413. Infection Control in Long-Term Care Facilities: Frequently Identified Gaps in Infrastructure, Surveillance and Safety
Session: Poster Abstract Session: HAI Non-Acute Care
Thursday, October 5, 2017
Room: Poster Hall CD
  • Fitzgerald IDWeek IP gaps in LTC.pdf (517.1 kB)
  • Background: The Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a CDC funded project.  ICAP team works in collaboration with NE Department of Health and Human Services to assess and improve infection prevention and control programs (IPCP) throughout the state. One of the areas of focus is to better prepare long-term care facilities (LTCF) to recognize and prevent outbreaks. Hence, we decided to study the frequency of practice gaps related to infection control infrastructure (ICI), surveillance and disease reporting (SDR), and health care personnel and resident safety (HRS) in LTCF.

    Methods: NE ICAP conducted on-site surveys in 30 LTCF to assess the IPCP using the CDC Infection Control Assessment Tool for LTCF that has 6 questions on ICI, 7 on SDR and 13 on HRS, representing 26 best practice recommendations (BPR). Gap frequencies were calculated for each BPR and factors studied for associations included LTCF bed size (BS), hospital affiliation (HA), presence of infection preventionist (IP), and weekly hours (WH) per 100 beds spent by IP on IPCP. Fisher’s exact test and Mann Whitney test were used for statistical analyses.

    Results: Only 4 (13%) LTCF reported all 26 BPR in place. LTCF that reported >80% BPR in place (n=17) compared to those with < 80% BPR in place (n=13) appeared more likely to have HA (35.2% vs. 7.6%), have higher median BS, (64 vs. 58), and IP WH/100 beds (8.51 vs. 3.52), along with increased likelihood of having a trained IP (76.4% vs. 38.5%). However, differences were not statistically significant (p values 0.10, 0.48, 0.11, and 0.06 respectively). There were 12 gaps that were present in at least 20% LTCF (Figure 1). When analyzing each of them separately, it was found that LTCF who had trained IP (n=18) compared to those who did not (n=12) were more likely to provide competency based training to their staff for managing blood borne pathogen exposure at the time of initial hire (94.4% vs. 58.3%, p=0.03) and annually (83.3% vs. 41.7%, p=0.04).

    Conclusion: Several IC gaps exist in LTCF that can be barriers for outbreak recognition and prevention. Absence of a trained IP was found to be a risk factor although larger scale studies will be needed to validate this finding. One mitigation strategy is to develop a LTCF IP training program incorporating gap findings.

    Teresa Fitzgerald, RN, BSN, CIC1, Regina Nailon, PhD, RN2, Kate Tyner, RN, BSN, CIC1, Sue Beach, BA1, Margaret Drake, MT, ASCP, CIC1, Elizabeth Lyden, MS3, Mark E. Rupp, MD4, Michelle Schwedhelm, MSN, RN5, Maureen Tierney, MD, MSc6 and Muhammad Salman Ashraf, MBBS7, (1)Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, NE, (2)ICAP, Nebraska Infection Control Assessment and Promotion Program/Nebraska Medicine, Omaha, NE, (3)Epidemiology, University of Nebraska Medical Center, Omaha, NE, (4)Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, (5)Infection Control & Epidemiology, Nebraska Medicine, Omaha, NE, (6)Public Health, Nebraska Department of Health and Human Services, Lincoln, NE, (7)Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE


    T. Fitzgerald, None

    R. Nailon, None

    K. Tyner, None

    S. Beach, None

    M. Drake, None

    E. Lyden, None

    M. E. Rupp, None

    M. Schwedhelm, None

    M. Tierney, None

    M. S. Ashraf, None

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