Background: There is a paucity of data on infection control (IC) gaps related to environmental cleaning and disinfection (ECD) in long-term care facilities (LTCF). Hence, we studied the gap frequencies (GF) related to ECD in LTCF.
Methods: The Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) in collaboration with NE Department of Health and Human Services conducted on-site inspections to assess infection prevention and control programs (IPCP) in 30 LTCF from 11/2015 to 3/2017. The CDC Infection Control Assessment tool for LTCF was used for on-site interviews. When possible, observations of ECD practices of environmental services staff (EVSS) were made using the Centers for Medicare and Medicaid (CMS) Hospital IC Worksheet. GF were calculated for each question (10 on CDC tool and 18 on CMS worksheet) representing best practice recommendations (BPR). The Fishers exact and Mann Whitney tests were used for statistical analyses examining associations of gaps with bed size, hospital affiliation (HA), having trained infection preventionists (IP), and IP weekly hours (WH)/100 beds for IPCP.
Results: GF identified during interviews are displayed in Figure 1. LTCF with at least 6 out of 10 BPR in place (n=12), as compared to those with <6, had higher median IP WH/100 beds but the difference did not reach statistical significance (9.06 vs. 3.25, p=0.054). Upon analyzing gaps individually, it was found that LTCF with policies on cleaning and disinfection (C&D) of high-touch surfaces in common areas had higher median IP WH/100 beds than others (8.5 vs. 2.5, p <0.05). A similar association was noted when examining presence of job specific training and competency validation on C&D procedures at time of hire (8.4 vs. 2.4, p<0.05). HA and having trained IP were also associated with a lower likelihood of the presence of one gap each. Upon analyzing actual practices of EVSS we found that most (n=16) of the 18 BPR on the CMS worksheet were being followed in over 80% of LTCF.
Conclusion: EVSS in LTCF in NE appears to be performing well in ECD. However, gaps related to BPR dealing with ECD policies and procedures still exist, which can be a threat to continuity of a good ECD program. Providing training and more dedicated time to IP towards IPCP may help mitigate some of the gaps.
S. Beach, None
M. Drake, None
T. Fitzgerald, None
E. Lyden, None
M. E. Rupp, None
M. Schwedhelm, None
M. Tierney, None
M. S. Ashraf, None