On Friday, March 31, 2017, in a session at the Society for Healthcare Epidemiology of America (SHEA) Spring 2017 Conference, Nimalie Stone, MD, MS, Team Lead, LTC, Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention (CDC), discussed “infrastructure differences between infection prevention and control (IPC) programs in nursing homes and other post-acute care settings versus [IPC programs in] hospitals" in her session entitled, “Perspectives on Infection Prevention Programs in Post-acute and Long-term Care.”
Dr. Stone started off her session by examining some key infrastructure aspects that are needed to perform “good healthcare epidemiology and infection prevention” in hospital settings in particular, and across healthcare facilities in general. Some of these aspects include: dedicated full-time registered nurses (RNs) who are certified in IPC, a dedicated physician lead who also has experience in healthcare epidemiology, a dedicated IPC support committee, dedicated office space equipped with computers that have functional internet access, dedicated emails, integrated electronic healthcare records, and access to IT support.
To further explain the importance of these aspects, Dr. Stone highlighted a 2012 study
which was conducted in British Columbia, Canada (BC), and analyzes gaps in IPC resources in long-term care facilities across the province. Researchers randomly polled 188 facilities out of the 800 total in the five health regions in BC. Among the polled facilities, 58% had no IPC physician support at all, whether in-house or external; 31% had facility local IPC committees, whereas 25% had no IPC committees at all; 36% had an on-site infection control practitioner (ICP), whereas 17% had no ICP available at all, neither in-house nor through a remote consult contract; and 41% of those infection control practitioners had more than 2 years of experience.
In a similar study
published in 2016 which evaluated IPC infrastructure in nursing homes, researchers surveyed 990 facilities across the United States. The group found that 36% of nursing home respondents received an IPC citation in their Centers for Medicare and Medicaid Services (CMS) review, whereas 41% of non-respondents received citation. “This ended up being statistically significant,” said Dr. Stone. Most (84%) of the respondents from these facilities were RNs, and the average years of experience in IPC-related activities among these RNs was 11 years; 54% of these respondents had two or more other responsibilities in addition to IPC; 39% of respondents had some IPC-specific training, and 3% had the Certification in Infection Control credential, which is the standard certification in acute-care; 50% of facilities received financial resources for continuing education in infection prevention. “In terms of turn-over, 40% of these facilities reported that they had three or more people in this position in a 3-year time frame. That is at least a new person every year, at best, but probably you had people cycling even faster.”