CMS · Survey deficiency reference

A-0747 Condition of Participation: Infection Prevention and Control and Antibiotic Stewardship Programs

Identifier and Official Title

A-0747 is the condition-level tag for 42 CFR §482.42. The heading as printed in Appendix A Rev. 238 reads, verbatim:

A-0747 (Rev. 238; Issued: 03-20-26; Effective: 09-05-25; Implantation: 09-05-25) §482.42 Condition of Participation: Infection Prevention and Control and Antibiotic Stewardship Programs

Verified against the full text of Rev. 238 on September 11, 2026.

What It Enforces (Verbatim)

The condition statement, as printed under the tag and identical to 42 CFR §482.42 in eCFR:

The hospital must have active hospital-wide programs for the surveillance, prevention, and control of HAIs and other infectious diseases, and for the optimization of antibiotic use through stewardship. The programs must demonstrate adherence to nationally recognized infection prevention and control guidelines, as well as to best practices for improving antibiotic use where applicable, and for reducing the development and transmission of HAIs and antibiotic resistant organisms. Infection prevention and control problems and antibiotic use issues identified in the programs must be addressed in collaboration with the hospital-wide quality assessment and performance improvement (QAPI) program.

The standards beneath the condition are tagged separately: the program’s organization and policies at A-0748 through A-0751 (§482.42(a)(1) through (a)(4)), including A-0749 (methods for preventing and controlling transmission) and A-0750 (clean and sanitary environment); antibiotic stewardship from A-0760 (§482.42(b)); leadership responsibilities; unified programs for multi-hospital systems; and respiratory illness reporting.

“Pest,” “vermin,” “rodent,” “insect,” and “infestation” do not appear in §482.42, anywhere in 42 CFR Part 482, or anywhere in Appendix A Rev. 238 (0 occurrences, measured). A pest condition reaches this condition only through the “nationally recognized infection prevention and control guidelines” the programs must adhere to, and through the sanitary-environment standard at A-0750.

Interpretive Guidelines (Verbatim, Complete)

Interpretive Guidelines §482.42

The hospital must have an active infection control program throughout the hospital for the surveillance, prevention, and control of Healthcare Associated Infections (HAIs) and other infectious diseases and a program for the optimization of antibiotic use through stewardship. These hospital-wide programs must include, at a minimum, a system for preventing, identifying, reporting (as applicable), investigating, and controlling infections and communicable diseases for all patients, staff, and visitors and a system for improving antibiotic use for patients.

The programs are based on the individual hospital’s assessment while demonstrating adherence to nationally recognized infection prevention and control standards of practice, as well as to best practices for improving antibiotic use where applicable, and for reducing the development and transmission of HAIs and antibiotic-resistant organisms. The hospital should have written standards, policies, and procedures and issues identified in the infection control program must be addressed more broadly through the hospital QAPI program.

Survey Procedures (Verbatim, Complete)

Survey Procedures §482.42

• Review policies and procedures of the infection control program for evidence that the hospital has an active, hospital-wide program for surveillance, prevention, and control of health associated infections and other infectious diseases based on national standards of practice and best practices.

• Review the antibiotic stewardship program for evidence that the hospital has an active hospital-wide program for the optimization of antibiotic use through stewardship based on national standards of practice and best practices.

• Review the infection control program for evidence that the hospital is working collaboratively between infection control and hospital QAPI when infection control issues are identified.

• Review the antibiotic stewardship program for evidence that the hospital is working collaboratively between antibiotic stewardship and hospital QAPI when antibiotic use issues are identified.

What the Surveyor Is Looking For

A condition-level citation is a judgment that the deficiencies under the standards, taken together, mean the condition is not met. For a pest matter that means a pattern: pest activity in a sterile processing area, an operating room, a pharmacy, a laboratory, a food service area, or an area housing immunocompromised patients, combined with evidence that the infection prevention and control program was not aware of, not monitoring, or not engaged in pest events in the building. The standard-level finding is usually written first at A-0750 and cross-referenced here.

The surveyor’s questions move from the observation to the program: Does the program’s risk assessment consider pests? Does the Infection Preventionist see the pest vendor’s records? Is there a route from a pest event to the infection prevention program, and does it work? Was the issue taken to QAPI?

Documentation That Satisfies It

• The infection control risk assessment, with pest activity addressed in it
• Evidence that the Infection Preventionist reviews pest management records and trend reports on a stated schedule
• The pest event reporting route through infection prevention, with an example of it working
• The pest management plan naming the high-risk areas HICPAC lists, with thresholds for the infection-sensitive spaces
• QAPI minutes showing pest-related environmental findings were taken up as infection control issues, which is what the condition text requires
• Coordination records with environmental services and, for construction, the infection control risk assessment process

Where Facilities Most Commonly Fail

• The pest program lives entirely in facilities or environmental services and the Infection Preventionist has never seen its records
• The infection control risk assessment does not mention pests
• A pest event in a sensitive area is handled as a maintenance call with no infection prevention notification and no QAPI record
• The corrective action for a physical environment finding is not carried across to the infection prevention program, so the cross-referenced A-0747 finding is left unanswered

Plan of Correction: What It Must Address

Appendix A’s own survey protocol (Rev. 238, exit-conference instructions) tells surveyors to:

Inform the facility that a written plan of correction must be submitted to the survey agency within 10 calendar days following receipt of the written statement of deficiencies.

and to explain the required characteristics of a plan of correction, which the protocol lists verbatim as:

Corrective action to be taken for each individual affected by the deficient practice, including any system changes that must be made;

• The position of the person who will monitor the corrective action and the frequency of monitoring;

• Dates each corrective action will be completed;

• The administrator or appropriate individual must sign and date the Form CMS-2567 before returning it to the survey agency; and

• The submitted plan of correction must meet the approval of the State agency, or in some cases the CMS Regional Office for it to be acceptable.

The protocol’s post-survey section adds that 42 CFR 488.28(a) allows certification with deficiencies “only if the facility has submitted an acceptable plan of Correction [POC] for achieving compliance within a reasonable period of time acceptable to the Secretary,” and that “After a POC is submitted, the surveying entity makes the determination of the appropriateness of the POC.”

For a condition-level finding the plan must answer the standards cited beneath it and show the program-level change: pest events inside the infection prevention program’s surveillance and monitoring, Infection Preventionist review of vendor records, and QAPI involvement, each with a monitoring position, a frequency, and a completion date. The structure is not a template, and the surveying entity decides whether the plan is acceptable.

Confidence Notes

HIGH confidence. The tag heading, condition text, Interpretive Guidelines, and Survey Procedures are transcribed from Appendix A Rev. 238 (Issued 03-20-26), read in full from the reference’s archived copy of the CMS PDF on September 11, 2026. The condition text was matched against the eCFR XML of 42 CFR Part 482. The description of how a pest finding reaches the condition is inference from the text of the tags and is labeled as such.