hand washing as part of infection prevention strategy

Nursing home owners and operators must stop viewing infection prevention as an add-on service and invest in related training resources and the time needed to develop effective nursing home programs, a panel said at a national quality conference Wednesday.

“We know that medical directors and even the clinical nursing leadership in a building don’t always drive the resource allocation for their centers,” said Nimalie Stone, medical epidemiologist for long-term care at the Center for Disease Control and Prevention. “The administrative leaders have to be at the table. They are a critical group in getting these strategies put into place.”

Stone’s comments came as part of a half day of sessions devoted to nursing home improvements at the virtual Centers for Medicare & Medicaid Services annual Quality Conference.

While fellow panelists discussed new training and certification options, as well as the expanding responsibilities of infection preventionists post-COVID, much of the talk centered on convincing leaders of the infection preventionists’ value.

“Training programs and toolkits alone are not enough to bring about implementable and sustainable quality improvement in nursing homes,” said Michael Wasserman, MD, a geriatrician, former chief medical officer of a major nursing home chain and sometime-critic of the nursing home industry. “The IP must have the support of nursing home ownership in order to do that full-time job.”

Clear business case

Wasserman is based in California, where state regulations require each nursing home to have a full-time IP. Federal regulation promulgated by CMS has not mandated the presence of a full-time IP, but has recommended one in larger buildings. Having a part-time IP who fulfills certain job responsibilities — even if multitasking in another position — still passes muster.

“Considering what we’ve learned during the pandemic, the business case for supporting IPs in their role is clear,” he said. “A fully empowered IP helps reduce the spread of infectious diseases, which reduces call outs and sick time, in addition to reducing resident hospitalizations and readmissions.”

Among other benefits that Wasserman said may be “unseen” by those who decided where to invest in a nursing home are reducing unnecessary antibiotics, which reduces labor-intensive cases of and antibiotic-related diarrhea, and other adverse events that consume nursing staff’s valuable time.

In today’s nursing homes, which Wasserman described as mini hospitals, daily operations will naturally include minor “emergencies.” But an IP with specialized training and a mission to implement infection control strategies shouldn’t be the one tasked with responding on a routine basis, Wasserman and co-panelist Angela Vassallo said. 

“Most IPs in the nursing home setting, prior to COVID, are just ‘designated,’ meaning they have the title, but they probably do four or five other things,” said Vassallo, a nationally recognized expert in infection prevention and epidemiology who has worked on CMS-funded infection prevention projects for nursing homes in California and Arizona. “During COVID, we began to see that these people really should be ‘dedicated’ to infection prevention.”

Raising the IP profile

She said IPs should invest in their own education and certification to bring their role to the forefront. Leadership training could be included in those efforts. Other buildings leaders should come to view IPs as a resource needed by an interdisciplinary team, much as medical director Swati Guar, MD, said she has come to lean on her nursing home IP since COVID’s early days. Stone also recommended that IPs deputize others to help support infection prevention and control objectives on each shift.

The payoff of fully incorporating the IP into more building programs and investing in their projects should make itself evident if given the chance to flourish, Wasserman said, especially as providers prepare for the next pandemic or multidrug resistant organism to enter their building. IPs can also be the eyes and ears to clinical and pharmacy partners, who are not always in the building to observe conditions or challenges.

“Encouraging and supporting the IP in fulfilling all their duties is critical to their success,” Wasserman said. “It shouldn’t require a law like California’s or even regulatory guidance from CMS in order for nursing home owners to support empowering IPs and allowing them to work full time in carrying out their critical job.”