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Significant gaps in infection prevention impact long-term care residents
Portland, Ore., June 14, 2017 – While nearly 400,000 residents of long-term care facilities die as a result of healthcare associated infections (HAIs), these facilities continue to lack the resources, including qualified personnel, necessary to implement adequate infection control programs, according to research presented at the 44th Annual Conference of the Association for Professionals in Infection Control and Epidemiology (APIC).
More than 1.4 million Americans reside in one of the nation’s approximately 15,654 nursing homes, according to the Centers for Medicare & Medicaid Services (CMS). Reducing HAIs is an important goal for CMS, who issued rules requiring all long-term care facilities (LTCFs) to strengthen their infection prevention and control programs. The rules require facilities to have an infection prevention and control officer, and an antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use.
Public health professionals from the Tennessee Department of Health and in Washington State assessed a sample of LTCFs to determine their infection prevention proficiency using a tool developed by the Centers for Disease Control and Prevention (CDC). Of the 43 assessments performed in the two states, researchers found many infection control officers in LTCFs had little-to-no formal training and lacked foundational skills for proper infection prevention. Researchers also discovered high turnover rates with facilities struggling to retain consistent, qualified personnel 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 LTCFs,” said Linda Greene, RN, MPS, CIC, FAPIC, 2017 APIC president. “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.”
“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,” said Colleen Roberts, MPH, a researcher on the Tennessee study and an HAI epidemiologist with the Tennessee Department of Health. “These assessments confirmed our suspicions that many LTCFs suffer from understaffing and lack of appropriate infection control training, which can impact patient care.”
In Tennessee, 56 percent of LTCFs assessed had infection control programs overseen by someone who had no additional training in infection control. On average, only 12.5 staff hours per week were dedicated to infection prevention activities. While 72 percent of facilities implemented an online competency-based training program for hand hygiene, only 50 percent provided real-time feedback to assess performance. In addition, 67 percent of facilities implemented a competency-based training program for proper use of PPE, but nearly half failed to provide feedback or observe return demonstrations to check whether personnel were donning and doffing equipment properly. More than 9 out of 10 facilities (94 percent) did not meet the requirements for an antibiotic stewardship program.
“Our analysis identified clear gaps in infection prevention practices and the urgent need to improve infection control infrastructure in long-term care facilities,” said Dorothy MacEachern, MS, MPH, CIC, infection preventionist with the Spokane Regional Health District and a researcher on the Washington State study. “Future efforts should be directed at providing training, ongoing education, and support for IPs in these settings.”
APIC’s mission is to create a safer world through prevention of infection. The association’s more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at www.apic.org. Follow APIC on Twitter: www.twitter.com/apic and Facebook: www.facebook.com/APICInfectionPreventionandYou. For information on what patients and families can do, visit APIC’s Infection Prevention and You website at www.apic.org/infectionpreventionandyou.
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