long-term care infection prevention
By Buffy Lloyd-Krejci , DrPH , MS , CIC , LTC-CIP
Supporting the Long-term Care Infection Preventionist in a Post-Pandemic World
Prior to the global COVID-19 pandemic disrupting our lives in 2020 , infections in long-term care ran rampant . In fact , the Centers for Disease Control and Prevention ( CDC ) reported that there were 1 million to 3 million infections within this healthcare sector annually . Worse , was that these serious infections led to 380,000 deaths . 1 This is more than 1,000 people dying every single day due to infections . Furthermore , infections are the most frequent cause of transfers and hospital readmissions in long-term care , with many of them preventable . 10 COVID-19 has further contributed to nearly 3 million infections and 165,000 resident and healthcare worker deaths . 2 If there is a silver lining to the last three years , I would say that infection prevention and control has been highlighted as a much-needed focus area within this vulnerable population . One critical piece to mitigating infections is having educated and trained staff that are dedicated to the infection prevention and control program .
In November 2019 , the Centers for Medicare and Medicaid Services ( CMS ) required all certified nursing homes to have at least a part-time dedicated infection preventionist ( IP ) on staff . The CDC recommends that a facility have “ at least ” one full-time infection preventionist with a facility that has more than 100 residents . 5 California Department of Public Health ( CDPH ) has taken things one step further and requires every facility to have a full-time IP . 6
IPs have numerous important duties such as identifying patterns of infections , educating staff members , residents , and families , conducting surveillance and analysis , evaluating antibiotic prescribing practices , and more . 3 They have a critical role to fill , yet challenges abound . Long-term care facilities are wounded and struggling to fill this role , with the industry losing about 15 percent of its workforce or 238,000 staff members since the start of the pandemic . 4 The burnout from the pandemic , low wages / benefits , and poor treatment of staff may have caused many to leave the industry , which is placing comprehensive infection prevention practices on the backburner for some facilities .
Fortunately , recent legislation allows for more qualified professionals to meet the requirements for the IP role . 7 This legislation allows professionals that are a “ licensed nurse , medical technologist , microbiologist , epidemiologist , public health professional , or other healthcare related field ” to be qualified for the IP role in a skilled nursing facility ( SNF ). This will hopefully invite more qualified individuals to enter the profession and ensure appropriate infection prevention practices are being followed and promoted .
What about the IPs themselves ? Are they being supported and equipped to appropriately perform their job ? Frequently when I am talking to IPs , I am told that they are the IP on “ paper only .” That the role of IP comes secondary to any other priority . They often have another role such as the assistant director of nursing ( ADON ) or director of nursing ( DON ) which leaves very little time , if any , for infection prevention practices .
One IP recently told me that she was constantly pulled to fill in elsewhere , often the med cart . She was “ never able to get caught up on infection prevention and control duties .” This left the facility in a “ control-only ” position , not allowing for any “ prevention .” We must
consider the harm that this is posing for residents and the healthcare team . Consider what is contributing to staff burnout . Part of it is having to work twice as hard for residents that are on transmission-based precautions for infections . Therefore , if we prevent infections from occurring in the first place , this could reduce staff burnout and turnover .
We must also prioritize education and training for IPs . A good starting point is with the CDC ’ s long-term care infection preventionist training course . 8 CMS state and federal surveyors will want to ensure that the IP has the appropriate training and has gone through this or a similar training , ensuring the facility meets this regulatory requirement .
This foundational training is only the beginning of education for the IP . The Association for Professionals in Infection Control and Epidemiology ( APIC ) has recently created a specialized certification for long-term care infection prevention ( LTC-CIP ) similar to the CIC certification for acute-care facilities . 9 Obtaining this certification will strengthen their IP & C knowledge base and set them apart as the specialized professionals that they are . This exam application will open on Feb . 1 , 2023 .
While California has been able to implement the requirement of having a full-time infection preventionist , some other states are unable to enact such a “ strict ” protocol . As indicated , some alternatives to ensuring there is proper infection prevention occurring in facilities include : the hiring of healthcare professionals other than a registered nurse or having an infection prevention team that consists of the designated IP , ADON , DON , and unit managers , where the duties are spread among the team . The guidelines and protocols are never static , so ongoing training and education is key .
While the industry has taken steps in the right direction , and each facility differs in its level of commitment to a robust IP & C program , generally this area of care is one that needs highlighting . As long as infection prevention is on the back burner , we will still be in control mode . Control mode often invokes the imagery of ‘ scrambling to catch up , to contain .’ We mustn ’ t perpetually curb the flood with sandbags – we must build the dams . The difference will be measured in lives .
Buffy Lloyd-Krejci , DrPH , CIC , is a leading authority on infection prevention in the long-term care industry . Her firm , IPCWell , delivers in-person gap analysis , training , and support to nursing homes across the country .
References :
1 . https :// www . ahrq . gov / hai / quality / tools / cauti-ltc / modules / resources / guides / infection-prevent . html 2 . https :// data . cms . gov / covid-19 / covid-19-nursing-home-data 3 . https :// apic . org / monthly _ alerts / who-are-infection-preventionists / 4 . https :// medicareadvocacy . org / all-time-low-nursing-home-staffing / 5 . https :// www . cdc . gov / coronavirus / 2019-ncov / hcp / infectioncontrol-recommendations . html 6 . http :// publichealth . lacounty . gov / acd / ncorona2019 / healthfacilities / snf / IPP / 7 . https :// www . hansonbridgett . com / Publications / articles / 220204-5100-infectionpreventionist 8 . https :// www . train . org / cdctrain / training _ plan / 3814 9 . https :// www . cbic . org / CBIC / Long-term-care-certification . htm 10 . https :// www . cdc . gov / nhsn / pdfs / training / 2017 / Bell _ March20 . pdf