- Tian W.
Issuance of Revisions to Interpretive Guidance at F Tag 441, as Part of Appendix PP, State Operations Manual (SOM), and Training Materials.
- Tian W.
National Healthcare Safety Network: Long-Term Care Facilities (LTCFs) Component.
A Call for Reimagining Infection Prevention and Control in Nursing Homes
Recommendations to Enhance Nursing Home Infection Prevention and Control Programs
|People||1.1||NH infection preventionists should have specialized infection control training|
|1.2||Regulatory and professional organizations should develop infection control competencies and training resources specific to the NH setting|
|1.3||The government and professional organizations should invest in research to identify the amount of time to be devoted to different infection control activities|
|1.4||Infection control staffing in NHs that provide the highest complexity of post-acute care should mirror staffing employed in hospitals|
|1.5||NHs should have an infection control committee comprised, at a minimum, by the facility administrator, director of nursing, and medical director|
|1.6||Consultant pharmacists should be used to support key antibiotic stewardship activities|
|1.7||NHs should find ways to use other facility staff, electronic medical record, and contracted microbiology laboratory to reduce the existing reporting burdens on the facility infection preventionist|
|Tasks||2.1||Facility nursing and nursing assistant staff should receive dedicated infection prevention and control education at hire and regularly throughout the year|
|2.2||Staff education should be a core competency of the facility infection preventionist|
|2.3||The infection preventionist should have sufficient time for their infection control duties|
|2.4||Infection control duties performed by the infection preventionist should be prioritized over direct resident care duties|
|2.5||NHs should develop pandemic and emergency preparedness plans|
|2.6||Key facility stakeholders should regularly participate in preparedness tabletop exercises|
|2.7||NHs with large referral volumes from hospitals should be active participants in regional and state emergency planning and response activities|
|Tools||3.1||NHs should find ways to use or purchase information systems to automate infection control surveillance activities|
|3.2||Increase the use of rapid and point-of-care diagnostic microbiology testing in NHs|
|3.3||Invest in research to better understand the benefits and optimal methods for implementing protective masking policies in NHs|
|3.4||The government should invest in research to develop more effective vaccines and respiratory tract infection chemoprophylaxis treatments for use in NHs|
|Organization||4.1||NHs should invest more staffing and resources to educate staff about basic infection prevention practices|
|4.2||NHs should invest more staffing and resources toward pandemic preparedness|
|4.3||NHs should establish staffing structures that make the facility more resilient to outbreaks and health care–associated infections|
|4.4||NHs should physically segregate long- from short-stay residents and cohort staff to these areas when feasible|
|Built Environment||5.1||NHs should be redesigned to eliminate shared resident bedrooms and bathrooms|
|5.2||The government should fund research to determine if enhancements of NH indoor air quality can make these facilities more resilient to outbreaks caused by viral respiratory track pathogens|
|External Environment||6.1||Local hospitals and public health systems should provide greater materials and technical expertise to NHs to support their infection prevention and control activities|
|6.2||The government should develop novel financing strategies to help not-for-profit NHs upgrade their aging infrastructure|
|6.3||The government should increase funding of research focused on how to make NH environments more resilient to infection|
|6.4||Redesign of financing and regulatory oversight to enhance the recruitment and retention of experienced NH infection preventionists|
|6.5||Redesign of the system of regulatory oversight and financial penalties to drive infection prevention and control practice in NHs|
Essential Resources for Effective Infection Prevention and Control Programs: A Matter of Patient Safety -- A Discussion Paper.
Interim infection prevention and control recommendations for healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic.
Infection Control Deficiencies Were Widespread and Persistent in Nursing Homes Prior to COVID-19 Pandemic. U.S. Government Accountability Office.
- Jones K.
- Mantey J.
- Washer L.
- et al.
The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. The National Academies Press.
- Marchand D.K.
- Argaez C.
- Coffey K.C.
- Roghmann M.C.
- Leung N.H.L.
Conclusions and Implications
- The burden of infection in long-term care.Infect Control Hosp Epidemiology. 2000; 21: 674-679
- Infection Trends in US Nursing Homes, 2006-2013.J Am Med Dir Assoc. 2017; 18: 635.e9-635.e20
- Longitudinal Assessment of Multidrug-Resistant Organisms in Newly Admitted Nursing Facility Patients: Implications for an Evolving Population.Clin Infect Dis. 2018; 67: 837-844
- Colonization of skilled-care facility residents with antimicrobial-resistant pathogens.J Am Geriatr Soc. 2001; 49: 270-276
- Acquisition of Multidrug-Resistant Gram-Negative Bacteria: Incidence and Risk Factors within a Long-Term Care Population.Infect Control Hosp Epidemiology. 2010; 31: 1148-1153
- Wounds, functional disability, and indwelling devices are associated with cocolonization by methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in southeast Michigan.Clin Infect Dis. 2011; 53: 1215-1222
- Functional disability and nursing resource use are predictive of antimicrobial resistance in nursing homes.J Am Geriatr Soc. 2015; 63: 659-666
- Infectious diseases in the nursing home setting: challenges and opportunities for clinical investigation.Clin Infect Dis. 2010; 51: 931-936
- The revolving door of rehospitalization from skilled nursing facilities.Health Affair. 2010; 29: 57-64
- One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation: a cohort study.Ann Intern Med. 2010; 153: 167-175
- An All-Payer View of Hospital Discharge to Postacute Care, 2013. HCUP Statistical Brief #205.https://www.hcup-us.ahrq.gov/reports/statbriefs/sb205-Hospital-Discharge-Postacute-Care.pdfDate: 2016
- Medical device-associated infections in the long-term care setting.Infect Dis Clin N Am. 2012; 26: 143-164
- Effects of Excessive Antibiotic Use in Nursing Homes.JAMA Intern Med. 2015; 175: 1339-1341
- Opportunities to Improve Antimicrobial Use in US Nursing Homes.JAMA. 2021; 325: 1259-1260
- Burden of Clostridium difficile infection in the United States.New Engl J Medicine. 2015; 372: 825-834
- Burden of Nursing Home-Onset Clostridium difficile Infection in the United States: Estimates of Incidence and Patient Outcomes.Open Forum Infect Dis. 2016; 3: ofv196
- Association of Exposure to High-risk Antibiotics in Acute Care Hospitals With Multidrug-Resistant Organism Burden in Nursing Homes.JAMA Netw Open. 2022; 5: e2144959
- Indwelling device use and antibiotic resistance in nursing homes: identifying a high-risk group.J Am Geriatr Soc. 2007; 55: 1921-1926
- Nursing Home Design and COVID-19: Balancing Infection Control, Quality of Life, and Resilience.J Am Med Dir Assoc. 2020; 21: 1519-1524
- SHEA/APIC guideline: infection prevention and control in the long-term care facility.Infect Control Hosp Epidemiology. 2008; 29: 785-814
- Assessment of infection control programs in Maryland skilled-nursing long-term care facilities.Am J Infect Control. 1994; 2: 83-89
- Requirements for Long Term Care Facilities -- HCFA.Fed Register. 1991; 56: 48826-48880
- Preventing infections in nursing homes: a survey of infection control practices in southeast Michigan.Am J Infect Control. 2005; 33: 489-492
- Nursing home deficiency citations for infection control.Am J Infect Control. 2011; 39: 263-269
- Issuance of Revisions to Interpretive Guidance at F Tag 441, as Part of Appendix PP, State Operations Manual (SOM), and Training Materials.https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/CMS1227887Date: 2009Date accessed: July 11, 2022
- Infection Prevention and Control Programs in US Nursing Homes: Results of a National Survey.J Am Med Dir Assoc. 2016; 17: 85-88
- Infection Control Deficiencies Were Widespread and Persistent in Nursing Homes Prior to COVID-19 Pandemic. U.S. Government Accountability Office.
- Reform of Requirements for Long-Term Care Facilities. Final rule.Federal Register. 2016; 81: 68688-68872
- Changes in US Nursing Home Infection Prevention and Control Programs From 2014 to 2018.J Am Med Dir Assoc. 2020; 21: 97-103
- Infection Control Citations in Nursing Homes: Compliance and Geographic Variability.J Am Med Dir Assoc. 2021; 22: 1317-1321.e2
- (AHRQ). An All-Payer View of Hospital Discharge to Postacute Care, 2013: HCUP Statistical Brief #205. Agency for Healthcare Research and Quality.http://www.hcup-us.ahrq.gov/reports/statbriefs/sb205-Hospital-Discharge-Postacute-Care.pdfDate: 2016
- Breaking the Chain of Infection in Older Adults A Review of Risk Factors and Strategies for Preventing Device-Related Infections.Infect Dis Clin N Am. 2017; 31: 649-671
- Thirty-day readmission and mortality among Medicare beneficiaries discharged to skilled nursing facilities after vascular surgery.J Surg Res. 2018; 221: 196-203
- National Healthcare Safety Network: Long-Term Care Facilities (LTCFs) Component.
- Factors Associated With Candida auris Colonization and Transmission in Skilled Nursing Facilities With Ventilator Units, New York, 2016-2018.Clin Infect Dis. 2020; 72: e753-e760
- Evaluating Movement of Patients With Carbapenem-resistant Enterobacteriaceae Infections in the Greater Atlanta Metropolitan Area Using Social Network Analysis.Clin Infect Dis. 2019; 70: 75-81
- Spread of Carbapenem-Resistant Enterobacteriaceae Among Illinois Healthcare Facilities: The Role of Patient Sharing.Clin Infect Dis. 2016; 63: 889-893
- Regional dissemination of vancomycin-resistant enterococci resulting from interfacility transfer of colonized patients.J Infect Dis. 1999; 180: 391-396
- Regional dissemination and control of epidemic methicillin-resistant Staphylococcus aureus.Infect Control Hosp Epidemiology. 1999; 20: 202-205
- Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes.JAMA. 1999; 281: 517-523
- Modeling Infectious Diseases in Healthcare Network (MInD-Healthcare) Framework for Describing and Reporting Multidrug-resistant Organism and Healthcare-Associated Infections Agent-based Modeling Methods.Clin Infect Dis. 2020; 71: 2527-2532
- The Role of Nursing Homes in the Spread of Antimicrobial Resistance Over the Healthcare Network.Infect Control Hosp Epidemiology. 2016; 37: 761-767
- Long-term care facilities: important participants of the acute care facility social network?.Plos One. 2011; 6: e29342
- Infectious disease outbreaks in nursing homes: an unappreciated hazard for frail elderly persons.Clin Infect Dis. 2003; 36: 870-876
- Types of infectious outbreaks and their impact in elderly care facilities: a review of the literature.Age Ageing. 2010; 39: 299-305
- Epidemiology and clinical features of COVID-19 outbreaks in aged care facilities: A systematic review and meta-analysis.EClinicalMedicine. 2021; 33: 100771
- Staffing Levels and COVID-19 Cases and Outbreaks in U.S. Nursing Homes.J Am Geriatr Soc. 2020; 68: 2462-2466
- COVID-19 Nursing Home Data.
- A systematic review on the causes of the transmission and control measures of outbreaks in long-term care facilities: Back to basics of infection control.Plos One. 2020; 15: e0229911
- SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients.Ergonomics. 2013; 56: 1669-1686
- Challenges and Strategies for Prevention of Multidrug-Resistant Organism Transmission in Nursing Homes.Curr Infect Dis Rep. 2017; 19: 18
- Infection Control in Alternative Health Care Settings An Update.Infect Dis Clin N Am. 2016; 30: 785-804
- Nursing Home Infection Preventionist Training Course.
- Impact of infection preventionists on Centers for Medicare and Medicaid quality measures in Maryland nursing homes.Am J Infect Control. 2014; 42: 2-6
- Staffing requirements for infection control programs in US health care facilities: Delphi project.Am J Infect Control. 2002; 30: 321-333
- Characteristics of hospitals and infection control professionals participating in the National Nosocomial Infections Surveillance System 1999.Am J Infect Control. 2001; 29: 400-403
- Essential Resources for Effective Infection Prevention and Control Programs: A Matter of Patient Safety -- A Discussion Paper.
- Interim infection prevention and control recommendations for healthcare personnel during the coronavirus disease 2019 (COVID-19) pandemic.
- How much is adequate staffing for infection control? A deterministic approach through the lens of Workload Indicators of Staffing Need.Am J Infect Control. 2020; 48: 609-614
- Template for an Antibiotic Stewardship Policy for Post-Acute and Long-Term Care Settings.J Am Med Dir Assoc. 2017; 18: 913-920
- The Case for Consultant Pharmacists as Key Players in Nursing Home Antibiotic Stewardship Programs.J Am Med Dir Assoc. 2020; 22: 6-8
- A Whole New World: Changes in the Nursing Home Infection Preventionist Role in Response to the COVID-19 Pandemic.Am J Infect Control. 2022; 50: S8
- Influence of staff infection control training on infection-related quality measures in US nursing homes.Am J Infect Control. 2017; 45
- Frequency of nursing home resident contact with staff, other residents, and the environment outside resident rooms.Infect Control Hosp Epidemiology. 2019; 40: 815-816
- COVID-19 Preparedness in Michigan Nursing Homes.J Am Geriatr Soc. 2020; 68: 937-939
- When Planning Meets Reality: COVID-19 Inter-pandemic Survey of Michigan Nursing Homes.Am J Infect Control. 2021; https://doi.org/10.1016/j.ajic.2021.03.016
- Is Higher Volume of Postacute Care Patients Associated With a Lower Rehospitalization Rate in Skilled Nursing Facilities?.Med Care Res Rev. 2011; 69: 103-118
- The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff. The National Academies Press.
- The implications of the COVID-19 pandemic for long term care facilities.Curr Opin Infect Dis. 2022; 35: 370-377
- Adoption of Health Information Technology Among US Nursing Facilities.J Am Med Dir Assoc. 2019; 20: 995-1000.e4
- Impact of electronic healthcare-associated infection surveillance software on infection prevention resources: a systematic review of the literature.J Hosp Infect. 2018; 99: 1-7
- Narrative review of primary care point-of-care testing (POCT) and antibacterial use in respiratory tract infection (RTI).Bmj Open Respir Res. 2015; 2: e000086
- Effect of C reactive protein point-of-care testing on antibiotic prescribing for lower respiratory tract infections in nursing home residents: cluster randomised controlled trial.Bmj. 2021; 374: n2198
- Optimizing treatment of respiratory tract infections in nursing homes: Nurse-initiated polymerase chain reaction testing.Am J Infect Control. 2019; 47: 911-915
- Clinical Implications of Multiplex Pathogen Panels for the Diagnosis of Acute Viral Gastroenteritis.J Clin Microbiol. 2021; 59: e01513-e01519
- Masks for Prevention of Influenza Transmission in Acute and Long-Term Care Settings: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines. Canadian Agency for Drugs and Technologies in Health.
- Loosen strict COVID restrictions in nursing homes; residents deserve freedom of choice.https://www.baltimoresun.com/opinion/op-ed/bs-ed-op-0809-covid-restrictions-nursing-hopes-20220808-plskmu4ylbgatbbcrx2tnjii6e-story.htmlDate: 2022
- COVID-19 Vaccines and SARS-CoV-2 Transmission in the Era of New Variants: A Review and Perspective.Open Forum Infect Dis. 2022; 9: ofac124
- Clinical Practice Guidelines by the Infectious Diseases Society of America: 2018 Update on Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak Management of Seasonal Influenza.Clin Infect Dis. 2019; 68: 895-902
- Influenza and antiviral resistance: an overview.Eur J Clin Microbiol. 2020; 39: 1201-1208
- Effect of Bamlanivimab vs Placebo on Incidence of COVID-19 Among Residents and Staff of Skilled Nursing and Assisted Living Facilities.JAMA. 2021; 326: 46-55
- Infection prevention and control in nursing homes during COVID-19: An environmental scan.Geriatr Nurs. 2022; 43: 51-57
- Nursing home staff networks and COVID-19.Proc National Acad Sci. 2021; 118 (e2015455118)
- Association Between Nursing Home Crowding and COVID-19 Infection and Mortality in Ontario, Canada.JAMA Intern Med. 2021; 181: 229-236
- Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths.J Am Med Dir Assoc. 2021; 22: 489-493
- Transmissibility and transmission of respiratory viruses.Nat Rev Microbiol. 2021; : 1-18https://doi.org/10.1038/s41579-021-00535-6
- Practical Steps to Improve Air Flow in Long-Term Care Resident Rooms to Reduce COVID-19 Infection Risk.J Am Med Dir Assoc. 2020; 21: 893-894
- The impact of organisational characteristics of staff and facility on infectious disease outbreaks in care homes: a systematic review.Bmc Health Serv Res. 2022; 22: 339
- Can Infection Prevention Programs in Hospitals and Nursing Facilities Be Integrated?: From Silos to Partners.JAMA. 2018; 319: 1089
Publication stageIn Press Uncorrected Proof
This author receives funding from the Agency for Healthcare Research and Quality (AHRQ grant no. R18HS022465 ) and from the Wisconsin Department of Health Services (grant no. 435100-G22-SHARP-01 & 435600-G19-NHINFECPREV-01 ).
The author declares no conflicts of interest.