Before the COVID-19 pandemic struck, infection prevention and control (IPC) in long-term care facilities was usually relegated to the sidelines. If it was focused on at all, IPC often fell squarely on the shoulders of each facility’s infection control nurse. Unfortunately, the nurse’s myriad other duties meant IPC was, at best, only a small part of their day-to-day activities.
In many ways, long-term care facilities’ reluctance to prioritize IPC makes sense. After all, most facilities are focused on more pressing issues. However, this approach often means facilities lack the strong culture IPC necessary to keeping their residents and staff safe from infectious disease outbreaks.
This needs to change. Long-term care facilities must find a way to incorporate effective IPC measures while maintaining a home-like, comfortable environment for their residents.
The good news is that these aims are not mutually exclusive. The first and most important step to achieving them: building a facility-wide culture that prioritizes educating every single staff member about the specific ways they can mitigate infection risks while performing their assigned duties.
The importance of educating the entire workforce about IPC — not just the nursing staff — cannot be overstated. For example, ancillary staff touch every aspect of residents’ care. If these specific departments don’t understand how to reduce the risk of spreading infections, you’re setting your facility up for problems.
Take housekeepers, for example. Do they start by cleaning a resident’s restroom, and then move on to cleaning the room itself (a common practice)? If so, they are cross contaminating the environment and opening the door to infectious disease risks. Educating them about cleaning best-practices is essential.
It’s not just environmental services staff, either. If laundry staff re-wear personal protective equipment (another common practice) while sorting soiled linen, or wash and dry microfiber cloths and mops incorrectly, they introduce the very real risk of cross-contamination. And if food service workers don’t regularly sanitize common equipment like ice machines, they may be putting residents at risk for infections such as Legionnaires disease. These are just a few examples of common practices that can increase the risk of infections; there are many more.
I know what you may be thinking: “This all makes sense, but how do we find the time and resources to train our staff in proper IPC measures?”
It’s a good question, and one we hear frequently from leadership in the facilities we work with. The answer lies in your infection preventionist (IP). If your facility receives funding from the Centers for Medicare & Medicaid Services, you are required to have at least a part-time IP onsite. If you have over 100 beds, a full-time onsite IP is recommended. In either case, your IP can monitor your staff and educate them about the specific role each of them play in preventing and controlling infections.
To be effective, your IP must be fully dedicated to their role. The reality is that, in order to do their job properly, an IP must have time to perform surveillance, audit infection rates, educate staff, monitor the antibiotic stewardship program, oversee water management, build a culture of IPC, and more. Being asked to take on additional non-IP-related responsibilities will reduce their effectiveness as an infection preventionist.
Your facility’s leadership and ownership must support them, too. Your IP might be knowledgeable and competent, but unless they have executive support and buy-in, they will struggle to create the kind of culture that is so important for resident safety and wellbeing.
As important as both things are to your IP’s success, the sheer number of duties and responsibilities they have means they must be willing and able to delegate some tasks to other staff members. For example, as we discussed earlier, ensuring that ancillary staff are engaging in appropriate IPC is a key part of reducing and controlling infections in your resident population. Auditing ancillary staff can take a lot of time. IPs can delegate the auditing practices to department supervisors, or even train the staff to audit each other.
Ultimately, for your IPC program to be effective, every member of your facility must be actively involved. When they are, the risk of cross-contamination and infectious disease outbreaks decreases. Furthermore, there is less need for transmission-based precautions, because there are less infections in the facility. As a result, staff morale is higher, there is less cost to the facility (because there’s less need for additional PPE), residents are better protected, and families are happier, too.
This aspirational scenario is eminently possible. I know, because my team and I have seen it play out time and again in facilities with a dedicated IP who has leadership support, adequate time, resources to focus on their job, and the ability and willingness to delegate various tasks. These IPs have what they need to fulfill their role, provide education to the rest of the staff, and create a strong culture focused on infection prevention and control. By following the strategies described here, you can set your facility up for similar success.
Buffy Lloyd-Krejci, DrPH, CIC, is the founder of IPCWell. Drawn to action to improve the infection prevention landscape for these communities, she utilized her over two decades of experience in the healthcare field and her doctorate in public health (DrPH) to launch IPCWell. Dr. Buffy and her team have provided training, education, and technical assistance (both in person and virtually) to hundreds of congregate care facilities throughout the COVID-19 pandemic.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
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