The tool uses existing evidence to form recommendations for staffing ratios in long-term care, acute and ambulatory care settings. All of the recommendations are based on key risk factors.

“We are excited to provide this tool to the infection prevention field,” Patricia Jackson, RN, president of APIC, said in a statement. “APIC members have been asking for a resource to help quantify staffing needs for years, and now we can begin to deliver on that promise. With member input, we will be able to provide a robust, accurate staffing tool that will help IP leaders make the case for adequate staff and resources to protect patients.”

The introductory version of the staffing calculator is an “exploratory approach,” APIC says. That is, it’s intended to provide a basic calculation of staffing needs and will collect data that can be used for creating a more rigorous algorithm in the future. 

Data gathered from healthcare facilities that use the tool will be utilized to update it so the tool improves over time. In the next year, an updated version will be released to reflect the accumulated data. In addition to updating the tool as it rolls out, APIC said that it will produce annual reports summarizing data to drive deeper insights into its effectiveness.

The news comes as more organizations are hiring chief infection prevention officers (CIPOs). An article published Dec. 7 in Infection Control Today shared details on this executive role that supports operational positions through the lens of preventing infection.

As sobering as this finding is, COVID-19 is far from the only infection threat facing long-term care facility residents. For example, studies have also shown that C. difficile — identified by the Centers for Disease Control and Prevention (CDC) as a threat level “urgent” pathogen — affects one out of every 50 residents and leads to 29,000 deaths every single year. 

On a broader scale, the 2004 National Nursing Home Survey (2004 was the most recent year that the CDC conducted this survey) revealed that the approximately 1.5 million people who live in long-term care facilities experience, on average, about two million infections per year.

The data is clear: infections are one of the most pervasive threats facing nursing home residents. To help protect their vulnerable populations, facilities must prioritize implementing infection prevention and control (IPC) best practices. These tips are especially important as we enter the holiday season all while influenza, COVID-19, and RSV continue to circulate in our communities. 

One of the easiest and most effective ways to help protect your residents from infection is to educate every individual who walks into your building about the role they play in reducing the spread of communicable and infectious diseases. For example, this signage can describe when visitors should wear a mask or avoid visiting their loved ones (when they are ill). Placing this education where it can be easily seen when entering the facility can go a long way toward keeping your residents safe. 

To be the most effective, signage should also be accompanied by relevant personal protective equipment (PPE). In other words, if you post education advising individuals to wear a mask, ensure there are masks available right next to it. If your sign is about hand hygiene, make sure it’s near an alcohol-based hand sanitizer dispenser (and that the dispenser is fully stocked).

The CDC also has posters you can print out for free that can be hung outside of resident living quarters indicating what precautions people should take when entering and exiting a resident room. All visitors need to be made aware of what transmission-based signage means when it is posted on a resident’s door. 

This typically indicates that specific PPE needs to be worn before entering the resident’s room. It is important to have a restocking process in place so that there is always an adequate supply of PPE. If the bins are empty, individuals may go into the resident’s room without PPE which increases the transmission risk. Consider assigning this role to the environmental service employees as they enter each resident room every day. They can check the PPE bins before entering the rooms. In addition, you could consider assigning it to the other staff who may conduct frequent stocking of supplies. Consider avoiding assigning it to one individual such as the infection preventionist as they are not always in the facility.

This approach is far better than taking the stance that keeping PPE stocked is “everybody’s responsibility.” Too often, that leads to nobody checking PPE, because everyone assumes someone else will take care of it. Assigning people to handle this task is a simple way to avoid this problem.

Finally, one of the best ways that visitors can protect their loved ones during the holidays is to stay up to date on all recommended vaccinations. This can include COVID-19, influenza and Tdap vaccinations. It is important to remember that long-term care residents are a vulnerable population and that outbreaks spread rapidly within this congregate healthcare setting. Everyone who enters a facility has the potential to protect or infect this community. 

Taking measures like these will help reduce and prevent infections among your facility’s vulnerable population. Reminding everyone who comes into the facility of the importance of hand hygiene — which is demonstrably one of the most important elements of effective IPC — and giving them access to alcohol-based hand sanitizer, for example, can reduce rates of bacterial and viral infections. 

Placing informational signs, keeping relevant PPE within easy sight and access to visitors for at-risk or infected resident rooms, and staying current with all recommended vaccinations can similarly reduce the spread of pathogens and mitigate the risk of infection outbreaks among other residents and staff. 

Ultimately, these IPC best practices are highly effective and can be part of every facility’s IPC program. They don’t require a large investment or time and can be put into practice today. 

Buffy Lloyd-Krejci, DrPH, CIC, is the founder of IPCWell. Drawn to action to improve the infection prevention landscape for these communities, she utilized her over two decades of experience in the healthcare field and her doctorate in public health (DrPH) to launch IPCWell. She and her team have provided training, education, and technical assistance (both in person and virtually) to hundreds of congregate care facilities throughout the COVID-19 pandemic.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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An article published Dec. 7 in Infection Control Today highlights the concept of having a chief infection prevention officer (CIPO). This executive role supports operational roles through the lens of preventing infection. The concept is gaining popularity in hospitals and other healthcare organizations and could influence the long-term care segment. 

This executive position oversees and enacts infection prevention and control activities for an entire organization. The person has to collaborate with administrative, board members, quality management, clinical microbiology, clinical engineering, nursing, materials management and environmental services personnel. The CIPO essentially supervises other infection preventionists, whether they’re at the same location or multiple facilities, the article noted. The CIPO also has to be able to represent the concerns and practices of infection control personnel and initiatives to executive level officers.

“Hospital epidemiologists play a vital role in orchestrating the efforts to prevent the emergence and transmission of infection within a hospital,” Shira Doron, MD, the chief infection control officer at Tufts Medicine, and a hospital epidemiologist, said in the article. “[CIPOs] … serve in that same role at a health system level, coordinating those efforts across multiple entities and various health care settings. As a hospital epidemiologist and CIPO, I have years of formal and on-the-job training that is highly specialized at the intersection of epidemiology, infectious diseases, public health, and clinical research methods.”

“As hospitals and other healthcare entities consolidate into larger health systems, having someone responsible for infection control oversight at the system level is critical,” Doron said.

The study was published today in the American Journal of Infection Control. The source of the data was 191 healthcare workers at the University of North Carolina Medical Center. The participants responded to surveys between July 2020 and January 2021. The questionnaires asked the workers to share their experiences on virus exposure and whether or not they stuck to infection precaution standards.

There were three groups of healthcare workers surveyed: 45% were doctors, advanced practice providers, physician assistants and nurse practitioners; 27% were registered nurses; and 28% were therapists, dieticians, and those working in food and environmental services. In addition to surveys, the researchers monitored the workers and reported data on their infection control.

Some 57.4% of registered nurses were in roles that put them at a higher risk of SARS-CoV-2 exposure (like dealing with people who had the virus), compared to nearly 29% of physicians and 38% of people in the third group. Healthcare workers who were more likely to be exposed to the virus were also 5.74 times more likely to say they made at least one error in following infection precautions in the previous two weeks.

In terms of sticking to personal protective equipment guidelines, 33.3% of registered nurses and 26.5% of doctors said they had one error in a two-week span compared to 9.6% in the other category of workers. Most had good access to gowns, gloves and other personal protective equipment.

Hand hygiene was a big sticking point, as it was the task that was performed incorrectly the most. The workers stuck to hand and glove protocol 40% of the time in rooms with people who had COVID-19, the study found.

“While error rates varied by job type, what this study really shows is that all three groups of healthcare personnel were at risk of SARS-CoV-2 exposure and were making errors in adherence to infection prevention protocols during the height of the pandemic,” Emily J. Haas, PhD, lead author and a research health scientist at the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health and National Personal Protective Technology Laboratory, said in a statement. “This is a clear demonstration that we need to improve engagement in our training for emergency preparedness and to create a more strategic response that will help our healthcare workers stay safe even in times of extreme stress.”

A recent article in Infection Control Today summed up how scrubs can help prevent infections. According to the author, the fabric for most scrubs is tightly woven, so it can stop pathogens from reaching your body. The material that scrubs are made of also can absorb or repel fluids and can stop the transfer from one patient or resident to another. Polyester-cotton materials and similar blends have been able to guard against infections and are easy to clean. Some scrubs are marketed with antimicrobial properties such as copper or silver nanoparticles; those can stop bacteria from growing and prevent infections from spreading, according to the article.

Even though workers at nursing homes may not be at risk for heavy interaction with personal fluids, the materials are equipped to handle it — a plus because nursing home workers never quite know what they’re going to deal with during a shift.

When purchasing scrubs, seek out those that are certified by organizations like the Association for Advancement of Medical Instrumentation, the author recommends. 

Taking care of scrubs as per the directions is key to ensure the garments maintain their viability for protection. They must be washed with hot water and detergent and dried at a high temperature, so look for materials that can handle high temperatures from frequent washing and drying.

Finding the right fit also is important if you’re looking for medical scrubs. Pockets can be useful, but too many folds or pockets in the scrubs can become hazardous or encourage the buildup of germs. Go for a fit that is not too loose and not too tight, as the fit also can play a role in the protective value of the tops and bottoms.

Nursing home residents are at an increased risk for infection, hospitalization and colonization with multidrug-resistant organisms. Finding effective agents is key to keeping them protected. Researchers conducted a cluster-randomized trial of universal decolonization with the agents, comparing the outcome to routine-care bathing. 

Data came from an 18-month-long baseline period and then an 18-month span when the staff used the decolonization intervention. Decolonization involved using chlorhexidine for all routine bathing and showering. The researchers evaluated data from 28 nursing homes in Los Angeles and Orange counties in California spanning 28,956 residents.

The residents took nasal povidone–iodine twice daily for the first five days after admission and then twice a day for five days every other week. The researchers looked at how many of the residents were then transferred to the hospital for infections, as well as being transferred to the hospital for any reason. 

Of people moved to a hospital who received routine care, 62.2% (the mean across all of the nursing homes) developed infections during the baseline period and 62.6% acquired infections during the intervention period. In the intervention group, 62.9% got infections during the baseline period while 52.2% got infections during the time of the intervention. 

Among the people sent to the hospital in the routine care group, 36.6% were transferred to a hospital for any reason during the baseline period and 39.2% went during the intervention period. In the intervention group, 35.5% went to a hospital due to any cause during the baseline period, while 32.4% went for any reason during the intervention period. 

The study was published Thursday in The New England Journal of Medicine.

The draft of the Isolation Precautions Guideline was released to the public on Nov. 2. The CDC accepted feedback on it until the end of the day Monday, which gave the public five days to comment. The rules haven’t been updated in 16 years. 

The guidance specifies infection control practices for healthcare facilities in the country. It refers to healthcare workers directly, not employers. The NNU said the guidance “inappropriately” shifted responsibility and risk to individual workers to protect corporate profits. 

“The focus of HICPAC’s draft is almost exclusively on personal protective equipment, and it fails to make strong recommendations on other essential measures, such as ventilation and patient screening and isolation,” the NNU stated.

“HICPAC’s draft is permissive and weak and seeks not just to maintain existing practice — which has been shown to be inadequately protective — but even rolls back the use of some important measures, such as airborne infection isolation rooms,” Zenei Triunfo-Cortez, RN, president of the NNU, said in the statement. “This draft guidance will only further degrade the already dangerous working conditions of nurses and other health care workers and further contribute to high rates of moral distress, which will only serve to drive more nurses away from the bedside and further deepen the staffing crisis in health care.”

“HICPAC is missing the perspective of frontline nurses, other health care workers, our unions,” Triunfo-Cortez said.

Triunfo-Cortez said research shows that healthcare workers need multiple measures to deal with viruses. The standards should include ventilation, PPE, screening and isolation, exposure notification, and other measures.

The NNU sent a letter to the CDC in July asking the federal agency to meet and discuss the the concerns about the rules; they also created a petition urging the CDC to recognize aerosol transmission of SARS-CoV-2 and other respiratory pathogens to strengthen the agency’s Isolation Precautions guidance. In September, nearly 2,000 experts in public health, infectious disease and industrial hygiene sent a follow-up letter to the CDC director asking for the CDC “to involve key experts and all stakeholders in the development process” and hold public meetings, the organization noted in its statement.

Researchers wanted to know if letting workers directly put on gloves without requiring them to wash first would help healthcare workers adhere to infection prevention practices better than requiring them to wash first before putting on gloves. Washing hands first means workers have to let their hands dry before putting on gloves, which can affect adherence and hamper operations in a time crunch, not to mention cause skin irritation. The study was published in JAMA Network Open last week.

The researchers utilized data from 13 hospitals and studied activities of 3,790 healthcare workers. The team of scientists randomly assigned hospital units to usual care (washing first, then putting on gloves) and direct gloving (the intervention). The team then tracked how well workers stuck to expected gloving practices when they entered and left the room. 

Adherence was greater in the six units with direct gloving compared to the units assigned to usual care, the data showed. 

In addition to the data on gloving, the researchers looked at attitudes on direct gloving among 25 doctors, nurses and other healthcare workers. Of them, 68% said there could be potential benefits such as better time efficiency, less skin irritation, staff satisfaction and adherence to infection control expectations. Of those 25 healthcare professionals interviewed, 60% weren’t worried about risks with direct gloving as long as it was proven safe. One participant said patients may view it negatively, while two participants said they weren’t comfortable with direct gloving.

Overall, the authors of the study say a policy endorsing direct gloving could help workers better stick to infection prevention techniques and glove use in medical settings.

A new study published Thursday in the American Journal of Infection Control (AJIC), shows interventions reduced healthcare-associated infection rates among vulnerable patient populations. These populations include people at long-term care communities who are more prone to infections and may have other health ailments that affect their immune systems. Long-term care facilities also implemented infection prevention and control measures during the pandemic. 

“Previous, large-scale studies revealed an alarming increase in some HAIs during the pandemic, which may be partly attributed to the necessary, dramatic shift in institutional infection prevention and control priorities,” Roy F. Chemaly, MD, chair of infectious diseases, infection control and employee health at MD Anderson, and the lead author, said in a statement. “Our findings suggest that enhanced and targeted IPC measures enabled our facility to avoid these increases and, in several cases, significantly reduce the incidence of HAIs among our patient population during the pandemic.”

In March 2020, the MD Anderson Cancer Center started using improved infection control and prevention practices — masking, visitor restrictions, personal protective equipment, disinfection — to stop the spread of the SARS-CoV-2. 

Chemaly’s team assessed incident rates of six healthcare-associated infections among about 30,000 people admitted at the center between 2016 and 2022. The researchers compared the incident rates for all infections for 42 months before the pandemic to the 25 months after the pandemic began in March 2020. The researchers also evaluated times during COVID-19 surges and in areas of the facility housing people with COVID-19.

C. difficile infection (C. diff), respiratory viral infections (RVIs) and central line-associated bloodstream infections (CLABSI) declined significantly.

Laboratory-identified C. diff (Li-CDI) significantly dropped after the pandemic, declining from 6.58 cases per 10,000 patient days to 4.31. Rates were similar between surge and non-surge periods of time. RVIs significantly went down from the pre-pandemic to the pandemic period, from 5.24 to 1.90 per 1,000 admissions. RVI rates didn’t change much between surges and non-surges. Like the other viruses mentioned, rates of CLABSI went down during the pandemic, from 0.51 per 1,000 catheter days to 0.32.

Even though leading infection control agencies say it is essential to use CP for people who have MRSA, the doctors who published the report said that’s not the case. The report came out on Sept. 21 in Clinical Infectious Diseases. 

Evidence doesn’t show that the recommendation to use CP is always warranted, the authors wrote.

The compendium advocating for broad CP use was published by the Society for Healthcare Epidemiology of America, the Association of Professionals in Infection Control and the Infectious Diseases Society of America.

There aren’t controlled trials to support broad use of CP to prevent MRSA, the authors said. The recommendations don’t prove that CP is better over other interventions such as cleaning and handwashing, they said. For example, there weren’t effects on people getting MRSA when healthcare facilities discontinued CP, the authors stated in their report.

When a long-term care facility requires CP, it can strain physical and human resources. It lowers interactions between healthcare professionals and residents, can extend the length of the stay for the person infected and raise hospital costs, the authors pointed out. 

CP also has negative effects on the environment, because it involves single-use plastics in personal protective equipment such as gowns and gloves, the authors said.

“The burden and harms of CP remain concerning, including the environmental impact of increased gown and glove use,” the authors said. 

It’s difficult to assess the effect of changes in CP use during the pandemic, the doctors who published the report said. That’s because of the differing standards among facilities and the stress on the infection prevention programs, the authors said.

The authors of the report don’t want to do away with CP completely. They suggest that CP should be included in the guidance under “additional approaches” in the recommendations should be enacted under special circumstances, such as outbreaks.