Establishing an Infection Prevention Program in a Nursing Home, With an Emphasis on COVID-19
Within nursing homes today, infection preventionists now stand beside the assistant directors of nursing (ADON), directors of nursing (DON) and administrators to plan and carry out COVID-19 response and mitigation. Eli K. DeLille, MSN, RN, CIC, FAPIC, consults with hundreds of nursing homes as an infection preventionist for Health Services Advisory Group (HSAG), the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for California and Arizona. Whether a home has a full-time infection preventionist or multiple staff members who share the role, DeLille observes that all facilities can follow a step-by-step process to establish and maintain an infection control program to meet the challenges of COVID-19. He outlined this process during the National CMS/CDC Nursing Home COVID-19 Training Series presented on July 16, 2020.
Where to Start
“Right now, a very small thing can really negatively impact residents in the long run,” DeLille says. That’s why DeLille encourages nursing home leaders to allocate time for their infection preventionists to complete the free Centers for Disease Control and Prevention (CDC) online training that will make them more effective and knowledgeable in their role. This training is structured as short modules that can be completed by the busiest infection preventionist, but DeLille recommends carving out time away from work demands to gain the most benefit.
Following this training, consider consulting this Infection Preventionist Orientation Checklist, which outlines the essential components of a nursing home infection control program. HSAG created this checklist with input from hundreds of nursing homes in its role as a QIN-QIO.
A facility self-assessment helps establish a baseline level of risk preparedness. DeLille recommends the CDC Infection Prevention and Control Assessment Tool for Nursing Homes Preparing for COVID-19, which can be repeated monthly or even more often during an outbreak.
Armed with self-assessment results, your facility can prioritize risk areas by level of urgency. This Risk Assessment Prioritization Worksheet from HSAG not only helps you assign infection risks by level of severity, but documents your findings to obtain buy-in from your care teams and other stakeholders.
Deploy an Action Plan
HSAG and other QIN-QIOs have created one-page action plans around common infection prevention issues that can be customized to your facility. These action plans help document interventions so they can be tied to outcomes. This action plan, for example, was created specifically to address COVID-19.
Ask for Feedback
You may not think you have time for a wider review of your plan. But in DeLille’s experience, obtaining feedback from your ADON and DON, consulting pharmacist, administrator, quality assessment and assurance nurse, medical director and other physicians is crucial. This feedback can not only expose any gaps in the infection control plan, but also open communication with other specialty areas.
DeLille says he recently met with leaders at one nursing home who used this review process to create a program to reengage staff in infection control processes. “Infection Prevention (IP) Bucks” are awarded to staff who are following hand hygiene and personal protective equipment (PPE) protocols. The IP Bucks will be awarded in cash to staff members during the holiday season.
Educate, Empower, Engage
Besides staff members and providers, DeLille recommends integrating residents into your infection prevention communication. “Residents are being asked to socially isolate in their own homes, to wear a mask, and to be placed in isolation for extended periods of time,” DeLille says. “One home we work with not only says that heroes work here, but that heroes live here.” Resident buy-in will help protect staff members and other residents, slowing the spread of COVID-19.
Encourage all stakeholders to speak up if they identify a concern. This may create opportunities to revise your infection control plan. It’s normal to modify your plan or even go back to the drawing board, especially during the COVID-19 pandemic when recommendations are sometimes changing daily.
There are several types of infection prevention surveillance, DeLille notes: process surveillance, which confirms that staff are following infection prevention policies and procedures; outcomes surveillance, which gathers data on individual infection cases and compares them to standard definitions; reporting, which allows your facility to identify trends and patterns; and data analysis.
Process surveillance includes audits, which are essential for the new infection preventionist. It may not seem like you have enough time in your day, but this hands-on time is essential to ensure that everyone in your facility is following the same processes and procedures. You don’t have to create your own audit tools: the CDC and others offer standard checklists for hand hygiene, environmental services, isolation compliance and more. You’ll want to share these tools with your staff so they know how they are being evaluated.
DeLille offers several tips to help integrate audits into your infection prevention plan:
- Quantify. Consider doing at least 10 observations when you go out on the floor to ensure that you’re capturing enough data.
- Change it up. You’ll want to vary days and times so you’re seeing different staff members in action.
- Share the task. Train your administrator, ADON, DON or others to conduct audits. Their differing perspectives all help identify opportunities for improvement within your facility.
The presentation slides offer more detail on the other types of infection prevention surveillance.
Have a Process to Escalate
Now more than ever, infection preventionists need leadership support to help keep employees and residents safe. DeLille advocates for processes to escalate concerns, noting that infection preventionist recommendations should carry the same weight as those coming from an administrator, ADON or DON.
To Learn More
Download the HSAG QIN-QIO slides and resources from the National CMS/CDC Nursing Home COVID-19 Training Series page, visit www.QIOProgram.org to connect with the QIN-QIO serving your state or territory and sign up for updates about the National CMS/CDC Nursing Home COVID-19 Training Series.