Pandemic Protocols : Laying the Groundwork for a Safer Future
By Buffy Lloyd-Krejci , DrPh , MS , CIC
Yes , COVID-19 has hit the long-term care industry hard . Yes , we have been charged with a monumental task . Yes , many of us in healthcare
• have been pushed to or beyond our limits . I have personally been on-site in more than 160 nursing
The dawn homes this past year , so I know and understand
I hope to see completely the dark times we are facing . I , too , have returned home from facilities and broken down in arise from this tears at the burdens and challenges and harms that darkness is an are facing our industry . I am human . industry that But I also strive to be optimistic . As difficult as realizes the this may be in these arduous times , I choose to hold importance on tightly to the adage credited to English author Thomas Fuller , who in 1650 wrote these words : of infection
“ It is always darkest just before the day dawneth .”
prevention and Whether Fuller composed these words himself , or he control ( IP & C ), was documenting an ancient proverb are irrelevant not only during to me , as I hold the meaning close . a pandemic ,
The dawn I hope to see arise from this darkness is an industry that realizes the importance of infection but every prevention and control ( IP & C ), not only during a day moving pandemic , but every day moving forward . An industry forward . that takes IP & C and conveys its importance to every person who walks through the door of a long-term care facility , or any healthcare setting . An industry in which every staff member at every position in the building , clinical or not , has adequate training and resources to implement the best care possible for our residents and patients . The long-term care industry suffered great and tragic losses of residents and staff during the pandemic , but prior to this , the estimated numbers of deaths and harms due to infection in long-term care were still appalling .
C . diff , MRSA , and UTI are a few of the culprits . According to the CDC , 1 million to 3 million serious infections occur in nursing homes each year , resulting in an estimated 380,000 deaths caused by serious infections . When I first heard this unacceptable number about five years ago , I quit my corporate public health position and vowed to fight full-time to protect our residents and staff from these harms and deaths .
To me , IP & C are two entirely different things . Infection control implies the idea that the job belongs
to one person , the expert we turn to during a crisis . Infection prevention bolsters the idea that this is everyone ’ s responsibility , and that every chain in the link , every member of the team is responsible for best practices . If a deadly virus tragically taking hundreds of thousands of lives can have a silver lining , I believe the strict processes we are getting accustomed to will save just as many , if not more , lives in the future . You may have had a loved one lose his or her life from this virus in a healthcare setting , whether staff member or resident , and moving forward we must ensure that these lives lost were not in vain .
When it comes to IP & C , not all healthcare settings are created equal . Hospitals have had high standards and strict protocols for decades , including a highly trained , full-time infection preventionist ( IP ) on staff . But as more complex and acute care has begun to shift to settings outside the hospital , the strict protocols haven ’ t followed . In late 2016 , the guidelines for IP & C in nursing homes began to become stricter , with implementation to begin over time . As of November 2019 , facilities were required to have an IP on staff . While the recognition of a problem is a good start , there were many snags in this new plan .
The IP & C protocols for a hospital and nursing home , while similar , do not identically transfer to the nursing home setting . The staffing and budgets for hospitals compared to nursing homes aren ’ t even in the same ballpark . The hospital setting devotes a full-time , trained position to IP & C , while nursing homes scramble to assign the title and role to a current staff member , usually a director of nursing ( DON ) already buried in responsibility .
This isn ’ t to say that they aren ’ t willing , or they aren ’ t strong enough to take on this additional responsibility , but even given all their effort they are unequipped to perform this additional role effectively . There exist plenty of IP & C training courses offered from credible , knowledgeable sources like the CDC and APIC , yet the bridge between information and implementation is long and difficult to traverse .
Each facility is unique , and while generalized instruction is a great start , the real-world application