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Long-term care facilities in US lack resources for infection prevention
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Public health officials reported at the Association for Professionals in Infection Control and Epidemiology annual conference that long-term care facilities in Tennessee and Washington state continue to lack resources needed to adequately prevent health care-associated infections, which result in approximately 400,000 deaths among residents each year, according to a press release.
Researchers found that many infection control officers in long-term care facilities (LTCFs) had minimal training, and that the facilities struggle to maintain qualified staff to manage infection control programs.
“The findings presented here are concerning and should prompt immediate efforts to increase education and support for infection prevention programs in all types of LTCFs,” 2017 APIC President Linda Greene, RN, MPS, CIC, FAPIC, said in the release. “Nursing home residents often have multiple, chronic diseases, transfer frequently between the hospital and the long-term care setting and are overexposed to antibiotics, all of which place them at higher risk for developing infections with antibiotic-resistant organisms.”
Colleen Roberts, MPH, epidemiologist with the Tennessee Department of Health, and colleagues conducted 23 assessments in LTCFs across Tennessee from January 2016 to November 2016. Using the CDC’s Infection Prevention and Control Assessment Tool for Long-term Care Facilities, the researchers evaluated infection control training and competency among staff, as well as implementation of policies and practices for nine infection control domains, including infection control programs and infrastructure, hand hygiene and personal protective equipment (PPE), according to the release.
Among the facilities in Tennessee, 56% had infection control programs overseen by a staff member with no additional training in infection control, and only 12.5 staff hours were dedicated to infection prevention activities each week. Although the majority of facilities implemented an online competency-based training program for hand hygiene (72%) and proper use of PPE (67%), about half provided feedback to assess performance. Overall, 94% of LTCFs failed to meet the necessary requirements for an antibiotic stewardship program.
“The lack of resources and training for infection prevention in LTCFs is concerning, especially given the fact that LTCFs admit sicker patients in higher numbers than in the past,” Roberts said in the release. “These assessments confirmed our suspicions that many LTCFs suffer from understaffing and lack of appropriate infection control training, which can impact patient care.”
In Washington, Dorothy MacEachern, MS, MPH, CIC, infection preventionist (IP) with the Spokane Regional Health District, and colleagues also used the CDC infection prevention and control assessment tool to assess 20 LTCFs in the state. They found that all LTCFs had designated IPs; however, only two (10%) had formal training and many were new to the field and had inadequate guidance from experienced IPs or written policies and procedures. In addition, many other facility staff members did not have complete infection prevention training upon hire and were even less likely to have subsequent training in most infection prevention domains after 1 year. Although 75% of LTCFs had implemented infection prevention policies, less than half (40%) were reviewed annually. Further, only 15% to 30% of facilities regularly reviewed assessed competencies.
“Our analysis identified clear gaps in infection prevention practices and the urgent need to improve infection control infrastructure in LTCFs,” MacEachern said in the release. “Future efforts should be directed at providing training, ongoing education and support for IPs in these settings.” – by Stephanie Viguers
References:
MacEachern D, et al. Measuring infection prevention capacity in long-term care facilities (LTCF). Presented at: Annual Conference of the Association for Professionals in Infection Control and Epidemiology; June 14-16, 2017; Portland, Oregon.
Roberts C, et al. What is the status of infection control programs in long-term care facilities? Presented at: Annual Conference of the Association for Professionals in Infection Control and Epidemiology; June 14-16, 2017; Portland, Oregon.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Vicki Allen, MSN, RN, CIC, FAPIC
Along with the rapidly growing elderly population, the fastest growing occupation in the United States in the next decade is projected to be health care professionals. Considering these statistics along with the current state of health care across the continuum of care, the provision of resources, training and investment in these young professionals to care for and prevent health care-associated infections in this growing elderly population is imperative.
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