Ensuring Better Care, Safety, & Compliance with Infection Control in Nursing Homes

The CDC estimates that on any given day, 1 in 31 hospital patients and 1 in 43 nursing home residents has a healthcare-associated infection (HAIs). The importance of infection control in nursing homes where residents are among the most vulnerable to infections due to age, underlying medical conditions, or both, can’t be overstated. Infection control in nursing homes involves a comprehensive approach that includes proper staffing, facility design, resource management, and the education of both staff and residents. 

Addressing the challenges nursing homes face in implementing infection prevention and control (IPC) measures requires a multifaceted approach. Leveraging an infection control audit tool for nursing homes, adhering to CDC infection control guidelines, and fostering a culture of safety and awareness among all stakeholders form part of the process of implementing IPC measures. 

This blog will help nursing homes bridge the gap between best practices and everyday operations, ensuring patient safety and regulatory compliance.

What are HAIs & How Do These Infections Spread?

Healthcare-associated infections (HAIs) are infections that patients may acquire while receiving treatment for other conditions within a healthcare facility. These infections can range from mild to severe, potentially leading to serious illness or even death. 

There are several common types of HAIs, which are often associated with medical or surgical procedures and the use of medical devices. These include:

• Central line-associated bloodstream infections (CLABSIs)
• Surgical site infections (SSIs)
• Catheter-associated urinary tract infections (CAUTIs)
• Ventilator-associated pneumonia (VAP)

HAIs can be caused by a wide range of pathogens, including bacteria, viruses, and fungi. It is estimated that 1 to 3 million serious infections occur every year in nursing homes, skilled nursing facilities, and assisted living facilities. 

So, how do these infections spread? 

Three key elements form part of the process through which an infection occurs. These include the following:

• Source: These can be viruses, bacteria, or other microorganisms. In nursing homes, common sources of infection include residents, healthcare workers, visitors, and the environment itself.
• Susceptible person: Not everyone who encounters germs will develop an infection. Residents with weakened immune systems due to age, underlying medical conditions, or recent surgeries are more susceptible to infections. For an infection to occur, germs must enter a susceptible person’s body and invade tissues, multiply, and cause a reaction.
• Transmission: It refers to the way germs move to susceptible people. Once a germ finds a suitable host, it requires a mode of transmission to spread and infect others. Common transmission routes in nursing homes include:
  • Direct contact
  • Indirect contact
  • Airborne transmission
  • Bloodborne transmission

Challenges Facing Nursing Homes in Infection Prevention and Control

Infection prevention and control in nursing homes present a set of unique and complex challenges. These facilities house some of the most vulnerable populations, including older adults and individuals with chronic medical conditions, making effective infection control critical for their safety. The US alone has over 1.5 million residents in 16,000 nursing homes, with these facilities experiencing around 2 million infections annually, leading to significant health implications and healthcare costs.

First, nursing homes often grapple with staffing issues. Adequate staffing is essential for infection control, yet many facilities experience shortages that strain their capacity to implement effective prevention measures. Staff training on infection control protocols is crucial, but the turnover rate and lack of specialized training can hinder the consistent application of these practices. During the COVID-19 pandemic, these staffing challenges were exacerbated, with facilities struggling to maintain operations in the face of increased demand and heightened infection risks.

Second, the physical layout of many nursing homes poses another significant challenge. The design and infrastructure of these facilities sometimes make it difficult to isolate infectious residents, manage airflow, and ensure proper sanitation. Shared rooms and common areas can facilitate the spread of pathogens. 

Resource limitations are other critical issues. Essential supplies like personal protective equipment (PPE), hand hygiene products, and cleaning agents must be readily available to implement effective IPC measures. However, budget constraints can restrict the procurement of these necessary resources, leaving facilities ill-equipped to manage infection risks adequately.

Audit Tool for Infection Control in Nursing Homes

Adhering to the CDC infection control guidelines can be a complex challenge. Infection control procedures may not be standardized or consistently applied by all staff members across all shifts. Paper checklists are cumbersome and error-prone, and manual data entry is time-consuming, making it difficult to identify trends and proactively address potential problems. Implementing digital audits on a user-friendly mobile app can help you solve several of these challenges.

Here’s how GoAudits audit and compliance software can help streamline infection prevention and control in nursing homes, long-term care and home health settings:

• It allows your staff to conduct inspections and document findings directly on their mobile devices. 
• Track corrective actions, making sure that issues are flagged and acted upon swiftly. Assign tasks to specific staff members, and set automated reminders for follow-up actions. 
• Analyze audit data to identify trends and areas for improvement. See which protocols are consistently followed, and quickly pinpoint any weaknesses in your IPC program.
• Make your ICP audits part of an integrated internal audits and care quality program, managed efficiently and digitally on an integrated platform. 

With GoAudits, you can:

• Close the gap between best practices and everyday actions, for a proactive and consistent adherence to CDC infection control guidelines.
• Enable your staff to spend less time on paperwork and more time on resident care; free up valuable time for the human interactions that truly matter.
• Conduct regular audits with clear documentation to demonstrate your commitment to resident safety and help you meet all regulatory requirements.

CDC Infection Control Checklists

GoAudits helps you simplify audits with an extensive library of pre-built healthcare checklists. You can even create your own checklist or let us do that for you – at no cost. 

Terminal Cleaning Checklist 

It is a CDC infection control checklist designed to help you deep clean patient rooms between occupants. This CDC infection control assessment tool aligns with the CDC infection control guidelines for minimizing infection risks in hospitals. It helps you ensure thorough cleaning procedures to maintain a safe environment for patients.

Infection Control Audit Template – General

This infection control checklist helps healthcare settings ensure hygiene and infection control, ensuring a safe environment for both patients and healthcare workers. It covers various areas including hand hygiene, clean utility supply, patient rooms, kitchen areas, and employee knowledge. 

Infection Control Inspection Checklist

This infection checklist is designed for regular infection control inspections in care facilities, including areas like bathrooms and sluice rooms. It covers various aspects, including the organization of compliance structures, records of health and safety meetings, infection control policies, cleanliness of clinical rooms and equipment, maintenance of bathrooms, and the cleanliness and proper management of sluice rooms. 

Infection Control Audit Template

This checklist focuses on preventing injuries and infections from blood/body fluids, sharps, bites, and splashes. It covers areas, including staff awareness and training, reporting of incidents, Hepatitis B immunization advice, and standards for sharps disposal. 

Here are some checklists nursing homes can use to improve the quality of care and patient satisfaction:

• Nursing Audit
• Hand Hygiene Audit Checklist
• Medication Audit Checklist
• Staff Training and Development Audit

What are CDC’s 2-Tier Precautions for Infection Control in Nursing Homes?

To safeguard the health of individuals in nursing homes and other healthcare settings, the CDC has established a comprehensive, two-tiered approach to infection prevention and control. This system is designed to mitigate the spread of infections through the implementation of Standard Precautions and Transmission-Based Precautions, addressing both general and specific risks of infection transmission.

Standard Precautions for All Patient Care involve a set of infection control measures applied to all patients, regardless of their diagnosis or presumed infection status. These precautions include common practices and the use of PPEs to protect healthcare providers from infection and prevent the spread of infection from patient to patient.

Transmission-based precautions (TBPs) are additional infection control measures applied to patients known or suspected to be infected with certain pathogens that require measures beyond standard precautions to prevent their spread. These precautions are categorized into three types based on the mode of transmission of the infectious agent: Contact, Droplet, and Airborne. For example, Airborne Precautions are necessary for diseases that are spread through airborne transmission, like tuberculosis or measles, and include measures such as placing patients in an Airborne Infection Isolation Room (AIIR) and using appropriate PPE like N95 respirators for healthcare personnel​​.

CDC Infection Control Guidelines for Safe Healthcare Delivery

The CDC’s core infection prevention and control practices are selected from existing CDC recommendations and represent fundamental standards of care that are not subject to frequent alterations. Let’s explore the essential aspects of these infection prevention and control practices.

1. Leadership Support

Successful infection prevention programs require unwavering support from all levels of the healthcare facility’s leadership. This includes allocating sufficient human and material resources to promptly address and mitigate infection risks, preventing their transmission. Empowering qualified individuals with expertise in infection prevention and control to manage the facility’s program is crucial to ensuring its effectiveness and adherence to evidence-based guidelines.

2. Education and Training of Healthcare Personnel

Equipping healthcare personnel with comprehensive infection prevention education and training is indispensable. Job-specific training should be provided before individuals commence their duties and refreshed annually to reinforce knowledge and address any lapses in adherence. Regular training sessions also enable healthcare personnel to stay abreast of newly recognized infection transmission threats and adapt their practices accordingly.

3. Patient, Family, and Caregiver Education

Empowering patients, their families, and caregivers with appropriate infection prevention knowledge is equally important. By providing clear and accessible information about infection transmission, prevention methods, and signs or symptoms that warrant reevaluation, healthcare facilities can foster a collaborative approach to infection control. Instructional materials and delivery methods should be tailored to accommodate varied levels of education, language comprehension, and cultural diversity.

4. Performance Monitoring and Feedback

Continuous monitoring of adherence to infection prevention practices and infection control requirements is essential. Prompt feedback on adherence and related outcomes to healthcare personnel and facility leadership enables timely adjustments and improvements. Training performance monitoring personnel and employing standardized tools and definitions ensure consistent and accurate assessments.

5. Standard Precautions

Standard precautions are applicable to all patient care settings regardless of the patient’s suspected or confirmed infectious state. These practices include hand hygiene, environmental cleaning and disinfection, injection and medication safety, risk assessment with appropriate PPE, minimizing potential exposures, and reprocessing of reusable medical equipment. By adhering to these fundamental measures, healthcare facilities can effectively prevent the transmission of infections between patients, healthcare personnel, and the environment.

What is the Role of the International Infection Control Branch (IICB) in Infection Control?

The International Infection Control Branch (IICB) plays a crucial role in global infection control efforts, focusing on safeguarding both patients and healthcare personnel worldwide, particularly in regions with lower economic resources. The core activities of the IICB revolve around developing and promoting infection prevention and control standards and practices that are critical for the safe delivery of healthcare services​​.

In addition to policy development, the IICB is instrumental in strengthening surveillance and prevention networks. This includes linking HAI and AR surveillance programs within national, regional, and global frameworks, facilitating a collaborative approach to understanding and mitigating the spread of infectious diseases​​.

The IICB also plays a crucial role in preparing for and responding to healthcare-associated outbreaks. Moreover, through the development of training materials, the IICB enables healthcare personnel with the knowledge and skills necessary to implement effective IPC measures and improve healthcare safety overall​​​​.

Are you ready to take the next step toward infection prevention and control? With GoAudits healthcare inspection software, nursing homes can ensure every protocol, every inspection, and every action aligns with CDC infection control guidelines. Eventually, nursing homes can improve their infection control processes and their staff to focus on what truly matters—caring for patients.