Tighter Focus on Nursing Home Infection Control Offers More Effective Patient Safety

Stricter controls 'will help people move more gracefully toward the end of life,' infection control industry leader says.

Infection control tended to be part of a list of responsibilities in most nursing homes, but now that the Centers for Medicare & Medicaid Services (CMS) is requiring facilities to have at least a part-time infection preventionist on-site, that focus on patient safety will make a difference, an industry leader said.

"Prior to COVID, I would venture to say there were some types of plans in place. Some places probably had better plans than others, and I know that there are places that reached out and got external expertise to try and guide their plans," said Linda Dickey, president of the Association for Professionals in Infection Control and Epidemiology (APIC). "But having someone on site, at a facility, watching practices, is really important."

Before the CMS requirement,  if someone was in charge of infection prevention, it was one of many responsibilities they carried, without any dedicated time or expertise, Dickey said, adding that an infection preventionist increases the focus on patient safety.

Duties of an on-site infection preventionist would include gathering and reporting data on different infections to the state and the U.S. Centers for Disease Control and Prevention and doing rounds through the facility to observe direct care practices, providing coaching and feedback if necessary. If a resident had previously been treated for an infection, the preventionist would follow up with them.

They also are charged with training staff to ensure they understand the importance of basic practices, such as getting flu shots, not just for  their own safety but for the residents’ safety as well.

If there is an outbreak, the infection preventionist is responsible for coordinating with public health investigations on how those transmissions occurred, as well as performance improvement to change practices and behaviors.

Adding an infection preventionist to a facility's staff won't be a quick or easy fix. The post-acute sector is struggling alongside other parts of the industry to hire during a staffing shortage, further exacerbated by the pandemic. Dickey noted that a large number of infection preventionists have begun retiring, and because it isn't a well-known profession, there's not a large pipeline from which to choose.

"Of the infection preventionists that are out there, there's not a huge number that specialize in long-term care," she added. "That may be part of what they know, but it isn't their sole focus."

There is currently no job code for the role of infection preventionist, and APIC is reaching out the nation's department of labor to correct that. A job code will help with salary benchmarking so that facilities can begin to market the role and its responsibilities.

Building a pipeline

To help with the lack of qualified talent, APIC has developed an internship program that would give healthcare professionals an introduction into what infection preventionists do. The program framework APIC provides has the worker reviewing topics and information over the course of 10 weeks, with the organization able to lay it out in a way that best suits their employees.

APIC also plans to partner with colleges and universities, and begin reaching out to high schools to introduce students to the career path. They're also developing academic pathways focusing on infection prevention that can be imbedded in nursing, public health, lab, or microbiology programs.

"There are programs out there and internship programs for infection prevention," Dickey said. "But they're not, I don't think, widely known. And there aren't a lot of degree programs where you can specialize in infection prevention, so that's what we're trying to bolster."

Typically, an individual has a degree in nursing, public health, or laboratory discipline prior to getting the infection prevention and control certificate (CIC) and must have at least two years of experience. While there's no specific medical degree required to pursue the certification, Dickey notes that most facilities won't hire someone unless they have a background in some sort of health-related degree.

"I don't think it’s just a money thing for these organizations. They want to do a good job and I think that they will see that there's value in infection prevention and doing it well," Dickey said. "It will save money, it will improve care, it will help care, and it will help people move more gracefully toward the end of life."