Better Infection Prevention Needed in U.S. Nursing Homes: Report

Nursing homes should have full-time staffers dedicated to infection prevention, according to a letter to Congress.

A group of health specialists are warning Congress and the Biden administration that adequate nursing home infection control measures are not in place at many facilities nationwide, and outlined a series of steps that could be taken to help reduce the risk of widespread problems and protect Americans that require long-term care.

The Association for Professionals in Infection Control and Epidemiology (APIC), which is a group of nurses, doctors, and public health professionals dedicated to infection control and prevention, submitted a letter to Congress (PDF) on June 16, in advance of expected federal action on nursing home staffing requirements.

In the letter, infection experts cite multiple government reports that have documented widespread nursing home infection problems. As a result, they urge legislators to require dedicated infection prevention staffing at nursing homes, increase federal inspection funding, and initiate a national tracking system for nursing home infections.

Nursing Home Infection Risks

The letter comes amid increased scrutiny of nursing home infection control problems in the wake of the COVID-19 pandemic. During the height of the pandemic, one-third of all COVID-19 deaths were linked to nursing homes. Those death rates prompted multiple federal investigations to determine if potential nursing home neglect and understaffing contributed to widespread COVID-19 mortalities in such facilities.

In response to high COVID-19 nursing home death rates, a 2021 Senate bill sought to bolster nursing home staffing and infection control. The bill cited data linking nursing home infectious disease outbreaks to long term cognitive decline in residents.   To reduce the impact of infection outbreaks on nursing homes residents, the bill introduced measures addressing many chronic nursing home issues such as low pay, high staff turnover rates, and understaffing, all of which are well known to increase nursing home neglect.

The APIC letter points to multiple government studies on nursing home infections, which found high contagion rates and evidence of substandard care. One study concluded that from 2013 to 2017, 82% of all inspected nursing homes had an infection prevention and control deficiency. Another study concluded that many nursing homes, especially those privately owned, consistently provide inadequate care, leading to avoidable resident harm.

The letter lays out several suggestions to improve nursing home contagion management. Chief among them is at least one required full time infection preventionist on staff, dedicated to infection prevention as their sole function. Current requirements dictate at least one staff member designated for infection prevention, meaning infection management is not their only duty.

Other recommendations in the letter include:

• Increased funding for The Centers for Medicare & Medicaid Services (CMS) Surveyor workforce, which handles nursing home inspections, and improved infection identification training for inspectors. Current CMS surveyors lack expertise in infection prevention and control (IPC), states the letter.

• Comprehensive surveys to inform consumers of which long-term care facilities are meeting requirements set forth by CMS.

• National infection tracking systems for nursing homes.

The letter states that the CDC’s healthcare associated infection (HAI) tracking system, the National Healthcare Safety Network (NHSN), currently requires infection surveillance in hospitals but not nursing homes. To adequately prevent and control infections impacting senior Americans, nursing facilities must be required to track, monitor, and address contagions as thoroughly as hospitals, the APIC letter states.

In an APIC press release, infection experts stressed the urgency of improved infection management in nursing homes. They also urged Congress and the Biden Administration to enact similar contagion prevention measures for senior nursing home residents already in place in many other types of healthcare facilities.

“The lack of infection prevention and control staffing, infrastructure, and surveillance in nursing homes is astounding, and the time for change is long overdue. How many more seniors must die before we act?” said APIC CEO, Devin Jopp, EdD. “We urge the Biden Administration and Congress to ensure that residents of these facilities receive at least the level of protection from deadly infections as they would in the hospital.”