A new proposed rule from CMS would make antibiotic stewardship programs mandatory for Medicare and Medicaid hospitals, along with changes in anti-discrimination policies, nursing requirements, readmissions information and patient nutrition standards.

The antibiotic and infection control portions of the rule deal with growing concerns among healthcare professionals about bacteria immune to antibiotics coupled with the risk of hospital-acquired infections.

Hospitals would be required develop and implement programs to manage the use of antibiotics, including placing someone in charge of overseeing antibiotic use throughout the facility.

“We would promote better alignment of a hospital’s infection control and antibiotic stewardship efforts with nationally recognized guidelines and heighten the role and accountability of a hospital’s governing body in program implementation and oversight,” the proposed rule stated. “We believe that these changes, together, would promote a more patient-centered culture of safety focused on infection prevention and control as well as appropriate antibiotic use, while allowing hospitals the flexibility to align their programs with the guidelines best suited to them.”

The proposed rule points out infection control guidelines have largely stayed the same since they were first introduced in the 1980s. Beyond the new requirement for antibiotic oversight, the rest of the infection control measures included in the rule, such as requiring hospital-acquired infection surveillance be active throughout facilities, have been a part of CMS’ Interpretive Guidelines since 2008.

The American Hospital Association said in a statement it’s still reviewing the rule.

“The emphasis on good infection control and antibiotic stewardship is consistent with the important work hospitals are doing to reduce infections and preserve the effectiveness of our current antibiotics,” the AHA said, according to the Wall Street Journal. “We join CMS in recognizing the importance of these programs and are always looking to make them more effective.”

The other components of the rule would require hospitals to:

• Create anti-discrimination policies which include prohibiting discrimination on the basis of race, color, religion, national origin, sex, gender identity, sexual orientation, age or disability.
• Change the term “licensed independent practitioner” to “licensed practitioner,” allowing hospitals to use physician assistants according to their “educational preparation and scope of practice, as determined by state law."
• Allow hospitals to form their own policies on which outpatient departments wouldn’t be required to have a registered nurse physically present.
• Require medical records contain information justify all admissions and continued hospitalizations, including all inpatient and outpatient stays, as well as discharge and transfer summaries.
• Require critical access hospitals to ensure individual patient nutritional needs “be met in accordance with recognized dietary practices and the orders of the practitioner responsible for the care of the patients," or by a qualified dietitian or nutritionist.