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A look back: Where were you when you first heard COVID-19 was in your nursing home?

Date: March 24, 2021 | By: El Harris, Chief Executive Officer, AMS Infection Prevention Partners

I don’t imagine many of us will soon forget where they were when they heard their long-term care facility had its first COVID-19 infection. How did you react? What were you most concerned about, and what were you most appreciative to have in place? 

Infection prevention and control (IPC) regulations have been in place for several years. The Centers for Medicare and Medicaid Services (CMS) expanded these regulations in 2016, and phased in updated regulations until the final ones were enacted in November 2019 – on what turned out to be the eve of the global pandemic.

This final regulation required that all nursing homes have a certified infection preventionist on staff

On Feb. 29, 2020, news of a COVID-19 outbreak in a long-term care facility was first reported. Within a few short months, the pandemic forced us into a nationwide lockdown, with nursing homes impacted more than any other population. In hindsight, CMS’ new IPC regulations were preparing us for just this situation, but unfortunately, several factors rendered these efforts insufficient.

CMS vs. Nursing Homes

No one disagrees with the necessity for better infection prevention protocols in long-term care and no one disagrees that antibiotics prescribed to combat many of these infections are utilized at extremely alarming rates. Unfortunately, nursing homes balked at the regulations and CMS pushed. The new regulations were costly and were implemented simultaneously with PDPM, the most significant nursing home reimbursement change in decades. PDPM took center stage over clinical improvement implementation. 

Every one of us wants a safe and infection-free home and workplace, however infections are a part of our daily existence. For those of us in long-term care, it’s even more important we understand how to respond when an infection is identified -- what is the infection and what are our policies and procedures to respond to the particular infection?  How do we not only protect our residents but ourselves and our families? The pandemic couldn’t be stopped without a vaccine, but what could we all have done to slow its evident spread? We can't change the past, but we can learn how to better prepare and protect ourselves from all infections going forward.

AMS Infection Prevention Partners has served hundreds of nursing homes, providing infection prevention and infection surveillance clinical services for more than three years. From our individual experiences serving seniors, to countless stories from medical directors, nursing home administrators, directors of nursing, Infection Preventionists (IPs), and especially our Certified Nurse Assistants, a common theme emerged - there was a serious lack of leadership and guidance when COVID-19 entered their homes and the LTC community. What stuck out most to our nursing home partners? The resiliency of their peers and care teams and how they made it through this grueling year--together.

Everyone is in agreement that IPC regulations are needed and are necessary. They were created out of observations and hard facts about growing infection and antibiotic overuse concerns. The regulations have great insight and opportunity to reduce all infections when followed - making it vital for facilities to understand and implement them (and not just stuff them in a binder to dust off prior to when surveyors arrive). Another approach to infection risk reduction is to partner with clinical consultants. AMS Infection Prevention Partners’ approach to reducing all infection risks is to focus on F880 and its guidelines for infection surveillance.

Our experience with F880

F880 is the largest citation three years running, and CMS has recently funded an additional $397 million to increase F880 surveys which is expected to now triple going into the rest of 2021. F880 identifies infection surveillance and its three components—process surveillance, outcome surveillance, and analytics—which reports and embeds infection surveillance insights into all of the nursing home’s quality assurance programs. Infection surveillance is time consuming and costly yet highly important to any successful IPC program.

AMS Infection Prevention Partners has identified infection surveillance as the best foundation for building all nursing home-specific IPC programs—what we learn from infection surveillance vastly reduces a nursing home’s rate of all infections. This F880 component is insightful and impactful, but difficult to employ so many times it is ignored.

Identifying infection risks needs to be an hourly agenda item for clinicians—not saved for an annual nurse consultant audit or a quarterly QAPI committee meeting review. Battling all infections is important to our residents, their families and loved ones, and your superhero staff, as well as referring hospitals. When the next infection outbreak is upon your home, instead of relying solely on your peers, know how to confidently respond and prevent the spread of infections in the home. 


CMS does provide the appropriate guidance to us, even if we don’t always agree with the way this guidance is provided. To protect your entire nursing home community and reduce your likelihood of an F880 tag, look to build a stronger infection surveillance platform. AMS Infection Prevention Partners can help. Contact us today.

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