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.

Have a column idea? See our submission guidelines here.

Given that many residents at long-term care facilities are especially vulnerable to viruses like COVID because they live in a congregate setting and often have multiple comorbidities, fears around outbreaks are very real. Happily, though, there are several practical strategies facilities can employ to reduce the risk of an outbreak and mitigate its effects should one occur.

As prevention is key, a multi-pronged approach can support your efforts. You will want to prioritize educating anyone who enters the building about the symptoms of COVID. A good way to do this is to post signs near entrances and in high-traffic areas that outline what to watch for. In addition, it is helpful to provide face masks, alcohol based-hand rub for hand hygiene and information to stay up to date with COVID-19 vaccines.

As important as it is to take precautions to lower the risk of an outbreak (defined as one positive case), it’s just as crucial to be prepared in the event one occurs. It is much harder to take the appropriate steps during an outbreak.  

The first step in preparing for an outbreak is to verify that you have an ample supply of testing kits. Ensure the tests have not expired, as that could interfere with their efficacy. Making sure you’re well-stocked with tests, will enable you to conduct rapid contact tracing as needed for anyone that has signs or symptoms of COVID.

Along with testing and taking steps to stop the spread, your facility is responsible for reporting the outbreak to your county’s health department. This can be done at the same time as contact tracing and further testing. If you need further support — more testing kits or information about the latest guidance for dealing with outbreaks, for example — your county’s epidemiologist and/or your state’s healthcare-associated infection (HAI) epidemiologist will be able to assist you.

As flu and COVID season gets underway, now is the time to ramp up your facility’s readiness for these potentially deadly diseases. Make sure you are taking appropriate steps to reduce the risk of an outbreak — including educating visitors and staff — and that you have solid processes in place to stop the spread in the event an outbreak occurs. By doing this now, you can create a positive culture of infection prevention and control (IPC) and keep your precious residents safe.  It’s crucial to have a well-defined and up-to-date infection prevention plan in place, especially in healthcare and long-term care facilities. Your infection preventionist (IP) plays a critical role in ensuring that your facility is prepared to combat outbreaks. Here are some key points to consider:

1. Regular Policy Review: It’s essential to review your facility’s written policies related to infection prevention regularly. The suggested interval of every six months is a good practice to ensure that your policies align with the latest guidance from authoritative sources like the Centers for Disease Control and Prevention (CDC). Staying updated on best practices is essential to effectively combat outbreaks.
2. Policy Alignment with CDC Guidelines: Monitor and align your facility’s policies with the most current guidance provided by the CDC or other relevant health authorities. This alignment helps ensure that your practices remain evidence-based and in accordance with industry standards.
3. Resource Assessment: It’s not just about having written policies; your facility must also have the necessary resources to implement these policies effectively. Regularly assess whether your facility has access to the required staff, equipment, and supplies to follow the policies as written. Inadequate resources can compromise infection prevention efforts.
4. Compliance with Internal Policies: Your facility must adhere to its own policies consistently. If state or federal surveyors visit your facility and find that you are not in compliance with your own established policies, it can lead to citations or regulatory issues. Regular auditing and monitoring of compliance are essential.
5. Contingency Planning: In healthcare settings, staffing and equipment shortages can occur, especially during outbreaks. Ensure that contingency plans are in place to address such scenarios. These plans can include strategies for managing shortages, reallocating resources, and maintaining essential services while minimizing the risk of infection spread.
6. Training and Education: Regular training and education for staff members are critical. The IP can coordinate educational programs to ensure that all staff are aware of and proficient in following the facility’s infection prevention policies.
7. Communication: Effective communication within the facility is key. Establish clear lines of communication so that everyone knows what to do in case of an outbreak or resource shortage. This includes reporting and escalation procedures.

As the flu and COVID-19 combined season approaches, long-term care facilities must prioritize readiness to protect their residents against these potentially deadly diseases. Implementing measures to reduce the risk of outbreaks, educating staff and visitors, and having solid outbreak response processes in place are paramount. 

By taking these proactive steps, facilities can foster a culture of infection prevention and control (IPC) and maintain the health and safety of their precious residents. In this ongoing battle against COVID-19, preparedness is the key to safeguarding the vulnerable populations within long-term care facilities.

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.

In many ways, long-term care facilities’ reluctance to prioritize IPC makes sense. After all, most facilities are focused on more pressing issues. However, this approach often means facilities lack the strong culture IPC necessary to keeping their residents and staff safe from infectious disease outbreaks.

This needs to change. Long-term care facilities must find a way to incorporate effective IPC measures while maintaining a home-like, comfortable environment for their residents. 

The good news is that these aims are not mutually exclusive. The first and most important step to achieving them: building a facility-wide culture that prioritizes educating every single staff member about the specific ways they can mitigate infection risks while performing their assigned duties.

The importance of educating the entire workforce about IPC — not just the nursing staff — cannot be overstated. For example, ancillary staff touch every aspect of residents’ care. If these specific departments don’t understand how to reduce the risk of spreading infections, you’re setting your facility up for problems. 

Take housekeepers, for example. Do they start by cleaning a resident’s restroom, and then move on to cleaning the room itself (a common practice)? If so, they are cross contaminating the environment and opening the door to infectious disease risks. Educating them about cleaning best-practices is essential. 

It’s not just environmental services staff, either. If laundry staff re-wear personal protective equipment (another common practice) while sorting soiled linen, or wash and dry microfiber cloths and mops incorrectly, they introduce the very real risk of cross-contamination. And if food service workers don’t regularly sanitize common equipment like ice machines, they may be putting residents at risk for infections such as Legionnaires disease. These are just a few examples of common practices that can increase the risk of infections; there are many more.

I know what you may be thinking: “This all makes sense, but how do we find the time and resources to train our staff in proper IPC measures?”

It’s a good question, and one we hear frequently from leadership in the facilities we work with. The answer lies in your infection preventionist (IP). If your facility receives funding from the Centers for Medicare & Medicaid Services, you are required to have at least a part-time IP onsite. If you have over 100 beds, a full-time onsite IP is recommended. In either case, your IP can monitor your staff and educate them about the specific role each of them play in preventing and controlling infections.

To be effective, your IP must be fully dedicated to their role. The reality is that, in order to do their job properly, an IP must have time to perform surveillance, audit infection rates, educate staff, monitor the antibiotic stewardship program, oversee water management, build a culture of IPC, and more. Being asked to take on additional non-IP-related responsibilities will reduce their effectiveness as an infection preventionist.

Your facility’s leadership and ownership must support them, too. Your IP might be knowledgeable and competent, but unless they have executive support and buy-in, they will struggle to create the kind of culture that is so important for resident safety and wellbeing.

As important as both things are to your IP’s success, the sheer number of duties and responsibilities they have means they must be willing and able to delegate some tasks to other staff members. For example, as we discussed earlier, ensuring that ancillary staff are engaging in appropriate IPC is a key part of reducing and controlling infections in your resident population. Auditing ancillary staff can take a lot of time. IPs can delegate the auditing practices to department supervisors, or even train the staff to audit each other.

Ultimately, for your IPC program to be effective, every member of your facility must be actively involved. When they are, the risk of cross-contamination and infectious disease outbreaks decreases. Furthermore, there is less need for transmission-based precautions, because there are less infections in the facility. As a result, staff morale is higher, there is less cost to the facility (because there’s less need for additional PPE), residents are better protected, and families are happier, too.

This aspirational scenario is eminently possible. I know, because my team and I have seen it play out time and again in facilities with a dedicated IP who has leadership support, adequate time, resources to focus on their job, and the ability and willingness to delegate various tasks. These IPs have what they need to fulfill their role, provide education to the rest of the staff, and create a strong culture focused on infection prevention and control. By following the strategies described here, you can set your facility up for similar success.

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. Dr. Buffy 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.

Have a column idea? See our submission guidelines here.

Even the language “infection prevention” was a shift from the former (still used) term of infection control. The subtle difference in these terms reflects the reactive nature of “control” and the proactive preparedness of “prevention.” While regulations began to take shape regarding the focus on IPC, the changes were designed to be enacted transitionally, in phases, to allow for facilities to adjust to the new protocols.  Facilities were slow to implement, and the Centers for Medicare & Medicaid Services delayed regulatory enforcement. 

Tragically, the global COVID-19 pandemic exposed the glaring IPC gaps, ultimately catapulting this underprepared industry into a catastrophic situation. Given the new regulatory requirements had only just begun, one would have expected the federal response to have been collaborative and supportive. However, in terms of solutions, facilities were left fighting the invisible enemy with little to no personal protective equipment, wide-ranging direction from different agencies, and increased inspection and regulatory enforcement. 

 A record number — $15 million worth — of Civil Monetary Penalties (fines) were handed down to “poor performing” facilities. For context, other healthcare settings such as hospitals had their annual regulatory surveys suspended, while in long-term care, inspections, surveys and punishment increased. This is often the federal response towards this industry. Punishment, fines, crackdowns! 

Sadly, it is often the poorest of the poor in underserved geographic locations that get hurt the most. Not only would I argue that this approach is harming, not helping, the dedicated and heroic staff trying to implement safe and effective care, but I can also easily say these measures are not the solution to safer and healthier residents. And isn’t that what matters here?

While the public health emergency has officially ended, the crisis in long-term care has not. COVID-19, despite exorbitant fines, has contributed to nearly 3 million infections and 165,000 resident and healthcare worker deaths.  So, where do we go from here? Are we going to continue throwing down the hammer on a severely crippled industry? Or can we use this dark season to advance practices including IPC? 

We must continue to ask how the safest and highest quality of care can be delivered to this vulnerable population. The understaffing, the burnout, the stress-filled environments that seize our healthcare workers is creating a chasm between providing care and the fundamental survival of the industry. When we can set up the staff for success, staff accordingly, train, educate, and support them, then everything changes, and the residents get the care and dignity they so vehemently deserve. 

A silver lining to the global pandemic is that funding has been made available for collaborative support for long-term care facilities.  The CMS Quality Improvement Networks-Quality Improvement Organizations (QIN-QIO) offer facilities remote and in-person support in navigating COVID-19 outbreaks, vaccinations, and data reporting. Many state health departments also offer in-person infection prevention and control assessments and support (see links below to contact your local supportive resources). 

We must continue to prioritize this type of engaging and collaborative support. We must also continue to prioritize the dedicated staff that are committed to staying in this wounded healthcare system. Join any long-term care Facebook group and you will see how burned out the staff are and how many hate their jobs. Many stay because they don’t believe they have any other options. I believe we can do better than this for these dedicated individuals. This is a call to all facility owners in ensuring that you first have a dedicated leadership team. Is your administrator and director of nursing mission-driven and committed to ensuring the highest quality of care is delivered to your residents? Are they committed to ensuring the staff are well supported and have the tools and resources that they need to be successful?  The tone and commitment of the leadership impacts everything else. 

I believe change is possible and I’m not naïve that it’s going to take time. However, as I see it, we can’t do business as we always have. “Cracking down” cannot be the message. It must be to build up. It is only in this way that change will be lasting and people will actually be drawn to work in long-term care instead of running from it. 

To locate your CMS QIN-QIO: https://qioprogram.org/locate-your-qin-qio 

To locate your State HAI department: https://www.cdc.gov/hai/state-based/index.html 

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. Dr. Buffy 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.

 Are we remembering that there are human beings behind every data point or statistic? Are we looking at residents and healthcare workers as “residents and healthcare workers,” or are we seeing them as our mothers, fathers, sisters, brothers, sons, daughters, our friends and our neighbors?  

I know what I see every time I’m in the field, in a nursing home, but I wanted to learn more – I wanted to put myself in the shoes of a long-term care infection preventionist (IP) – people who take on the responsibility of leading the IPC program in a facility every single day. I recently had a video conference with three IPs to get the real scoop.  

I began by asking them what a typical day looked like for them in their facility. First and foremost, they all agreed that every single day was different. The feeling though, was not one of joyous wonderment but rather one of anxious unease to never know what they were walking into. These IPs had plenty on their plate; however, they were often pulled in many different directions to put out other fires or fill in elsewhere. It was as if the role of the IP was secondary to whatever else needed to be completed, not the priority.  

This was surprising given the Centers for Medicare & Medicaid Services requirement that all CMS-certified nursing homes have at least a part-time dedicated Infection Preventionist on staff. Given the challenges the three IPs had even getting buy-in for the prioritization of their role, I wonder if this “part-time” designation is even sufficient.  

The Centers for Disease Control and Prevention recommend that a facility have “at least” one full-time infection preventionist if that facility has more than 100 residents.  The California Department of Public Health requires every facility to have a full-time IP. 

In our video conference, one full-time IP spoke of how she would only spend two of her eight hours each day completing IP work, and during the other six, she was just another clinical member of the staff. This led to her staying late to catch up with work or taking eight hours of IP work and trying to fit them into two hours. Does this sound like a sustainable situation? One even spoke of doing just enough to stay within compliance so that the facility wouldn’t get fined – because one owner repeatedly asked her, “Are you going to pay the fines?”

Never being able to catch up on infection prevention and control duties means the job is no longer about prevention – it’s about control. It means prioritizing prevention efforts is impossible, which ultimately means harms and deaths due to infections are not being mitigated. Imagine the frustration of an IP that knows infections and harm can be prevented yet is unable to dedicate time to these efforts.

We can compare it to an engineer hired to build a dam to prevent flooding yet is only allowed to haul sandbags to the shore. Given the time to properly complete the job, the flooding could be prevented in the first place. 

One of the IPs described how, when completing a chart review, she found a resident that was on an antibiotic long after the required course of treatment. The physician missed it, nurse managers missed it, her supervisor missed it. When she found it by completing her surveillance, she was appalled at this oversight. This is only one small example of how critical it is for the IP to be afforded the appropriate time to perform their job. 

Each Infection Preventionist I spoke with told specific stories of trying to play catchup, always being behind, uncertainty, and staving off burnout – or burning out. According to the National Consumer Voice for Quality Long-Term Care, nursing homes continue to experience 52% staff turnover. The reason? Studies continue to point toward high workloads, inadequate training, poor management and poor pay to name a few. 

Quoting another IP – “I was completely alone in the infection control practices…” The company was putting profit over protocol. Her building had residents that should have been on isolation precautions, including separate rooms, but was told by management that they couldn’t adhere to this until they hit their numbers with admissions. She said this was less than six months into her position, and already she was completely exhausted and burned out. Who could blame her? 

The simplest way to think about this is if we want healthy and safe residents, we need healthy and safe staff. This is not a groundbreaking stance. We need to invest in the infection preventionist. Not as secondary or for compliance only. 

If we have learned anything from the global COVID-19 pandemic, it should be the high prioritization of infection prevention measures within our long-term care facilities, including the staff to implement evidence-based measures. 

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. Dr. Buffy 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.

Any employee who is satisfied in their position is more engaged and productive. The healthcare industry is no different. This is not controversial or shocking. I am not going out on a limb when I talk about it. I am stating the obvious. 

While there are steps a company can take to improve retention, like recognition and culture, better pay and benefits will always be a stronger retainer. But in a recent American Health Care Association (AHCA) survey, 81% of nursing homes said that higher reimbursements are necessary for better pay and benefits to become reality.

“In far too many states right now the reimbursement for Medicaid is dramatically less than the actual cost of taking care of people in nursing facilities.” – Mark Parkinson, AHCA President 

As temporary relief measures such as the public health emergency (PHE) dry up, 12 states are looking to the future by enacting Medicaid add-ons that are tied to the end of the PHE. The hope from industry leaders and advocacy groups is that all 50 states revisit and adjust their Medicaid rates – not just looking at old numbers and attaching an inflation percentage to them – actually taking a close and detailed look at the cost of taking care of vulnerable residents in this setting. 

CMS has encouraged states to specifically allocate Medicaid dollars toward improving staffing, but no measures have been made mandatory. CMS has the power to enact such a measure, so why not make this required and ensure that the reimbursement goes where it is needed most? As providers and advocacy groups push for rate increases to state officials, it’s important to provide realistic solutions.

For example, I think Illinois’ blueprint for advances in funding is on the right track. Of the $700 million increase in nursing home funding approved by the state earlier this year, much is allocated toward staffing — up to $350 million in staffing incentives and $83 million for Certified Nursing Assistant (CNA) compensation and support for workforce retention, tenure, promotion and training. 

Florida added conditions to its rate increases, with a new minimum wage for all nursing center employees. They also increased Medicaid reimbursement rates by 7%, but only if they allow a public review of their financials, promoting much-needed transparency.

I cannot stress enough the importance of the need for higher reimbursements and ensuring these funds are allocated to the staff caring for this vulnerable population. Without it, the downward spiral toward ineffective care happens fast. 

If a facility is at financial risk and cannot adequately support the staff, this rapidly leads to staff turnover. Now the facility is operating under a staffing shortage (not uncommon) which leads to the development of unsustainable working conditions where the staff are unable to provide high-quality care to the residents, creating burnout and poor mental health for the staff and poor care for the residents. This leads to more shortages, bad headlines, and worsening financial situations, exacerbating the entire cycle of diminishing resident care.

Rather than looking at the issues of quality of care, healthcare worker retention, healthcare worker shortage, underfunding, resident health, etc., as individual issues, we must realize these issues are all connected in a messy, convoluted web, and they must be addressed in an organized, multi-tiered approach that looks at the system of causes and outcomes as a whole.

In order to provide the safest environment for our residents, we need to provide the best environment for the staff. To do so, we need to increase pay and benefits so employees are not severely overworked and facilities are not understaffed. 

To do this, we need reform at the level of lawmakers to not only look at the costs of what reimbursement covers but to change the way the industry must spend these reimbursements. This includes eliminating any self-dealing that may occur and establishing cost category reimbursement methods that require facilities to spend on targeted categories like staff and enacting direct care ratios, allowing specific portions of reimbursement to go directly toward the well-being of residents.

The well-being of the staff and residents is priority #1, and the only way to ensure the residents and healthcare workers are taken care of is by stepping back and seeing the bigger picture.

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. Dr. Buffy 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.

Infection prevention begins with fundamentals, and there is nothing more fundamental than hand hygiene. However, there is a lot of confusion in the industry regarding the placement of alcohol-based hand rub (ABHR) dispensers and even if they are allowed per the fire and safety regulations. 

Some facilities have them inside resident rooms, some outside, and some scattered throughout the resident hallways. Which of these options is a best practice? 

Our team has been implementing boots-on-the ground onsite visits to hundreds of nursing homes since our conception in 2017. We found that in 2021, only 30% of the nursing homes we visited had ABHR outside of the resident’s room, while 45% had it only inside of the room. This was alarming for two reasons. 

One, many nursing homes were lacking in ABHR access overall, and two, the Centers for Disease Control and Prevention (CDC) recommends that nursing homes have ABHR with 60-95% alcohol inside AND outside of every resident room if possible. 

One common explanation for not having ABHR inside and outside of the resident rooms is because it “violates the fire code”. However, per the Life Safety Code requirements, so long as there is not more than 10 gallons of ABHR fluid used within a corridor (smoke compartment) there can be ABHR dispensers outside of each resident room. ABHR dispensers located within resident rooms are not included in the 10-gallon figure as those are considered separate smoke compartments.

Studies show that when ABHR dispensers are located in areas where hand hygiene often needs to occur, like directly inside and outside of the resident rooms, hand hygiene compliance increases. Having easy access to ABHR to hard-wire this prevention practice is essential for nursing homes to decrease infections. 

I understand that implementing additional ABHR dispensers can be a costly endeavor for a facility. However, in my experience, many vendors will supply the ABHR dispensers free of charge. Consider discussing this option with your ABHR vendor today! 

Research continually demonstrates that contaminated hands are one of the easiest ways that infections are transmitted. Did you know that just washing one’s hands alone can reduce diarrhea related illnesses by 30% and respiratory infections by 20%? This in turn can reduce the amount of unnecessary antibiotic use within a facility as keep residents healthier! 

To measure hand hygiene compliance, facilities should consider conducting competency and opportunity audits on a scheduled basis. A competency audit is where a staff member, such as the infection preventionist (IP), watches another staff member, such as the Certified Nursing Assistant (CNA), perform hand hygiene. 

An opportunity audit is where the IP or other staff members evaluates if the staff member is conducting hand hygiene when it is appropriate such as before and after contact with a resident.  

Hand hygiene seems like a no brainer and a topic that many staff members tend to brush off. However, this is by far one of the most significant ways to decrease infections within nursing homes. To encourage staff members to conduct proper hand hygiene regularly, consider hosting staff in-service training sessions using the product Glo-Germ, paint, or even chocolate pudding to demonstrate how quickly germs can spread! Thank you to all the healthcare heroes out there keeping our loved ones safe! 

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. Dr. Buffy 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.