As the most significant global health crises in recent history, the COVID-19 pandemic not only impacted millions of lives but also highlighted the importance of preparedness and effective infection control in nursing homes. Unfortunately, nursing home resident were put at an elevated risk for severe complications from the virus due to their age, chronic medical conditions, and the close and shared living quarters that made it easier for the virus to spread.
As of April 30, 2023, the CMS COVID-19 Nursing Home Data confirmed:
- Over 1.6 million resident cases,
- Over 1.6 million staff cases
- Over 166,000 deaths among nursing home residents
- 3,099 deaths among staff
What are the unique challenges of seniors in nursing homes during the pandemic? One of the ways to better understand the vulnerability of nursing home residents is through Maslow’s hierarchy of needs, which theorizes that humans have a set of needs that are organized into five levels, such that fulfillment of the lower levels allows one to focus on higher-level needs. These needs are categorized as:
- Physiological
- Safety
- Love and belonging
- Esteem
- Self-actualization
By applying this framework, we can identify the unique challenges faced by nursing home residents. In addition to the challenges that community-dwelling older adults (those outside of long-term care) face, nursing home residents have a pronounced lack of capabilities to fulfill their lower-level and higher-level needs.
In the context of the current pandemic, nursing home residents are more vulnerable on account of being more isolated from family and friends. Additionally, the health and well-being of nursing home residents are heavily dependent upon the ability of staff to provide adequate infection control in nursing homes, in addition to the regular care they need as dictated in their care plans.
Other challenges faced by nursing homes during the pandemic included:
- Inadequate staffing: Many nursing homes struggled with staffing shortages, partly due to the high risk of infection among staff members. This led to increased workloads for existing staff and, in some cases, compromised care quality.
- Insufficient Personal Protective Equipment (PPE): During the early stages of the pandemic, nursing homes often faced difficulties acquiring adequate PPE supplies, leaving staff and residents exposed to risks of infection.
- Limited testing and delayed results: Inadequate access to testing and slow turnaround times for results made it challenging to quickly identify and isolate infected residents and staff members.
- Ineffective infection control in nursing homes: Some of America’s nursing homes lacked comprehensive infection control plans, leading to the rapid spread of the virus within their facilities.
The pandemic underscored the need for nursing homes and other long-term care facilities to be better prepared for infectious outbreaks. In the next section, we will review what we learned about infection control in long-term care settings during the pandemic.
Infection Control in Long-Term Care: Regulations and Best Practices
Inadequate infection control in long-term care facilities resulted in the spread of the virus in nursing homes, worsening the impact of the pandemic on America’s seniors. Adhering to Infection Prevention and Control (IPC)—a scientific approach and practical set of measures designed to prevent and reduce the risk of transmission of infectious diseases within healthcare settings, such as nursing homes, assisted living facilities, and other long-term care facilities—helps reduce such risks.
For this reason, it is upon every long-term care leader to understand the core components of infection prevention and control, which are:
- Establishment of IPC programs: Developing comprehensive IPC programs at both the national and healthcare facility levels is the first step in preventing Healthcare-Associated Infections (HAIs) and managing antibiotic resistance. These programs should involve dedicated and trained teams in healthcare facilities who work in collaboration with relevant organizations and national-level programs.
- Development of evidence-based guidelines: Any IPC guidelines should be evidence-based and designed for both national and facility-level infection control in nursing homes.
- Continuous education and training: Long-term care workers must receive ongoing IPC education and training tailored to their roles. This training covers practical and simulation exercises, risk identification, and preventive measures. Allocating long-term care staff time for IPC education and control activities is vital for successful infection control in nursing homes.
- Surveillance of Healthcare-Associated Infections (HAIs): This is key to guiding interventions and detecting outbreaks. Establishing facility surveillance linked with national surveillance programs ensures data feedback for healthcare workers and stakeholders, enabling prompt response and action.
- Implementing multimodal IPC strategies: This refers to having an integrated approach to IPC programs with several components, such as system change, education and training, monitoring and feedback, reminders, and culture change. A multimodal approach ensures that all aspects of IPC are effectively addressed.
- Monitoring, evaluating, and providing feedback: These three actions should be performed at the facility and national levels. Feedback from evaluations should be shared with relevant staff in a blame-free, non-punitive manner, which helps promote continuous improvements.
- Addressing workloads, staffing, and bed occupancy: Resident overcrowding and facility understaffing greatly impact infection control in nursing homes. Therefore, it is vital for leadership to ensure adequate staffing based on workloads and maintain proper bed occupancy for effective IPC.
- Maintaining a clean and hygienic environment: Cleanliness is at the core of effective healthcare services. Hand hygiene stations with water, soap, clean towels, and alcohol-based hand rub should be in key areas. Additionally, standards for water quality, sanitation, and environmental health should be implemented, along with the provision of Personal Protective Equipment (PPE) at the point of care and other necessary locations.
The National Healthcare Safety Network (NHSN) tracks and analyzes infection data across various healthcare settings, including nursing homes. Reporting infection data to the NHSN is a mandatory part of healthcare and infection control regulation. It plays a vital role in monitoring infection trends, identifying potential outbreaks, and informing evidence-based strategies to enhance infection prevention and control measures nationwide. These guidelines must be followed even after the COVID-19 Public Health Emergency (PHE) ends.
Contact us here if you are interested in a long-term care EHR with infection control capabilities.
What Types of PPE Should Be Available to Employees of a Nursing Home?
Let’s now briefly look at what types of PPE should be available to employees of a nursing home. The shortage of PPE during the pandemic highlighted the crucial role it plays in safeguarding the health and well-being of healthcare workers, long-term care residents, and the broader community.
The use of PPE by long-term care staff plays an essential role in infection control in nursing homes by minimizing the risk of transmission and protecting everyone involved. So what PPE do nursing home staff need in their infection prevention and control efforts? It includes:
- Gowns serve as an essential barrier by protecting the skin and clothing of healthcare workers during procedures and patient care activities that may generate splashes or sprays of infectious substances. These gowns should be fluid-resistant and cover as much of the body as possible to minimize the risk of exposure to potentially harmful substances. In addition, one should note that proper disposal or laundering of gowns is a vital part of infection control in long-term care, as it prevents cross-contamination.
- Gloves made from latex, nitrile, or vinyl are critical for protecting the hands of nursing home employees from pathogens and should be worn during patient care activities, particularly when there is a risk of contact with blood, body fluids, mucous membranes, or contaminated surfaces. Proper hand hygiene before and after glove use should be observed, and gloves should be replaced between patients and tasks.
- Face and eye protection such as goggles, face shields, and safety glasses act as barriers to infectious substances. They should be used in conjunction with other PPE, such as gowns and gloves, when caring for those who need long-term care. This type of protection is critical during procedures that may generate splashes or sprays.
- Facemasks offer protection against infectious materials and should be used alongside other PPE, such as gowns and gloves.
- Respirators are used for situations that require airborne transmission-based precautions. They filter at least 95% of 0.3 µm-size particles, protecting the respiratory tract and, in some cases, the face and eyes from airborne pathogens.
By providing and promoting the correct use of PPE, nursing homes can protect their staff, residents, and the community from the spread of infections, ultimately enhancing the health and well-being of everyone involved.
The Role of Technology in Infection Control in Nursing Homes
Technology has played a significant role in long-term care, revolutionizing various aspects of care delivery, analysis, and management. In the realm of infection control in nursing homes, innovative solutions have helped nursing home admins improve their preparedness, responsiveness, and effectiveness in combating infectious diseases.
One such innovation is the long-term care Electronic Health Record (EHR). This software can play a crucial role in infection control by enabling nursing homes to track and monitor infections efficiently. With an efficient EHR, nurses can identify patterns, track the progression of infections, and facilitate data sharing with relevant stakeholders, such as local health departments. By embracing such technology, nursing homes can enhance their infection control measures and create a safer, healthier environment for residents, staff, and visitors.
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