Nearly 1 in 4 for-profit nursing homes may not be complying with federal requirements regarding the designation and training of an infection preventionist to oversee infection control practices at their facilities, according to a new federal report. 

The new report, released Tuesday by the US Department of Health and Human Services Office of Inspector General, conducted an audit survey of 100 for-profit nursing homes nationwide to determine their compliance with federal requirements for infection preventionists (IPs). 

They found that 17 of those facilities did not meet the requirement that the IP complete specialized infection prevention and control training prior to assuming the role and seven did not comply with the requirement to designate an IP.

“On the basis of our sample results, we estimated that 2,568 for-profit nursing homes nationwide (approximately 1 in 4) may not have complied with federal requirements pertaining to IPs during our audit period,” the report found. “As a result, there may be increased health and safety risks for the residents and staff of these nursing homes.” 

Infection control experts say they were not surprised by the report’s findings. 

“I thought it would have been even higher,” said Buffy Lloyd-Krejci, DrPH, MS, CIC, LTC-CIP, an expert in infection prevention and control for nursing homes and other long-term providers. 

Lloyd-Krejci is president and founder of IPCWell, a consulting company that provides expert advice, assessment and training to nursing homes and other LTC providers in infection control practices. She said many facilities either don’t have a designated infection preventionist or the person assigned to do the job is often also asked to do other nursing tasks, which takes them away from their primary infection control duties. 

Deb Burdsall, PhD RN-BC, CIC, LTC-CIP, FAPIC, an infection preventionist consultant and a board member at-large for the Association for Professionals in Infection Control and Epidemiology (APIC), also said she was not surprised by the results, especially since many of the audit surveys for the report were done between mid-2021 and 2022, when COVID-19 was still a major impediment to normal routines.

“Staffing has always been a challenge in long-term care, and it was a real challenge during COVID-19,” she noted.

“There are many experienced and proficient long-term care nurses but that doesn’t make them a trained dedicated infection preventionist,” she added. 

‘Grateful’ for report

Lloyd-Krejci said nursing homes need to provide the necessary support and training for infection preventionist staff. 

“A lot of the infection preventionists have never done it before,” Lloyd-Krejci said. “It’s a very big job and if you don’t have the right type of support in that role, you’re not set up to succeed. They need to be well supported to carry out the functions of their job and a lot of times they’re not.”

Lloyd-Krejci said the need for dedicated and trained infection preventionists is greater than ever, given the rise in COVID-19 cases and the risks of other infectious diseases. 

Burdsall said one of the unexpected lessons that came out of COVID is that it drew greater attention to infection control in general. Before COVID, she said very few long-term care facilities had a designated infection preventionist who solely focused on infection control but that is now changing. 

“Being an infection preventionist is a profession, not a side job,” she said firmly.

The IG report says the nursing homes that were in non-compliance with the IP regulations cited a number of reasons, such as difficulty hiring and retaining experienced IPs, challenges of staff to complete the training in a timely manner due to pandemic work demands and changing regulatory requirements and difficulty accessing statewide in-person or online training. 

The report recommended that state agencies follow up with the 24 nursing homes that may not have complied with federal requirements to ensure corrective actions were taken and to share the results of the audits with the state survey agencies to encourage them to focus their oversight on verifying nursing homes designate an infection preventionist and that the IPs complete the necessary training prior to filling that position. 

“I’m grateful this report came out. It’s something we’ve been advocating for as well,” Lloyd-Krejci said. “We need infection preventionists and we need them to have a strong voice. We need to make this a priority.”

The OIG report focused only on for-profit nursing homes, and Burdsall said she would like to see another report that includes both for-profit and nonprofit nursing homes to see if there are any differences in their practices.