance on environmental cleaning consult the following resource(s):
10. Reprocessing of Reusable Instruments and Devices
Practice Performed
If answer is No, document plan for remediation
  1. Facility has policies and procedures to ensure that reusable medical devices are cleaned and reprocessed appropriately prior to use on another patient (Note: This includes clear delineation of responsibility among HCP.)
Yes No
 
  1. Policies, procedures, and manufacturer reprocessing instructions for reusable medical devices used in the facility are available in the reprocessing area(s)
Yes No
 
  1. HCP responsible for reprocessing reusable medical devices are appropriately trained and competencies are regularly documented (at least annually and when new equipment is introduced)
Yes No
 
  1. Training and equipment are available to ensure that HCP wear appropriate PPE to prevent exposure to infectious agents or chemicals (PPE can include gloves, gowns, masks, and eye protection). (Note: The exact type of PPE depends on infectious or chemical agent and anticipated type of exposure.)
Yes No
 
The above basic information allows for a general assessment of policies and procedures related to reprocessing of reusable medical devices. Ambulatory facilities that are providing on-site sterilization or high-level disinfection of reusable medical equipment should refer to the more detailed checklists related to sterilization and high-level disinfection in separate sections of this document devoted to those issues.

Critical items (e.g., surgical instruments) are objects that enter sterile tissue or the vascular system and must be sterile prior to use (see Sterilization Section).

Semi-critical items (e.g. , endoscopes for upper endoscopy and colonoscopy, vaginal probes) are objects that contact mucous membranes or non-intact skin and require, at a minimum, high-level disinfection prior to reuse (see High-level Disinfection Section).

Non-critical items (e.g., blood pressure cuffs) are objects that may come in contact with intact skin but not mucous membranes and should undergo cleaning and low- or intermediate-level disinfection depending on the nature and degree of contamination.

Single-use devices (SUDs) are labeled by the manufacturer for a single use and do not have reprocessing instructions. They may not be reprocessed for reuse except by entities which have complied with FDA regulatory requirements and have received FDA clearance to reprocess specific SUDs.

Note: Pre-cleaning must always be performed prior to sterilization and/or disinfection

For additional guidance on reprocessing of medical devices consult the manufacturer instructions for the device and the following resource(s):

11. Sterilization of Reusable Instruments and Devices
Practice Performed
If answer is No, document plan for remediation
  1. All reusable critical instruments and devices are sterilized prior to reuse
Yes No
 
  1. Routine maintenance for sterilization equipment is performed according to manufacturer instruction (confirm maintenance records are available)
Yes No
 
  1. Policies and procedures are in place outlining facility response (i.e., recall of device and risk assessment) in the event of a reprocessing error/failure.
Yes No
 
For additional guidance on sterilization of medical devices consult the manufacturer instructions for the device and the following resource(s):
12. High-Level Disinfection of Reusable Instruments and Devices
Practice Performed
If answer is No, document plan for remediation
  1. All reusable semi-critical items receive at least high-level disinfection prior to reuse
Yes No
 
  1. The facility has a system in place to identify which instrument (e.g., endoscope) was used on a patient via a log for each procedure
Yes No
 
  1. Routine maintenance for high-level disinfection equipment is performed according to manufacturer instruction; confirm maintenance records are available
Yes No
 
For additional guidance on reprocessing of high-level disinfection devices consult the manufacturer’s instructions for the device and the following resource(s):
Additional Information:
CDC. Guide to Infection Prevention in Outpatient Settings: Minimum Expectations for Safe Care Website. May 2011.
http://www.cdc.gov/HAI/settings/outpatient/outpatient-care-guidelines.html
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