1236. Infection Control Risk Mitigation and Implementation of Best Practice Recommendations in Long-term Care Facilities
Session: Poster Abstract Session: Healthcare Epidemiology: Non-acute Care Settings
Friday, October 5, 2018
Room: S Poster Hall
Background: Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a quality improvement initiative supported by the NE Department of Health & Human Services. This initiative utilizes subject matter experts (SMEs) including infectious diseases physicians and certified infection preventionists (IP) to assess and improve infection prevention and control programs (IPCP) in various healthcare settings. NE ICAP conducted on-site surveys and observations of IPCP in many volunteer facilities to include long-term care facilities (LTCF) between 11/2015 and 7/2017. SMEs provided on-site coaching and made best practice recommendations (BPR) for priority implementation. Impact of this intervention on LTCF IPCP was examined.

Methods: Using a standardized questionnaire, follow-up phone calls were made with LTCF to evaluate implementation of the BPR one-year post-assessment. Descriptive analyses were performed to examine BPR implementation in LTCF that had follow-up between 4/4/17 to 4/17/18 and to identify factors that promoted or impeded BPR implementation.

Results: Overall, 45 LTCF were assessed. The top 5 IC categories requiring improvement were audit & feedback practices (28 of 45, 62%), PPE supplies at point of use (62%), IC risk assessments (58%), TB risk assessments (56%), and supply & linen storage practices (56%). Follow-up assessments were completed for 270 recommendations in 25 LTCF. Recommendations reviewed ranged from 3 to 26 per LTCF (median=15). The majority of the 270 recommendations (n=162, 60%) had been either completely (35%) or partially (25%) implemented by the time of the follow-up calls. The ICAP visit itself was reported as the most helpful resource for BPR implementation (77 of 162). Lack of staffing was the most commonly mentioned barrier to implementation when LTCF implemented BPR partially or implementation was not planned (37 of 85). BPR Implementation most frequently involved additional staff training (64 of 162), review of policies and procedures (38 of 162), and implementing audit (34 of 162) and/or feedback (23 of 162) programs.

Conclusion: Numerous IC gaps exist in LTCF. Peer-to-peer feedback and coaching by SMEs facilitated implementation of many BPR directed towards mitigating identified IC gaps.

Teresa Fitzgerald, RN, BSN, CIC1, Regina Nailon, RN, PhD2, Kate Tyner, RN, BSN, CIC1, Sue Beach, BA1, Margaret Drake, MT, ASCP, CIC3, Teresa Micheels, MSN, RN, CIC4, Mark E. Rupp, MD5, Michelle Schwedhelm, MSN, RN1, Maureen Tierney, MD, MSc6 and Muhammad Salman Ashraf, MBBS7, (1)Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, NE, (2)Nursing Research & Quality Outcomes, Nebraska Medicine, Omaha, NE, (3)Division of Epidemiology, Nebraska Department of Public Health, Lincoln, NE, (4)Infection Control and Epidemiology, Nebraska Medicine, Omaha, NE, (5)Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, 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

T. Micheels, None

M. E. Rupp, None

M. Schwedhelm, None

M. Tierney, None

M. S. Ashraf, None

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