An effective Infection Preventionists plays the part of guardian, detective, and scientist as they lead facility efforts in preventing and controlling infections through a robust Infection Prevention and Control (IPC) program. As facilities move beyond the COVID era, applying lessons learned and sustaining these key functions diligently is the priority.
The purpose of an IPC is “to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.” (CMS SOM Appendix PP). Effective IPC programs, with their strong emphasis on prevention, will reduce the risk of pathogen transmission and development of healthcare-associated infections and improve residents’ quality of life. Key priorities for the Infection Prevention to focus efforts include the following:
A major factor in infection prevention is the strength of the facility immunization program for residents and staff. Residents and staff should be offered the Influenza vaccine annually and the Pneumonia vaccine as recommended (try CDC’s PneumoRecs Vax Adviser app). Of course, the COVID vaccine, including any recommended booster doses, must also be offered.
Key areas to address include:
- Compliance rate: Consider arranging for the pharmacist or a local infectious disease physician to provide education on the risks and benefits of vaccinations for your residents, their families and staff.
- Evidence that residents and staff are being re-approached, on a routine basis, if they initially decline vaccines: Educate the residents and their families, as well as staff, on the risks and benefits of each and every vaccine. Document all education provided and each time you offer the vaccine.
- Effectiveness of documentation of resident vaccinations in the clinical record.
Education and Adherence to Policies and Procedures
Well written policies and procedures are only effective when staff apply them in their daily work. Are you confident that staff are knowledgeable about each resident’s care plan including precautions and what PPE to wear? Consider these strategies:
- Perform walking rounds to monitor for adherence to hand hygiene and other infection control standards.
- Following staff education, assess competency for donning and doffing PPE. Repetition is key to developing effective habits as part of the workflow.
- Apply a coaching approach. For example, dialogue regularly about when hand hygiene should be performed, observe peri-care, monitor meal trays being passed on the unit. Recognize positive performance and address concerns in real time. Training provided during day-to-day care activities develops positive habits for long-term success.
- Document each time you educate staff. Use facility audit tools and competency checklists and maintain these records as proof of routine infection prevention activities.
Cleaning and Disinfection
A study cited in a March 2022 issue of the American Journal of Infection Control found that over 90% of high-touch surfaces in LTC facilities were contaminated with fecal matter and other potential sources of infectious disease spread. Handrails, equipment controls, and patient beds were 4 times more likely than other surfaces or locations to have high levels of fecal matter. The facility’s Infection Preventionist should use a risk-assessment approach to identify high-touch surfaces and then coordinate appropriate cleaning and disinfecting policies and schedules with the housekeeping staff. These policies should address at a minimum: (1) Product selection (2) Proper use of the product (3) Standardized process for cleaning and disinfecting and (4) Frequency of cleaning/disinfecting. The same process should be followed for a review of resident equipment, including taking steps to (1) Identify what are the high-touch surfaces/items (2) Who cleans them (3) Frequency (4) Product to be used and (5) Storage and labeling. In addition to strong policies, education on proper procedures for the use of the cleaning/disinfecting products should be provided, as well as routine monitoring for compliance. The CDC has a checklist available for monitoring terminal cleaning.
The Infection Preventionist should have readily accessible surveillance data on all current and past infection concerns. Data should be divided by infection type. For example, line listings should be kept of infections in real time (e.g., UTI’s, COVID-19 or other respiratory concerns, GI issues, etc.) Ensure that tracking tools are up to date and that documentation includes identification and analysis of any notable trends.
Antibiotic use, culture results and symptomatology data documentation should address tracking and trending in real time to catch any emerging threats or patterns. Evaluate surveillance data for trends related to factors such as, but not limited to resident location, infection type, and staff assignment. It is the job of an efficient and observant IP to catch any emerging concerns before they become widespread, and to implement interventions to prevent the escalation of problems.
COVID-19 Screening and Testing Considerations
The last CMS updates to the CMS guidelines for screening and testing were provided in QSO-20-38-NH revised on 9/23/22 https://www.cms.gov/files/document/qso-20-38-nh-revised.pdf. While CMS does not mandate testing for nursing home visitors, it is required that effective screening procedures are implemented. Procedures should include education on risks of COVID-19 and proper source control use EACH TIME a visitor enters the building. Also, when a visitor is demonstrating symptoms, a process must be in place to initiate specific action steps to safeguard against the possible spread of infection.
Staff and residents must still be tested based on Table 1 below from the QSO. The best prevention for keeping your residents free from COVID-19 is a strong defense at the front door. Any necessary screening and testing should occur BEFORE staff report to the unit. Visitors should be educated on hand hygiene and staff should be sure hand sanitizer is readily available.
While the Public Health Emergency is expected to end May 11, 2023, facilities are required to continue to follow weekly NHSN reporting per guidelines and communicating outbreaks appropriately to staff, residents, family members, and public health authorities. It is MANDATORY for LTC Facilities to report required data every 7 days in the NHSN portal. Use a consistent day each week to report. Identify appropriate back-up personnel in case your primary person is unavailable. Detailed guidance on the NHSN reporting requirements can be found at https://www.cdc.gov/nhsn/ltc/index.html.
Equip your Infection Preventionist to succeed by registering for the virtual 8-week series The Proficient Infection Preventionist beginning April 12, 2023. Join other Infection Preventionists across the country as we emphasize skill building for the post-acute care Infection Preventionist with in-depth discussion of implementing an effective IPC program in the SNF/LTC/AL setting with solid systems, effective processes for surveillance and data collection, as well as outbreak management, and guidance for managing evolving regulatory requirements. Contact Proactive for IPC program review and consultation.
Written By: Proactive LTC Consulting
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