Nursing homes need infection prevention education
Jennifer Sanguinet, MBA-HCM, BSIS, CIC, Director Infection Prevention
The “no healthcare facility is an island” effect is growing concern for acute and sub-acute infection prevention programs.1 Between an estimated one and three million serious infections occur in long-term care facilities each year, and these infections have been demonstrated to impact infection rates at regionally-associated hospitals and nursing homes.2,3
In an effort to identify areas for “infection preventative maintenance” in our hospitals' admission and discharge network, we tested the infection prevention knowledge of 177 nurses at 11 nursing homes in Los Angeles County, including 88 certified nursing assistants (CNAs), 20 licensed vocational nurses (LVNs) and 69 registered nurses (RNs).
The aptitude test consisted of 23 questions, which varied among “true or false,” matching pairs and multiple-choice types. The questions tested knowledge of general infection prevention concepts and techniques including pathogen transmission, isolation precautions, personal protective equipment use, and sterilization procedures.
The study, presented in June at the 42nd Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC), showed participating LTC nurses received a mean test score of 38.5% and significantly different mean scores across the 11 facilities.
Nursing credentials accounted for no statistical difference on the test outcome; the average test scores for CNAs, LVNs, and RNs were 34.0%, 38.6% and 44.3%, respectively.
Of the four categories tested, sterilization procedures scored the highest at 58.2% while isolation precautions scored the lowest at 30.7%. PPE and pathogen transmission scored in the middle at 32.0% and 46.9%, respectively.
Just under 34% of participating nurses identified the use of droplet precautions for influenza and 20.9% identified contact precautions for an MRSA infection, despite being among the most prevalent pathogens in long-term care.4
Numerous factors may have contributed to the overall low scores, including unfamiliar test nomenclature, idiosyncratic facility policies and education, or even participant apathy. However, given the well-documented infection prevention challenges in long-term care, a general lack of infection prevention knowledge in the participating LTC nurses was the likely the largest contributor to the results.
A large majority of LTCs do not have dedicated infection prevention nurses, and one study the IP staffing provided in these duties were shown to be four times less than those of a similar sized acute care hospital.5,6 Additionally, many states do not have specific training requirements for LTC infection preventionists nor mandate staff time dedicated to infection prevention.7
In practicality, this study helped determine where and how nursing homes in our community needed infection prevention education. Staff education was prioritized in low scoring facilities and considering the homogeneity of test scores between CNAs, LVNs, and RNs, all LTC nursing staff received the same education in subsequent inservices. Though there were significant differences in scores across each category, inservices included educational reinforcement of knowledge for all categories tested.
Although the clinical and economic benefits of the regional outreach are currently unknown, the Center for Disease Control and Prevention states frequent infection prevention education can reduce infections acquired in LTC. Targeted and sustained infection prevention education in our local LTC facilities will reduce infections, and hopefully, in turn reduce costly hospital readmissions.
Jennifer Sanguinet, MBA-HCM, BSIS, CIC, is the director of infection prevention at West Hills Hospital Medical Center, West Hills, CA. Cody Haag is the vice president of research and development at Clean Sweep Group.
1 McDonald LC, et al. Vital Signs: Preventing Clostridium difficile Infections. MMRW. 2012; / 61(09) 157-162.
2 Strausbaugh LJ, et al. The Burden of Infection in Long-Term Care. Infect Control Hosp Epidemiol 2000; 21: 674-679.
3 Lee BY, et al. The importance of nursing homes in the spread of methicillin-resistant Staphylococcus aureus (MRSA) among hospitals. Med Care. 2013; 205-15.
4 Montoya A, et al. Common infections in nursing homes: a review of current issues and challenges. Aging health. 2011 Dec; 7(6): 889–899.
5 Smith P, et al. SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol 2008; 29(9): 785-814.
6 Roup BJ, et al. Infection control program disparities between acute and long-term care facilities in Maryland. AJIC 2006; 34(3):122-27.
7 Roup BJ, et al. How Maryland increased infection prevention and control activity in long-term care facilities, 2003-2008 AJIC, 2011; 39:292-295.