long-term care infection prevention
long-term care infection prevention
By Katherine Lunt, MBA, MPH, CIC
Persistence of Healthcare-Acquired Infections in Long-term Care Facilities
While it may seem that HAI prevention in LTCFs is daunting and overwhelming, it is crucial for the safety of residents. Developing an infection control and prevention committee that has a dedicated sponsor and tracks the facility’ s progress regarding HAIs, antimicrobial stewardship, and action plans, is a first step to ensure that HAIs are being monitored and treated appropriately.”
Despite the focus on infection prevention during the COVID-19 pandemic, healthcare associated infections( HAIs) in long-term care facilities( LTCFs) are increasing. HAIs are infections that a resident develops from complications of healthcare. 1 LTCF residents may reside in nursing homes, assisted living facilities, group homes, and can include people of all ages and developmental stages. Residents of LTCFs are particularly vulnerable to HAIs because many residents have a risk factor that increases their risk of acquiring an infection. Risk factors include, but are not limited to, being older than 65, having underlying disease and / or chronic conditions( e. g., diabetes mellitus type 2), impaired mental status, or use of indwelling devices, such as a foley catheter.
According to the Centers for Disease Control and Prevention( CDC), each day, 1 in 43 nursing home residents contracts a HAI. 2 In 2023, Pennsylvania alone saw an 18.6 percent increase in HAIs in LTCFs from 2022. 3 In 2020, Pennsylvania reported that respiratory tract infections( RTI), such as pneumonia and influenza, were the most frequently reported infection type, but skin and soft tissue infections( SSTI) were the most frequently reported infections in 2021, 2022, and 2023. 4 Examples of skin and soft tissue infections include decubitus ulcers, cellulitis, and abscesses. To complicate infections, many HAIs are caused by multi-drug-resistant organisms( MDROs). MDROs are microorganisms that are resistant to at least one or more antimicrobial agents. 5 An example of an MDRO is Candida auris, which is a multidrug-resistant yeast that is prevalent in healthcare facilities across the United States. HAIs and MDROs can cause severe illness, sepsis, or death.
Currently, the CDC does not require LTCFs to report HAIs, such as influenza, MDROs from any specimen, 6 Clostridiodes difficile, and both catheter and non-catheter associated urinary tract infections 7 to the CDC’ s National Healthcare Safety Network( NHSN), but it is optional. 8 The lack of federally required reporting indicates that is unknown how prevalent and severe HAIs are in LTCFs nationally.
While it may seem that HAI prevention in LTCFs is daunting and overwhelming, it is crucial for the safety of residents. Developing an infection control and prevention committee that has a dedicated sponsor and tracks the facility’ s progress regarding HAIs, antimicrobial stewardship, and action plans, is a first step to ensure that HAIs are being monitored and treated appropriately. It is also important to track, analyze, and share HAI investigations and data with frontline staff and key stakeholders. Verify that current policies and procedures align with evidence-based guidelines on infection prevention and control in LTCFs. Facilities may want to consider allocating funds to employ and continuously educate a full-time infection preventionist.
To understand your facility’ s baseline in HAI prevention, analyze current workflows to identify latent and active failures( e. g., lack of accessible ABHR for hand hygiene) that may contribute to an increased risk of infection in residents. Facilities also need to have the proper infection prevention strategies in the residents’ home. An example is assessing the availability of accessible alcohol-based hand rub( ABHR) and tools to successfully implement enhanced barrier precautions. Conder adopting a systems approach to implement an HAI prevention checklist or toolkit that incorporates evidence-based guidelines and recommendations to address risk and safety concerns for both residents and staff( e. g., Loeb and McGeer Criteria: A Practical Guide for Use in Long-Term Care).
As your infection prevention program advances, leverage electronic-based tools to ensure that residents who are at risk of developing or spreading an infection are appropriately identified and placed on precautions. Review HAIs, identify the root cause of the infection, and create action plans to address identified causes of infection. Build a culture of safety reporting system through the application of just culture principles to strengthen psychological safety of staff.
Empower residents and their families to assist with HAI prevention and mitigation. Educate residents, family members, and visitors on the risks associated with developing an infection, especially if a resident has an indwelling device, as indwelling devices put a resident at a higher risk of infection. Use resident councils to teach residents and family members about the importance and basics of infection prevention, including vaccination( e. g., pneumonia and influenza). Encourage residents, family members, and visitors to ask their healthcare providers to wash their hands before performing resident or clinical care.
Staff education is also crucial. All nursing and clinical providers should receive training on appropriate antibiotic usage, and facilities should track antibiotic usage to combat the rise in MDROs. Provide staff with training on and access to appropriate types of personal protective equipment, convenient hand hygiene opportunities, and disinfectants. Recognize that you may have staff( and residents) who have a different first language other than English. Translate signage, education, checklists, and tools to ensure competency and safety of multilingual staff.
When a resident acquires an infection, the acuity of their care increases. As the baby boomer generation ages and care continues to shift from the hospital to the home, there will be a greater demand
32 • www. healthcarehygienemagazine. com • jul-aug 2025