the npsgs have become a critical method by which the joint commission promotes and enforces major changes in patient safety for 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.