For years the government has sounded the alarm about infection control lapses in nursing homes, a deficiency underscored at the outset of the coronavirus pandemic when many residents of a Kirkland, WA nursing home were stricken with COVID-19 and died, and today as healthcare-associated infections (HAIs) are resurgent.
Now we are sounding the alarm again over a particularly problematic missed opportunity: the Biden Administration’s recently announced efforts to address overall nursing home staffing requirements. The requirements are a step in the right direction for direct patient care. But the effort fails to protect nursing home residents from infections.
That’s important because the Government Accountability Office found that from 2013 to 2017, 82% of all inspected nursing homes had an infection prevention and control deficiency identified through Medicare and Medicaid surveys.
During the pandemic, 34% of deaths were linked to nursing homes. Those with more than 40% minority residents reported coronavirus case and death counts that were 3.3 times higher than facilities with more than 97% white residents.
The consequences remain deadly, even after the COVID-19 pandemic has ended. There are between 1.6 and 3.8 million HAIs in long term care every year. Around 380,000 of those patients died each year, prior to the pandemic.
The lack of data collection is also problematic. Nursing homes are not required to track infections through the CDC’s National Healthcare Safety Network,, unlike hospitals which have had HAI reporting requirements since 2011. When hospitals started tracking infections and made that data public, improvements followed, and HAI rates declined.
Not surprisingly, when surveyors inspect nursing homes, infection control is the most common type of deficiency cited. Still the Centers for Medicare & Medicaid Services leaves it up to nursing home owners and operators to determine if resources should be dedicated to protecting patients.
Specifically, CMS does not require that each nursing home employ a full-time, onsite, infection control professional who is fully dedicated (meaning that infection prevention is their sole function) to ensuring that the facility has an infection prevention and control plan and that it is being followed.
In September 2020, a CMS-commissioned MITRE Corporation report stated that, “this position [infection preventionist] is traditionally assigned to a supervisor, nursing manager or provider as an added (rather than a core) responsibility, yielding insufficient response to the demands of the current pandemic.”
Instead of a full-time person dedicated to the role, infection prevention responsibilities have become an afterthought, designated to a part-timer as an added duty. Part-time IPs spend less than a third of their time on critical infection prevention and control (IPC) work like establishing IPC protocols, conducting surveillance and scouring electronic health records and lab reports for clues about deadly pathogens.
Without a dedicated and trained infection preventionist, no one is in place to create protocols, properly train staff on how to prevent transmission of infectious diseases, or ensure that a facility’s policies are being followed.
Unless the government acts and requires a full-time dedicated infection preventionist and reporting of HAIs, nursing home residents will continue to suffer disproportionately from infectious threats. Why do we allow nursing homes to have lower standards than hospitals when it comes to protecting our most vulnerable fellow citizens?
Devin Jopp, EdD, MS is the CEO of the Association for Professionals in Infection Control and Epidemiology (APIC), the 15,000-member association for infection preventionists and epidemiologists.
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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