Joint Commission promotes and enforces major changes in patient safety or thousands of participating health care organizations in the United States and around the world. The 2009 NPSGs included regulations targeting the spread of infection due to multidrug-resistant organisms, catheter-related bloodstream infections (CRBSI), and surgical site infections (SSI). The new regulations for CRBSI and SSI prevention apply not only to hospitals, but also to ambulatory care and ambulatory surgery centers. Engaging patients in patient safety efforts is also a major new component of the NPSGs. The Universal Protocol to reduce surgical errors and existing regulations on medication reconciliation have been modified for 2009, based on feedback received by The Joint Commission. International healthcare accreditation Joint Commission International, or JCI is one group that provides international health care accreditation services to hospitals around the world and brings income into the U.S.-based parent organization. This not-for-profit tax-exempt private corporation (a 501(c) organization) currently accredits hospitals in Asia, Europe, the Middle East, Africa, and South America and is seeking to expand its business further. The JCI has a small staff which includes principal consultants and a number of other consultants from around the world. Cost of accreditation JCI quotes an average fee of $46,000 per year to maintain accreditation, plus travel and other costs. For hospital to be successful in the accreditation process, there may be additional costs related to consultancy work prior to accreditation. International accreditors incur different levels of costs with some costing less than JCI. Criticisms A Harvard-led research study published in the BMJ found that US hospital accreditation by independent organizations was not associated with lower mortality or with reduced readmission rates for common medical conditions. The authors concluded that there was no advantage for patients to choose a hospital accredited by the Joint Commission over a hospital accredited by another independent accrediting organization. The Wall Street Journal suggested that the underlying reasons for this is the failure of the Joint Commission to revoke or modify the accreditation status of hospitals with major infractions considered to be so significant they caused, or were likely to cause, a risk of serious injury or death to patients. The nonprofit's revenue was $147M in 2013, and in that fiscal year, it paid its CEO more than $1M. Hospitals pay the Joint Commission up to $37,000 in fees annually to maintain their accreditation status. Inspections cost approximately $18,000 every three years. See also