CMS · Survey deficiency reference

A-0750 Clean and Sanitary Environment (§482.42(a)(3))

Identifier and Official Title

A-0750 is the tag for 42 CFR §482.42(a)(3). The heading as printed in Appendix A Rev. 238 reads, verbatim:

A-0750 (Rev. 238; Issued: 03-20-26; Effective: 09-05-25; Implantation: 09-05-25) §482.42(a)(3) The infection prevention and control program includes surveillance, prevention, and control of HAIs, including maintaining a clean and sanitary environment to avoid sources and transmission of infection, and addresses any infection control issues identified by public health authorities; and

Under this tag the regulation text is the heading itself; the Interpretive Guidelines follow directly. The heading was verified against the full text of Rev. 238 on September 11, 2026, and the tag’s existence and subsection were independently confirmed by the operator’s search of the same PDF on September 10, 2026.

Correction to this reference’s earlier text. Until September 11, 2026 this page quoted, as the Appendix A sanitary-environment language, a sentence beginning “The hospital must provide a sanitary environment to avoid sources and transmission of infections and communicable diseases. There must be an active program for the prevention, control, and investigation of infections…” That sentence does not occur in Rev. 238. It tracks the pre-2019 text of §482.42. The passages below are what the current manual says.

What It Enforces (Verbatim)

From 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:

[…]

(3) The infection prevention and control program includes surveillance, prevention, and control of HAIs, including maintaining a clean and sanitary environment to avoid sources and transmission of infection, and addresses any infection control issues identified by public health authorities; and

“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).

Interpretive Guidelines (Verbatim, the Environmental Passages)

Interpretive Guidelines §482.42(a)(3)

The hospital must provide and maintain a clean and sanitary environment to avoid sources and transmission of infections and communicable diseases. All areas of the hospital must be clean and sanitary. This includes all hospital departments and off-site locations. The infection prevention and control program should include appropriate monitoring of housekeeping, maintenance (including repair, renovation and construction activities), and other activities to ensure that the hospital maintains a sanitary environment. Examples of areas to monitor would include the hospital’s: 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.

The guidance continues with water management (Legionella and other waterborne pathogens, referencing the ASHRAE standard and the CDC toolkit), hospital-wide surveillance, and outbreak recognition. Those passages are not pest-relevant and are not reproduced here; they are in the primary source at the tag.

Survey Procedures (Verbatim, the Environmental Bullet)

Survey Procedures §485.42(a)(3)

• Observe the hospital for the sanitary condition of their environments of care, noting the cleanliness of patient rooms, floors, horizontal surfaces, patient equipment, air inlets, mechanical rooms, food service activities, treatment and procedure areas, surgical areas, central supply, storage areas, medication preparation etc.

(The heading’s “§485.42” is CMS’s own error, reproduced as printed; the tag is §482.42(a)(3).) Three further bullets direct the surveyor to the program’s surveillance policies and public-health reporting, its water management documentation, and its outbreak procedures.

Why This Is the Tag for a Pest Finding Framed as Infection Control

Pest control is not named anywhere in the tag. But the tag is the only place in Appendix A where the surveyor is told to observe the sanitary condition of specific areas, and the list of areas to monitor (food storage and dish rooms, refrigerators, ice machines, waste handling, supply storage, surgical areas) is the list of places where pest activity is found. A pest observation is an observation that one of those areas is not clean and sanitary, or that the program’s monitoring did not catch it. That is why a hospital pest finding framed as an infection control deficiency is far more likely to be written here than at A-0749, whose subject is methods for preventing transmission and which names no area. This is the reference’s inference from the two tags’ text, consistent with the publicly posted Form CMS-2567 reports reviewed while building this section; it is not a CMS statement.

What the Surveyor Is Looking For

Two things, and the second matters more than the first. First, the observed condition: pest activity or evidence, in one of the areas the guidance names, that the surveyor regards as a source or transmission risk. Second, the program’s monitoring: whether the infection prevention and control program was monitoring that area, knew about the condition, and acted. “Appropriate monitoring of housekeeping, maintenance … and other activities” is the operative phrase; a program that had no monitoring of the dish room or the waste-handling area, or had it and did not act on a pest event there, is the finding.

Documentation That Satisfies It

• The investigation record for the specific pest event: who was notified, when, what was found, what was done
• The infection prevention program’s standing procedure for pest events, showing the investigation step
• The program’s environmental monitoring records for the cited area (housekeeping rounds, environment-of-care rounds, or equivalent) showing the area is on the schedule
• The pest management plan and its coverage of the affected area
• Environmental services cleaning and disinfection records for the affected area following the event
• Trend reports showing the program tracks pest activity as an environmental infection risk

Where Facilities Most Commonly Fail

• The pest event was remediated but never entered the infection prevention program’s records, so there is nothing that shows “monitoring”
• The infection prevention program has no procedure for pest events
• The cited area (loading dock, waste holding, a satellite kitchen, an off-site location) is not on any monitoring schedule at all; the guidance is explicit that the requirement “includes all hospital departments and off-site locations”
• The response addresses the physical environment tag (A-0701) and leaves the A-0750 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 at A-0750, the plan has to show: remediation of the observed activity and the harborage that produced it, with the service records; the inspection of comparable areas, not only the room the surveyor entered; the system change that puts the cited area, and pest events generally, inside the program’s monitoring (revised rounds, a pest-event procedure with an investigation step, infection prevention review of vendor records); the named position that monitors it and how often, with results reported to a named committee; and a completion date for each action. The structure is not a template, and the surveying entity decides whether the plan 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, and agree with the operator’s independent search of the same PDF on September 10, 2026. The regulation text was matched against the eCFR XML of 42 CFR Part 482. The statement about citation practice is an inference and is labeled as such.