BACKGROUND: Over 4 million Americans are admitted to or reside in nursing homes each year. It is estimated that 380,000 people die of infections in LTCFs every year and up to 75% of antibiotics in this setting are prescribed incorrectly. These statistics demonstrate the need to improve infection control infrastructure in these facilities. The South Carolina Department of Health and Environmental Control (DHEC) sought to determine the status of infection control and antibiotic stewardship practices in Nursing Homes.
METHODS: DHEC designed a survey to evaluate the status of infection control and antibiotic stewardship policies and practices in Nursing Homes. DHEC collaborated with the Carolinas Center for Medical Excellence (CCME), the state’s quality improvement organization, to distribute the survey. CCME enrolled 130 Nursing Homes (NH) into the Action Collaborative for Excellence (ACE). DHEC attended 3 ACE learning sessions across the state where a total of 54 NHs were present; 50 facilities completed the survey (93%).
RESULTS: The majority of NHs (74%) didn’t have a dedicated infection preventionist (IP), with 30% of NHs identifying the Assistant Director of Nursing (ADON) and 22% identifying the DON as the person responsible for infection control activities. Ninety-four percent of NHs reported that they have evidence-based infection control policies and procedures available for staff. All facilities had provided training on hand hygiene in the last 12 months, but only 66% provided training on infection surveillance and 26% on antibiotic stewardship. NHs reported that they always receive information from a transferring facility about a patient’s infection status 22% of the time, often receive information 38% of the time and sometimes receive information 38% of the time. Only 24% of facilities reported following the updated McGeer criteria for surveillance definitions; 22% of NHs said they often prescribe antibiotics for asymptomatic bacteriuria and 46% said they sometimes prescribe. Only forty-eight percent of NHs reported having a leader for antibiotic stewardship activities.
CONCLUSIONS: LTCFs struggle to keep a consistent, qualified person to oversee the infection control program. This is problematic as LTCFs admit sicker residents in higher numbers than in the past. Facilities can enhance their ICP by sending a delegate to a formal IP training program where they can ascertain skills, tools and resources to establish and continually improve their infection control program. DHEC used these results to target facilities for participation in the consultative Infection Control and Response visits.