Impact of COVID-19 on Infection Control Practices in Skilled Nursing Facilities

Infection control practices in the skilled nursing facility (SNF) setting have been a critical priority during COVID-19. Our study observed specifically which practices, as predicted by SNF infection management staff, are likely to remain in place in the future, and how they may change.

26 semi-structured, qualitative interviews were conducted with administrators, directors and assistant directors of nursing, infection preventionists, and Minimum Data Set (MDS) coordinators at 13 SNFs across the country from June to September 2021. Interview transcripts were analyzed using a content analysis approach.

SNF infection management staff agreed that there is increased awareness of infection control practices due to COVID-19, as well as greater education and monitoring of ongoing infection control practices. Staff, families, and other visitors entering the SNF are screened upon entering the SNF. When someone has symptoms of an influenza-like illness, testing increased and training of staff about proper protocol when an individual is symptomatic increased. Overall visitation within the facility is more controlled. Other changes to infection control practices include enhanced capabilities of isolating symptomatic residents, presuming that new admissions are infectious by placing them in a quarantine unit, closing common areas of the SNF, having more easily accessible personal protective equipment throughout the SNF, and quicker, more frequent, and more thorough cleaning. Prior to the COVID-19 pandemic, infection control practices varied more widely by facility. For example, during influenza season some facilities required staff to wear masks if they chose not to receive a flu vaccine, while other facilities did not. However, since the pandemic, mask-wearing mandates for anyone inside a SNF, including staff, residents, and visitors, are nearly universal. Most people that were interviewed agreed that mask-wearing would continue well into the future and that decreases in influenza outbreaks over the course of the COVID-19 pandemic were due in part to increased infection control practices, such as mask-wearing. However, continued mask wearing was not always viewed as positive; some worried that continued mask-wearing would disincentivize staff from getting a flu vaccination, particularly in facilities where staff needed to wear masks if they did not receive their influenza vaccine prior to COVID-19. Some expressed that continued mask-wearing, in addition to continued increased screening and monitoring, would lead to staff burnout, making it difficult to staff SNFs in the future.

The COVID-19 pandemic led to significantly enhanced and more uniform infection control practices in SNFs. While there may be some negative consequences of continued enhanced infection control practices, such as staff burnout, infection management staff at SNFs agreed that enhanced infection control practices have contributed to decreases in influenza outbreaks.

This collaborative work was funded by Sanofi Pasteur.