Long-term care (LTC) facilities are feeling the squeeze of record-breaking staffing shortages these days. Two years of the COVID-19 pandemic, compounded by “The Great Resignation” has left so many reeling for more support in every department. But perhaps one of the hardest-hit departments or roles in LTC facilities is that of the infection preventionist (IP).

​

I travel to facilities across the country in my role as Chief Infection Prevention Officer for AMS Infection Prevention Partners, and I have experienced first-hand the hardships felt by so many nursing homes because they have no present IP, or an IP that is serving in several other capacities. IPs are typically an existing clinician, ADON or DON who is dual-certified in IP and is thus given that responsibility. While I do see some facilities with a dedicated, full-time IP, it continues to be rare going into the spring of 2022. Because the IP is also an experienced clinician, they are typically “pulled” in multiple directions, especially now when staffing is so lean. Adding to this—the IP role rarely has a leader, someone to mentor and guide them on how to be successful in reducing and containing infection risks.

 

A stretched-thin or no IP is extremely dangerous for long-term care. IPs play a critical role in keeping our residents, our staff, and their families safe. And if that isn’t enough, infection prevention and control infractions can lead to large fines. F880 continues to be a top citation and CMS is presently targeting infection prevention and control more than ever due to the pandemic. Nursing home managers should think twice before asking their IP (for example) to fill in as the medication nurse and pushing IP responsibilities to a lower priority. This happens and it is expected from time-to-time, but should not be the norm. When I see this happening, the nursing home’s infection prevention and control program is always one being reactive and not a preventative care one.

 

The good news is that the solution isn’t terribly complex and LTC leadership can start today! Support, educate and empower your IPs. Your IP wants to do the right thing but often lack the experience (and empowerment) to do so! Many times, your IP is assigned multiple clinical responsibilities, minimizing their ability to implement effective IP programs. Let them do the job they were hired to do!

 

Stop and think about it - how many hats is your IP wearing today? Chances are, most of their workday today was filled with tasks completely unrelated to infection prevention. And compounding these issues is that LTC leadership often falls short of continuing an ongoing IP support and professional education, and many medical directors are not fully engaged in an antibiotic stewardship program, antibiograms or IPCP regulations. Ensuring a system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for all residents, staff, volunteers, and all other individuals in your facility is in place is not only best practice, but is also required under F880. Some simple, yet often overlooked IP preventative care programs that I recommend and that your entire nursing home team should discuss and support are:

• Linen storage and handling – beyond the basics of processing laundry, this program should include how to properly transport clean and dirty linen (by all staff), ensuring linen carts / closets are kept free of contaminants and not overlooking processes for cleaning / disinfecting laundry equipment;

• Surveillance and data analysis – should be proactive and ongoing and include both outcome and process surveillance. Effective surveillance and data analysis is more than audits / observations, and should include all aspects of the facility and all departments, and should be documented clearly; and

• Environmental cleaning / disinfecting – to include a procedure for cleaning privacy curtains and shared equipment, as well as a plan for communicating resident discharges and room changes with EVS staff in a timely manner.

 

Set your IP up for success by providing them with both the time to perform their IP duties and with your help to manage and mentor them.