CMS · Survey deficiency reference

A-0749 Infection Prevention and Control Program: Methods for Preventing and Controlling Transmission (§482.42(a)(2))

Identifier and Official Title

A-0749 is the tag for 42 CFR §482.42(a)(2). The heading as printed in Appendix A Rev. 238 reads, verbatim:

A-0749 (Rev. 238; Issued: 03-20-26; Effective: 09-05-25; Implantation: 09-05-25) §482.42(a)(2) The hospital infection prevention and control program, as documented in its policies and procedures, employs methods for preventing and controlling the transmission of infections within the hospital and between the hospital and other institutions and settings;

(“Implantation” is CMS’s own typographical error, reproduced as printed on every Rev. 238 tag heading.) Under this tag the regulation text is the heading itself; the Interpretive Guidelines follow directly.

This page was rebuilt on September 11, 2026. An earlier version, written while the CMS manual was unreachable, withdrew any statement about what A-0749 covers. The manual has since been read in full and the tag’s subject is now stated from it.

What It Enforces (Verbatim)

The regulation, as it appears in 42 CFR §482.42(a) (eCFR, Part 482, point-in-time 2026-09-08):

(a) Standard: Infection prevention and control program organization and policies. The hospital must demonstrate that:

[…]

(2) The hospital infection prevention and control program, as documented in its policies and procedures, employs methods for preventing and controlling the transmission of infections within the hospital and between the hospital and other institutions and settings;

The words “pest,” “vermin,” “rodent,” “insect,” and “infestation” do not appear in §482.42 or anywhere else in 42 CFR Part 482 (0 occurrences in the Part 482 eCFR XML), and do not appear anywhere in Appendix A Rev. 238 (0 whole-word and 0 substring occurrences across all 613 pages).

Interpretive Guidelines (Verbatim, Complete)

Interpretive Guidelines §482.42(a)(2)

The hospital infection prevention program must establish policies and procedures for implementing methods of preventing and controlling the transmission of infection in the broader sense, to include not only the hospital but between the hospital and other institutions or settings. The development of such policies and procedures will require hospitals focus efforts to prevent and control infections not just between patients and personnel, but also between individuals across the entire hospital setting (for example, among patients, personnel, and visitors) as well as between the hospital and other healthcare institutions and settings and between patients and the healthcare environment. It is expected that hospitals consider the impact of their outpatient facilities on their inpatient units with the development and implementation of a hospital wide infection control and prevention program policies.

We believe this section reflects current best practices that are in place in most hospitals. The reality is that patients move between settings with great frequency and carry organisms with them, hence it is imperative that hospitals approach multi-drug resistant organism control from the broader perspective in order to protect their patients and staff. A concrete example of this already being part of current practice is that hospitals are already required to track both hospital- and community-onset cases of CDI and MRSA, because research has shown that community onset cases of these pathogens can impact hospitals. Hospitals should consider how they can partner with facilities with whom they frequently share patients (e.g. nursing homes) to establish ways to share information on patients who harbor potentially transmissible pathogens. Likewise, the role of the environment is being increasingly recognized as an important source of infections and this change simply reflects this data and best practices. There are many good examples of hospitals working on preventing the spread of infection between healthcare environments. This update also fits with the clarification that these CoPs apply to both a hospital’s inpatient and outpatient locations.

Survey Procedures (Verbatim, Complete)

Survey Procedures §482.42(a)(2)

• Review the hospital policies and procedures for infection control and prevention to provide evidence that the hospital is following policies and procedures that employ the methods for preventing and controlling the transmission of infections within the hospital and between the hospital and other healthcare settings.

• Determine whether the infection control program is being applied throughout the hospital to both inpatient and outpatient settings.

Where a Hospital Pest Finding Framed as Infection Control Is Actually Written

A-0749 is about methods of preventing and controlling transmission, with its only environmental hooks being the phrases “between patients and the healthcare environment” and “the role of the environment is being increasingly recognized as an important source of infections.” It names no area of the hospital and no environmental condition.

The next tag, A-0750, enforces §482.42(a)(3), whose regulation text requires “maintaining a clean and sanitary environment to avoid sources and transmission of infection,” and whose Interpretive Guidelines list the areas the program is expected to monitor: “onsite laundry facilities, food storage, preparation, serving and dish rooms, refrigerators, ice machines, air handlers, autoclave rooms, venting systems, inpatient rooms, treatment areas, labs, waste handling, surgical areas, supply storage, equipment cleaning, etc.” A pest observation is an observation about the sanitary condition of one of those areas. A hospital pest finding framed as an infection control deficiency is therefore far more likely to be written at A-0750 than at A-0749. That is this reference’s inference from the two tags’ text; it is consistent with the publicly posted Form CMS-2567 reports reviewed while building the deficiency section, and it is not a CMS statement.

A pest finding framed as a physical plant failure is written under A-0701 (§482.41(a)) or, for facilities and supplies, A-0724 (§482.41(d)(2)). If the number on your paperwork is one that does not exist in Appendix A, start at A-0758 does not appear in Appendix A.

The 2016 “Techniques for Pest Control” Bullet

The 2016 archived edition of Appendix A carried a bullet reading “Techniques for pest control” in the interpretive guidance under the §482.42(a)(1) tag, which was then numbered A-0749. That bullet is absent from Rev. 238; so is every other pest term. Any vendor material, consultant template, or prior research quoting the bullet as current CMS guidance is quoting a superseded archive. The renumbering also means “A-0749” in a 2016-era document and “A-0749” on a current Form CMS-2567 point at different regulation text: §482.42(a)(1) then, §482.42(a)(2) now.

What the Surveyor Is Looking For

Under A-0749 the evidence is program-level and documentary, exactly as the Survey Procedures say: the policies and procedures, and whether they are applied hospital-wide, inpatient and outpatient. If a surveyor writes pest activity to this tag, the assertion is that the program’s documented methods for preventing and controlling transmission did not reach an environmental source the program should have addressed. The surveyor will ask whether pests appear in the infection control risk assessment, whether the program has a defined response to pest events in infection-sensitive areas, and whether the Infection Preventionist is engaged with the pest management program.

Documentation That Satisfies It

• The infection control risk assessment, with pest activity as an assessed environmental risk
• Program policy assigning responsibility for pest events in infection-sensitive areas to the infection prevention program, and the route by which a pest sighting reaches it
• Evidence of Infection Preventionist review of pest management records and trend reports, on a stated schedule
• The pest management plan’s coverage of the high-risk areas HICPAC names (kitchens, laundries, central sterile supply, operating rooms, loading docks, construction areas), with infection prevention sign-off
• Evidence the program is applied at outpatient locations as well as inpatient units

Where Facilities Most Commonly Fail

• The response cites the removed 2016 bullet as if it were current, which tells the reviewer the facility is working from secondhand material
• Pest risk is absent from the infection control risk assessment
• The infection prevention program has no defined role in the pest management program, so a pest event in a sterile or food area is handled as a maintenance call with no infection prevention record
• The plan answers the physical environment tag and leaves the §482.42 finding 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.”

Applied to a pest finding written under A-0749, the plan has to show: the corrective action for the observed condition and for the program gap it exposed (with the service records and the revised policy); the system change that puts pest events inside the infection prevention program’s documented methods; the named position that monitors it and how often; and a completion date for each action. The plan-of-correction structure is not a template; the surveying entity, not the facility, decides whether it is acceptable.

Confidence Notes

HIGH confidence. The tag heading, regulation 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 regulation text was matched against the eCFR XML of 42 CFR Part 482. The statement about where a pest finding is more likely to be written is an inference from the two tags’ text and is labeled as such. The 2016-archive finding is carried from this reference’s State Operations Manual page.