As federal entities push for greater infection prevention and control resources in nursing homes, some researchers in the space argue that even more needs to be done to keep pace with rising acuity and a multitude of comorbidities in today’s residents.
The space will need a mix of long-term and immediate solutions, according to Dr. Christopher Crnich, including but not limited to separating long-term and short stay residents, overhauling private room construction and providing greater resources to infection preventionists (IPs). He discussed the need to reimagine infection control in an article published by the Journal of the American Medical Directors Association (JAMDA) on Wednesday.
“The dual challenges of rising complexity of medical care delivered in [nursing homes] and an increasing frequency of outbreaks caused by high consequence pathogens require reimagining what is possible in this setting,” said Crnich. “The existing structure of the infection control program in most [nursing homes] is inadequate and requires major change for these settings to become safer and more resilient health care environments.”
The warning comes at a time when the sector faces a ‘tripledemic,’ with Covid-19, Respiratory Syncytial Virus (RSV) and the flu spreading during winter months.
Updated requirements of participation issued by the Centers for Medicare & Medicaid Services (CMS) did have infection control front and center, calling on operators to reduce room crowding and and have an IP in place. Updates fall in line with the Biden administration’s reform initiatives announced in February.
Among his suggestions: IPs need more support from other parts of the nursing home “work system,” referring to operator leadership and local government entities. The number of hours an IP devotes to infection control has “almost doubled” since the onset of the pandemic, he added, from 20 to 38 hours per week, according to a study conducted by Michigan nursing homes.
Training resources should be made available on a regular basis to make sure IPs have the most up-to-date education, he said. Staffing ratios specifically for IPs should be implemented too – Canadian long-term care facilities already have such a ratio in place, requiring one fulltime IP per 150-200 beds.
Interim recommendations by the Centers for Disease Control and Prevention (CDC) go further, according to Crnich, suggesting a full-time IP per 100-bed facility or for any facility that provides on-site ventilator or hemodialysis services.
Expanded expectations of IPs should be coupled with a more sophisticated staffing model that really looks at the amount of time an IP should devote to surveillance, staff education, occupational health and quality improvement. Automated surveillance can help IPs cut down on surveillance time, he added.
An infection prevention committee made up of the administrator, director of nursing, medical director and potentially a consulting pharmacist would be helpful too, he said, while hospitalists could lend their expertise to neighboring nursing homes.
“Hospitals that find ways to extend their infection control resources and technical expertise to [nursing homes] in their referral networks has the potential to reduce avoidable readmissions and introduction of multidrug-resistant organisms which should generate benefits for both parties,” he added.
A more long-term recommendation to better manage the colonization and spread of multidrug-resistant organisms lies in separating long-term and short stay residents, as well as the staff that care for them, he said.
The suggestion echoes what Skilled Nursing News has heard from other leaders in the space to separate short-stay and long-term care residents, also citing rising acuity in patients and expanding business lines among nursing facilities.
Robust redesigns of skilled nursing space includes private rooms and bathrooms, which many operators have already been working toward, and upgrading building ventilation were other long-term recommendations made in the JAMDA article.
While the level of ventilation is far below what one might find in an acute care setting, Crnich did say studies linking poor ventilation to respiratory viral outbreaks are needed as the sector moves ahead.
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