Many of nursing homes’ infection prevention and control weaknesses initially exposed by the COVID-19 pandemic still demand additional support and resources, researchers warn in a new JAMDA study.
The investigation analyzed survey data from approximately one-third of all US nursing homes — and in-depth interviews from a subgroup of facility leaders.
The results indicated a need for more clinical guidelines and public policies designed to bolster providers’ limited resources — including ensuring that nursing homes have enough funding to address IPC concerns, study authors said.
“[Nursing home] leaders continue to struggle delivering quality IPC care post-pandemic and require focused support in several areas,” they explained. “Clinical practice guidelines should include IPC practices to prevent the infection and spread of any COVID-19 variant in this endemic phase. Policies should support continued reporting of IPC related metrics and adequate funding to account for the long-term financial burden NHs face.”
Policymakers should adopt a holistic approach to supporting providers in these areas, according to lead author Liza Behrens, PhD, Assistant Professor at Penn State Ross and Carol Nese College of Nursing.
“They [policymakers] are cherry picking resources to support according to best practice guidelines. In doing this we are trading off quality care outcomes such as resident quality of life,” Behrens told McKnight’s Tuesday — noting that additional funding would be a significant step for improving IPC outcomes in nursing homes.
A major part of the struggle for providers is the ongoing staffing shortage — since IPC measures can be labor-intensive and time-consuming.
The researchers noted the significance of these challenges, both in terms of the time and money required from providers.
“Alongside vaccinations, early identification of infections is crucial for effective IPC,” they wrote. “While early identification is important in preventing the spread of infections, point-of-care testing has financial and staffing implications.”
Staffing was far from the only challenge the researchers turned up, however.
Vaccine hesitancy among both staff and residents contributed to high infection rates. Also, while most nursing homes now have access to testing supplies, supply chain issues persist — forcing some providers to purchase in greater bulk than they require and subsequently waste supplies.
The study also ran into a lack of quantitative data about trained infection control nurses and other care staff vital to IPC. This was a major limitation that should be addressed and further studies, Behrens told McKnight’s.
The researchers identified a broad array of policy interventions that could help alleviate provider challenges.
“Policies should ensure ongoing preparedness and oversight that supports NHs organizational readiness to deal with future pandemics,” study authors explained. “This includes support for facility renovations, education and IPC resources such as PPE supplies, testing kits, vaccinations, and other supplies. Additionally, there’s a need for innovative approaches to recruit and support the NH workforce.”
Many of these methods are being tried across the country, such as efforts to build new worker pipelines, increase staff retention through innovative career paths, and incentivize providers to build or renovate their facilities using “household” models, with private room layouts that are less susceptible to the spread of infections.
These programs, however, are often conducted on a small scale and in ways that may not be replicable across state lines.
The researchers also noted that providers should better manage their supply chains — as logistical issues forced many providers to pay a premium for the PPE supplies they needed to meet government requirements during the pandemic.
