Closeup image of gloved hands spraying surface with disinfectant; Image credit: Getty Images

With the lessons of the COVID-19 pandemic fresh in mind, now is the time for long-term care facilities to commit to recruiting and training dedicated, on-site infection preventionists, according to the Association for Professionals in Infection Control and Epidemiology.

The organization on Wednesday issued a broad call to action urging the U.S. healthcare industry, including long-term care facilities, to strengthen infection control strategies for future pandemic preparedness. 

The industry can no longer ignore the complexity of infection prevention and control (IPC) in nursing homes and the need for better training, hiring and regulation, co-author Deborah Burdsall, Ph.D., RN-BC, an APIC board member and veteran long-term care clinician, said.

Recommendation for full-time, on-site preventionist

APIC is urging the Centers for Medicare & Medicaid Services to require that nursing home facilities have at least one full-time — and ideally certified — infection preventionist located on-site, based on CDC minimum recommendations. 

In addition, other nursing home staff should be trained in IPC basics to allow facilities to handle surge capacity when an infectious disease outbreak occurs, APIC said. The organization also is advocating for an expanded CMS requirement for routine mandatory surveillance for healthcare associated infections.

Facility operators are arguably in the same position they were in when Minimum Data Set reporting became mandatory and many realized they needed a dedicated staff member to collect the data required to competently care for residents, Burdsall said. The duties of proper infection control are even broader, making training and certification necessary to achieve similar IPC competency, she added. 

“It’s a situation where you need an infection preventionist, working under the administrator because it is an interdisciplinary role and a separate profession,” she said. 

A nurse’s license doesn’t necessarily translate to expertise in infection prevention, Burdsall added. And most of the time in long-term care, the IPC role is assigned to someone who is also immersed in other duties.

“If you’re a director of nursing or assistant director of nursing and you’re trying to deal with [IPC job challenges], in addition to all of the components of a mature infection prevention and control program, it’s frustrating,” she said.

Federal, state help at the ready

Burdsall’s recommendation is that long-term care administrators recognize the complex interdisciplinary nature of IPC in their facilities and take the time to recruit and train an interested staff member to fill a dedicated position.

There currently are many sources of help for making this significant staffing change, she added.

“The advantage that people have right now is that CDC and CMS, since the Affordable Care Act, have put a lot of the tools in place that will help an IPC program function at the highest level,” Burdsall said.

The Quality Assurance and Performance Improvement (QAPI) process tools are helpful, as is the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) and the CDC’s Project Firstline, a training program for frontline healthcare personnel on infection control protocols, she added.

In addition, “requirements for facility assessments flow beautifully into infection control risk assessments, and there are national associations like APIC that are really putting a focus on long-term care,” she added. Certain state and local health department initiatives can help as well. These include state-based healthcare associated infection (HAI) prevention programs, for example.

The hurdles involved in adding a full-time infection preventionist to the staff may appear daunting, but Burdsall advises operators and long-term care clinicians not to panic, and to prepare for a marathon, not a sprint. 

“The pandemic requires a new approach,” she said. “We need to be doing something different. The tools are out there, and there is support. You don’t have to reinvent the wheel, you just have to reach out.”