Come November, Repertoire readers in the long-term-care market may find themselves calling on a new decision-maker.
Effective Nov. 28, long-term-care facilities will be required to have in place at least one infection preventionist, that is someone for whom the facility’s infection prevention and control program is a major (though not necessarily full-time) responsibility. It’s F-Tag 882, that is, part of the revised Requirements for Participation for Nursing Homes, which were published in November 2016.
The Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention are helping long-term-care facilities gear up for the change. In March, the two agencies announced a free, on-line infection prevention and control training program for nursing home staff, which includes a half-hour module on the role and responsibilities of the infection preventionist.
An estimated 1 to 3 million serious infections occur every year in nursing homes, skilled nursing facilities and assisted living facilities, according to the CDC. Infections include urinary tract infection, diarrheal diseases and antibiotic-resistant staph infections, and they are a major cause of hospitalization and death. As many as 380,000 people die of infections in long-term-care facilities every year.
What’s more, infections almost always involve big expenditures. The Agency for Healthcare Research and Quality estimates that LTC facilities spend from $38 million to $137 million annually for antimicrobial therapy and $673 million to $2 billion for hospitalizations. Catheter-associated urinary tract infections are a particular problem. AHRQ estimates that 7% to 10% of all long-term-care residents have urinary catheters, including 12% of all new admissions at the time of transfer from acute-care facilities.
Most frequently cited
But two of the most frequently cited impediments to effective infection control in the long-term-care setting are also two of the most basic: failure by staff to adequately wash their hands, and incorrect (or inadequate) usage of gloves.
“A common reason hand hygiene is cited is because people don’t wash their hands long enough,” says Amy Stewart, MSN, RN, DNS-MT, QCP-MT, RAC-MT, vice president of curriculum development, American Association of Nurse Assessment Coordination. In the live clinical setting, staff are often preoccupied with patient-care-associated exigencies, and hence may hurry the handwashing process. Regarding gloves, facilities need to educate not just the nursing staff on proper usage, but also those in environmental services, laundry, dietary and other areas where gloves are required.
“These deficiencies can be eliminated or be cited at a lower scope and severity if staff are provided with education on these two very important aspects of infection control,” says Stewart. “I would suggest facility leaders consider providing staff competency education. This would include providing staff with the knowledge about facility-specific practices, along with a return demonstration of what was learned. Then, to ensure the information is carried over into the live clinical setting, facility leaders should audit staff to ensure proper knowledge was carried over into practice.”
Given inevitable staff turnover, leaders should include such training in the facility’s orientation program, and they should offer it regularly throughout the year.
Infection preventionists’ role
A solid infection control and prevention system in place includes having a process to prevent, identify, report, analyze, and control infections and communicable diseases for all residents, staff, visitors, and volunteers, says Stewart. Having a sound system should be improved with the requirement of the infection preventionist.
“This person’s role would include all of the above-mentioned items along with oversight of the antibiotic stewardship program,” she says. “Facility leaders should be preparing now to get this person properly trained and up-to-speed on their role. This would include reviewing all current policies and practices used by the facility.”
The infection preventionist must be at least a part-time employee, and though they don’t necessarily have to be a nurse, they should demonstrate some expertise or training in microbiology or epidemiology. “We are awaiting further clarification [on the role] from CMS, says Stewart. But it’s safe to assume that the infection preventionist will be a key decision-influencer or decision-maker regarding infection-prevention-related supplies, devices and equipment.
“Now is a great time [for LTC facilities] to look at what is working and what isn’t working, and make the changes to the program,” she says. “For example, if facilities struggle to track and analyze staff infections, now is a great time to review the policy for reporting them and look for ways to improve the process. This may include a new method of tracking and trending these infections.
“As with any policy change, staff need to be informed and understand why and how the policy change impacts them.”