Dr. Stone addressed the infection preventionists and epidemiologists in the audience, saying, “Just thinking about your own work in infection prevention and healthcare epidemiology, if you have that kind of turn-over in your infection prevention leadership, it [would be] very hard to get anything started, let alone sustained.”
When giving an example of an effective strategy to improve infrastructure in long-term care settings, Dr. Stone cited the CDC’s Infection Control Assessment Tools
- Long Term Care Facilities. In 2015, “the CDC, [with the aid of] Ebola Response Supplemental Funding, was able to send some dedicated resources to state and local health departments, to work beyond hospitals and beyond Ebola assessment… to do more basic assessments and educational visits to providers interested in getting support for their infection prevention and control programs,” said Dr. Stone. She continued, “Where we see the most value from this investment has been outside of hospitals, where health departments have been able to get in front of nursing home providers, hemodialysis clinics, and outpatient clinics. These are the settings where we often don’t [put] as many resources toward.”
Long-term facilities are assessed along the following domains: policies and procedures, staff training and education, auditing and monitoring adherence to policies, feedback to staff adherence, and availability of supplies, and infrastructure to support activities.
To exemplify the assessment tools, Dr. Stone shared “hot off the press” CDC data on infrastructure assessment of IPC programs in long-term care facilities from January 2017. Forty-two health department partners across the country carried out 618 infection prevention assessments in nursing homes, 85% of which included on-site visits by Infection Control Assessment and Response (ICAR) teams. Almost all of the facilities in question (96%) had a dedicated person in charge of coordinating the IPC program, which was aligned with nursing home regulatory requirements. However, less than half (48%) of these designated individuals were trained in infection control. “This still seems pretty high to me, actually,” declared Dr. Stone.
She went on to say that most of the health departments had a clear-cut designation of what applied as proper infection control training, and even developed accessible content on infection prevention for nursing home providers. In addition, some health departments supplied funding to nursing home providers to send a staff person to an infection prevention course.
Commenting on the January 2017 assessment results, Dr. Stone said, “Those numbers look pretty high when you take them individually, but this really jumped out at me: when you look at all elements in place for that domain, only a third [35%] of the homes that were assessed had everything. I don’t think anything on that list was [a] super high-stretch goal.” Some of the areas where nursing homes were lacking included basic policies about emergency preparedness, training, and dedicated time for infection prevention practices.