Nursing homes face a critical challenge: protecting their residents from infections. This is a serious issue, as these facilities house individuals who are particularly vulnerable, whether they're there for a short stay post-hospitalization or as long-term residents. The threat of infections, from antibiotic-resistant bacteria to common viruses like the flu and COVID-19, can have devastating consequences for these patients.
Infections spread rapidly in close-knit communities, and nursing homes are no exception. However, a new guideline, backed by five major national professional societies and published in Infection Control & Hospital Epidemiology, offers a glimmer of hope. It outlines key steps that nursing homes can take to safeguard their residents.
The guidance emphasizes the need for dedicated infection prevention staff at every nursing home. This is a crucial step, as it ensures that infection prevention is not just an add-on to someone's existing role but a full-time focus. Larger homes are advised to have multiple staff dedicated to this task, given the complexity and scale of the challenge.
The guidance also highlights the importance of training and vaccinating clinical staff, as well as protecting and supporting them in their daily work. It calls for stronger partnerships between nursing homes, hospitals, and public health agencies, and for the involvement of non-clinical staff in infection prevention efforts. This holistic approach recognizes that infection control is everyone's responsibility.
But here's where it gets controversial: the guidance also addresses the delicate balance between maintaining the 'home' environment and preventing social isolation, while also controlling infections. It suggests allowing visitors and social activities even during outbreaks, with appropriate precautions in place. This is a fine line to tread, as social interaction is vital for residents' well-being, but so is infection control.
The guidance also tackles the presence of medical supplies in patients' rooms, a potential source of infection. It recommends a careful moderation of these supplies to minimize risk.
Lona Mody, M.D., M.Sc., who led the writing of this guideline, brings a wealth of experience. She has dedicated over two decades to studying infection transmission and prevention in nursing homes, both as a geriatrician and a professor. Her expertise is invaluable in developing effective strategies.
Mody emphasizes the complexity of infection prevention in nursing homes, stating, "There's no single magic bullet... all our interventions are multicomponent." She highlights the need for a comprehensive approach, one that considers the unique challenges of this sector.
The COVID-19 pandemic has brought these challenges into sharp focus, and Mody believes it's time for a paradigm shift: "We can't just discharge hospital patients to nursing homes thinking everything will be fine – they need protection there too."
Her co-author, Suzanne F. Bradley, M.D., a professor emerita and infectious disease physician, notes the evolution of the nursing home industry since the last guidance of this kind in 2008. She points out that residents now arrive sicker and require more complex care, making infection prevention even more critical.
Bradley adds, "We hope that this new guidance will provide an updated, evidence-based discussion of major issues, and help infection control practitioners choose and prioritize effective interventions."
The guidance also addresses the issue of staff training and education. With a high turnover rate in nursing homes, it's essential to ensure that clinical staff are properly trained in infection prevention practices. This includes everything from proper cleaning techniques to wearing protective gear when dealing with multidrug-resistant organisms (MDROs) or 'superbugs.'
The authors emphasize the importance of vaccination and making it easily accessible for staff, patients, and visitors. They also stress the need for staff to stay home when sick, recognizing the potential conflict between duty and financial need.
Mody's research on MDROs has informed this guidance. Her team found that these organisms often travel with patients from hospitals to nursing homes and can spread beyond patient rooms to shared areas like gyms and dining rooms. Treating infections caused by MDROs is challenging, and prevention requires a multi-pronged approach, including education, protective gear, and diligent practice of core infection prevention practices by all.
The rise in short-stay post-hospital nursing home care has coincided with the increase in MDROs, making this an urgent issue. The new guidance provides information on testing, treating, and managing MDROs, as well as the careful use of antibiotics to prevent bacterial resistance.
The guidance also emphasizes the importance of nursing homes connecting with and partnering with local hospitals and public health agencies. Mody believes that seeing nursing homes as a vital part of the healthcare ecosystem is crucial, especially in light of the COVID-19 pandemic.
Within nursing homes, the guidance calls for infection prevention to be integrated into the roles of facilities staff, custodial staff, and even information technology staff, who can aid infection control staff with data analysis.
Patients and their loved ones also have a role to play. Mody and Bradley encourage residents and family members to speak up about their concerns, take daily steps to clean hands and cover coughs, and report symptoms promptly. They also recommend asking about the precautions nursing homes take to protect residents and visitors, including vaccination.
The authors hope that regulators and healthcare quality reporting organizations will use this new guideline to ensure nursing homes meet evidence-based standards. Mody believes that more public reporting of infection-related quality measures could empower patients and families to make informed choices when selecting a nursing home.
While implementing these guidelines may come at a cost to nursing home operators, Mody argues that the investment is worthwhile. Her research with U-M colleagues has shown that preventing infections saves money in the long run. "Preventing infection is the right thing for patients and staff, and it translates to a better business case too," she says.
In conclusion, this new guideline offers a comprehensive roadmap for nursing homes to protect their residents from infections. It's a challenging task, but with dedicated staff, effective training, and a holistic approach, nursing homes can create a safer environment for their vulnerable residents.
