KHN: Nursing Homes Struggling With 'Basic Infection Prevention Protocols'

A Kaiser Health News (KHN) report highlights the struggles of many nursing homes around the country — including some that have received the highest government rating for overall quality — with following "basic infection prevention protocols."

A KHN federal records analysis revealed that more than 9,000 nursing homes — or about 61% of all such facilities — were cited for one or more infection-control deficiencies.

Furthermore, the analysis showed that since the beginning of 2017, government health inspectors cited more nursing homes for failing to ensure workers follow infection prevention and control rules than any other type of violation. KHN notes that inspection reports indicate many of the infection prevention and control errors cited are attributable to lapses in following fundamental best practices, such as workers not washing their hands as they move between patients and failing to don masks, gloves and gowns when in rooms with isolated, contagious patients. Violations were also more common at homes employing fewer nurses and aides than those with higher staffing levels.

Patricia Hunter of the Washington State Long-Term Care Ombudsman Program, which advocates for residents of nursing homes, adult family homes and assisted-living facilities, told KHN, "It's all these little things that are part of infection-control practices that when they are added up can create an environment for an infection outbreak."

Of those nursing homes with the maximum government overall quality rating (five stars), KHN noted that 4 in 10 have been cited for an infection-control lapse. This includes the Life Care Center in Kirkland, Wash., where several residents have succumbed to the coronavirus. One publication has described the nursing home as the "national epicenter of coronavirus."

Unfortunately, nursing homes are likely to continue struggling with infection prevention and control. As KHN notes, these facilities are challenged by frequent staff turnover, new workers less likely to know facility protocols, keeping potentially infected workers at home (in part due to low pay and limited time-off benefits) and finding replacement staff.

On Wednesday, March 4, the Centers for Medicare & Medicaid Services (CMS) announced several actions it hopes will limit the spread of COVID-19. These include the following:

• Issuing a call to action to healthcare providers nationwide to ensure they are implementing and maintaining infection control procedures.

• Directing state survey agencies and accrediting organizations to focus facility inspections exclusively on issues related to infection control and other serious health and safety threats, beginning with nursing homes and hospitals.

• Outlining a survey regime that focuses on infection control and other emergent issues, including COVID-19.

CMS Administrator Seema Verma stated,. “All healthcare providers must immediately review their procedures to ensure compliance with CMS’ infection control requirements, as well as the guidelines from the Centers for Disease Control and Prevention (CDC).” 

WHO: PPE Shortage Could Increase Health Worker Risk From COVID-19

The World Health Organization (WHO) is warning of increased risk for health workers of exposure to COVID-19 and other infectious diseases due to the growing shortage of personal protective equipment (PPE).

As WHO notes, disruption to the global supply of PPE has been caused by "rising demand, panic buying, hoarding and misuse" of PPE, including medical masks, respirators, gloves, gowns and aprons. As a result, health workers are increasingly finding themselves ill-equipped to care for patients, including those with or believed to have the new coronavirus.

WHO is calling on industry to increase manufacturing of PPE by 40% and governments to incentivize such production, including easing restrictions on export and distribution of medical supplies.

"We can't stop COVID-19 without protecting health workers first," said WHO Director-General Dr. Tedros Adhanom Ghebreyesus.

Infection Prevention Tip: Whether to Allow Staff to Launder Scrubs At Home

The Infection Control Consulting Services (ICCS) team has been asked on multiple occasions whether organizations should allow staff members to take their scrubs home and wash them. To answer this question, we think it's best to look to the guidelines from the Association of periOperative Registered Nurses (AORN).

To summarize, AORN recommends that after each daily use, scrub attire should be laundered at a healthcare-accredited laundry facility, by the organizations themselves and following state regulatory requirements, or by the organizations themselves and following Centers for Disease Control and Prevention (CDC) guidelines if no state requirements exist.

AORN also includes guidance about how staff should launder scrubs at home if an organization goes that route. These guidelines are available to current AORN members.

ICCS recommends organizations query their accreditation agency about standards concerning scrub laundering and try to determine whether their state's department of health makes scrub laundering an area of focus.

With all of that said, ICCS is not in favor of home-laundered scrubs. Among the reasons why: How will the organization control the laundering? Who will monitor the process in individual homes? Organizations must ultimately decide whether to permit home-laundered scrubs and develop a policy that reflects their decision.