Should all nursing homes have a full-time ID expert on staff?
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According to the CDC, up to 3 million serious infections occur every year in nursing homes, skilled nursing facilities and assisted living facilities.
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These facilities were hit hard during the COVID-19 pandemic, and their residents and staff were among the first to be eligible for vaccines against the coronavirus.
In recommendations published earlier this year, the Association for Professionals in Infection Control and Epidemiology urged policymakers to allocate funding to ensure that all nursing homes have at least one dedicated infection prevention expert on staff.
We asked Lilian M. Abbo, MD, MBA, professor of infectious diseases at the University of Miami and associate chief medical officer for infectious diseases at the Jackson Health System, and Aaron E. Glatt, MD, MACP, FIDSA, FSHEA, chairman of the department of medicine and chief of infectious diseases at Mount Sinai South Nassau in New York and professor of medicine at Icahn School of Medicine at Mount Sinai, if all nursing homes should employ a full-time infectious disease expert.
Lilian M. Abbo, MD, MBA
In order to justify a full-time employee for infection control, I think there has to be some assessment of the size of your long-term care facility or nursing home. It’s not the same if you have five beds vs. if you have 40 beds, but I do think that having a part-time or full-time employee with infection control knowledge depending on the size of your facility, number of employees and number of patients, is extremely valuable.
We have seen with the COVID-19 pandemic the consequences of poor infection control measures in residences with visitors. You need family education as well as employee education. This is also not like in a hospital, where I can put someone in isolation. You need to have someone with the expertise and an understanding of the guidelines and regulations for that environment, which is very different from just extrapolating from an acute-care hospital.
Right now in nursing homes, for example, we are seeing cases of influenza, respiratory syncytial virus, COVID-19, of course, and other respiratory infections, but you also have things like Candida auris and other infectious agents that are highly transmissible. Having the expertise of an infection preventionist and a physician trained in infectious diseases and epidemiology is of extreme value. If that should be a part-time position or a full-time position, however, will depend on the size of the nursing home and the population that they serve.
- Reference:
- CDC. Nursing homes and assisted living (long-term care facilities [LTCFs]). https://www.cdc.gov/longtermcare/index.html. Accessed Nov. 30, 2022.
Aaron E. Glatt, MD, MACP, FIDSA, FSHEA
In an ideal situation, the answer would be “yes.” If money wasn’t an issue — sure. Every patient should have access to having the appropriate professional staff. However, nursing homes are often able to do this only with either consultants or with part-time people or with other members of their staff who are qualified. This often depends on the size of the facility. It’s a system — it would have to be part of that system.
Certainly, at a minimum though, patients should have access to infectious diseases physicians as needed and should have the resources available. I certainly think that access to at least consultants or part time infectious disease physicians would absolutely be a benefit to them.
Now, note, there is differentiating between the care of patients with infectious diseases and oversight of infection control the care of patients — that’s a different discussion. But regardless, you need to have those appropriate staff there.
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