Infection control is a crucial, though sometimes overlooked, component of health care. It’s been suggested that nursing home residents are at greater risk of developing infections than the general population. This can be tied to the congregative setting of the nursing home, as well as the comorbidities that many of the residents within the nursing home suffer from, making them more susceptible to outbreaks of infectious diseases. Therefore, implementing an infection prevention and control plan that minimizes the risk of infection facility-wide is essential.
Because the long-term care setting can pose an inherent risk to our residents, staff, and visitors, facilities are responsible for preventing infections before they start. The updated Requirements of Participation (RoP) pave the way for better clinical outcomes with the updated infection control requirements and expanded facility responsibilities. New requirements include:
- Antibiotic Stewardship (F-tag 881) which is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves resident outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms. and
- Infection Preventionist (F-tag F882) which states the facility must designate one or more individual(s) as the infection preventionist(s) who are responsible for the facility’s Infection Prevention and Control Program (IPCP).
According to the Centers for Disease Control and Prevention, antibiotics are among the most frequently prescribed medications in nursing homes, with up to 70% of residents in a nursing home receiving one or more courses of systemic antibiotics when followed over a year. Studies have shown that 40–75% of antibiotics prescribed in nursing homes may be unnecessary or inappropriate, (CDC 2020). To help combat these statistics CMS defined seven core elements of an antibiotic stewardship program:
- Leadership commitment
- Accountability
- Drug expertise
- Action
- Tracking
- Reporting
- Education
The new Infection Preventionist guidelines require that each facility has an Infection Preventionist who meets the following requirements:
- Primary professional training in nursing, medical technology, microbiology, epidemiology, or other related field
- Is qualified by education, training, experience or certification
- Works at least part-time at the facility
- Has completed specialized training in infection prevention and control
- Is a member of & reports to QAPI committee on the IPCP on a regular basis
Every infection control program should develop a well-defined written plan outlining the goals of the program, and include a process for performing a root-cause analysis of infection occurrences in the facility. The IP should use outcome-based measures for monitoring, using standard definitions and criteria for data collection. Policies should be reviewed annually to review the program’s effectiveness and to make necessary updates. Not only does tracking this information improve care, but it’s a great opportunity for your facility to review the effectiveness of the action plan interventions to determine whether the practice changes successfully corrected the issue or if there are additional areas for improvement. Areas of focus might include the following:
- Surveillance of infection; understanding frequency and evaluating patterns
- Analysis of infection data to establish infection rates
- Monitoring for resistant organisms
- Monitoring the use of antibiotics and identifying characteristics that increase the risk for infection
- Establishing and monitoring compliance with infection control policies
Infection prevention and control is an integrated, responsive process that applies to all departments within the organization. It requires collaboration throughout the facility and the interdisciplinary team to develop, implement, and evaluate the program. Complying with the requirements and implementing effective strategies will help facilities reach their goals.
References
- Centers for Disease Control and Prevention. Prevention Tools. Retrieved from: https://www.cdc.gov/longtermcare/prevention/index.html
- Centers for Disease Control and Prevention. The Core Elements of Antibiotic Stewardship for Nursing Homes. Retrived from: https://www.cdc.gov/longtermcare/prevention/antibiotic-stewardship.html
- Centers for Disease Control and Prevention. Nursing Home Infection Preventionist Training Course (2020). Retrieved from: https://www.train.org/cdctrain/training_plan/3814
- Centers for Disease Control and Prevention. The Core Elements of Antibiotic Stewardship for Nursing Homes. (2020) Retrieved from: https://www.cdc.gov/longtermcare/prevention/antibiotic-stewardship.html
