BACKGROUND: Over five million Americans are admitted to or reside in nursing homes, skilled nursing or assisted living facilities (collectively known as long-term care facilities or LTCFs). Healthcare-associated Infections (HAIs) are a major cause of hospitalization and death in these facilities. Each year in the United States an estimated 380,000 deaths in LTCFs are caused by HAIs. The Infection Control Assessment Tools (IC Tools) have been developed by CDC for awardees under the Epidemiology and Laboratory Capacity (ELC) Infection Control Assessment and Response (ICAR) Program, to assist health departments in assessing infection prevention practices and guide quality improvement activities at healthcare facilities. The objective of this study is to examine the aggregate findings obtained from on-site infection control assessments of LTCFs conducted by the Houston Health Department (HHD).
METHODS: Between March-December 2016, ten LTCF on-site assessments were conducted by the HHD via the IC Tool. The IC Tool is a fillable Word document with 74 Yes/No questions. All responses were obtained via a discussion with the person responsible for coordinating the infection prevention program (infection preventionist or IP) at the facility. The applied definition of an active infection prevention competency-based training program is in accordance with the CDC’s recommendation which includes trainings, competency validations, audits and feedbacks. Descriptive analysis was performed by ICAR Database tool v4_1.
RESULTS: Among the ten LTCFs, the mean of total staff hours per week dedicated to infection prevention activity was 21 hours (ranged from 4-40 hours/week). The mean of total licensed bed capacity in the LTCFs was 117 beds (ranged from 37-200 beds). In eight facilities, the IP had not received infection prevention and control training and in no facility was the IP certified in infection control. The number of facilities with an active competency-based training program were as follows: hand hygiene (n=5), personal protective equipment (n=4), injection safety (n=4) and environmental cleaning (n=3).
CONCLUSIONS: Although education and training of the IP are at the discretion of the hiring facility, certification in infection control is highly recommended. The Association for Professionals in Infection Control and Epidemiology recommends 40hrs per week dedicated to infection control per 150-250 beds. Further studies are needed to identify the effective number of staffing hours for the IP in LTCFs. Education on competency-based training in all areas of infection control is needed for LTCFs within Houston. In 2017, HHD will be conducting additional on-site visits to further expand the ICAR program.