First came the federal requirement that every nursing home must have an infection control preventionist on staff. Now, a government watchdog says that minimum training requirements should be established for those vital clinicians — and nursing homes’ primary regulatory agency agrees.
The Government Accountability Office made three recommendations to the Centers for Medicare & Medicaid Services Wednesday to improve infection control practices in nursing homes. CMS agreed on the IP training but was less enthusiastic about two other suggestions.
In a larger report on the physical and mental health of nursing home residents during the pandemic, one of the GAO’s main takeaways was that infection control needed to improve, including adding specific standards for the recently mandated infection preventionist position.
CMS agreed with that but only said it would “consider” a recommendation to collect infection preventionist staffing data in order to determine whether current staffing requirements are sufficient.
The agency asked that GAO outright to withdraw its third recommendation: that CMS provide additional guidance in the State Operations Manual on making scope and severity determinations for infection prevention and control-related deficiencies.
Staffing concerns
Any change in training or role definition could be critical, noted Amy Stewart, vice president of education and certification strategy for the American Association of Post-Acute Care Nursing.
Despite recent updates to the infection preventionist regulations, many facilities still struggle to understand the expectation and understand who can serve in that role, Stewart told McKnight’s Long-Term Care News Wednesday. She said it’s important to look at a provider’s assessment data to better understand the unique infection prevention and control needs of each facility.
The GAO is not making any suggestions for staffing in the report, emphasized John Dicken, GAO Director of Health Care for Public Health & Private Markets.
“The GAO report does not recommend specific staffing requirements, but further information on the level of staffing for this role in nursing homes could help inform considerations of whether that staffing is sufficient and how it could vary among homes with different facility, resident and staff characteristics,” he told McKnight’s Long-Term Care News.
Who’s an infection control specialist?
The requirements for the infection preventionist say the person must be employed at the facility at least part-time. In addition, one or more individuals may carry out the role.
“It could be added to another person’s job responsibilities. However, facility leaders need to ensure that the person taking on this role has adequate time to do the tasks necessary,” Stewart said. “I’ve seen several instances where the DNS or DON is given the job.
“It may be possible if the facility has a low census that allows for this individual to focus time and efforts on infection prevention and control tasks,” she added. “If the facility has a high census, or high volume of infections that require tracking and a plan to lower that trend through infection control education, then the DNS may not have ample time in his or her schedule to do this.”
For this reason, Stewart said facilities will benefit from having more than one person trained in infection prevention and control. She noted that CMS offers free infection preventionist training online.
An American Health Care Association/National Center for Assisted Living Infection Prevention Control Officer training course has specially trained thousands of individuals to effectively implement and manage an infection prevention and control program in their respective centers. The group said in an email to McKnight’s that it “will continue to advocate for meaningful resources and policies that benefit the safety and wellbeing of our residents.”
The Association for Professionals in Infection Control and Epidemiology applauded the GAO for its e recommendations in an emailed statement to McKnight’s.
“Too often this role is understaffed or filled inappropriately by someone expected to serve as the infection preventionist and as a full-time staff nurse with other major responsibilities. More than one-half of infection preventionists in nursing homes do not have specialized training and less than 10% are certified. The COVID-19 pandemic showed us the result of treating long-term care residents like second-class citizens when it comes to risk of infectious diseases. It’s time we put expectations for patient care in long-term care on par with hospitals.”
Overall worsening of health
The report was part of a CARES Act mandate that GAO monitor the federal pandemic response. GAO reviewed documents from CMS and the Centers for Disease Control and Prevention, analyzed CMS resident health data from 2018 through 2021. It also interviewed CMS, CDC, state survey agency, and nursing home officials from eight states chosen for variation in factors such as geographic location.
More generally, the GAO analysis of CMS data reported by nursing homes indicated that seven of the eight key indicators of patient mental and physical health declined at least slightly in 2020, the first year of the pandemic, compared to the years prior.
“I am not surprised by the worsening of depression and weight loss during the pandemic,” said Stewart. “Many residents suffered from social isolation due to the restrictions the pandemic imposed. Fear of spreading COVID-19 to vulnerable residents led to visitor restrictions that were beyond the control of facility leaders.”
