Remote Infection Control Assessments of US Nursing Homes During the COVID-19 Pandemic, April to June 2020

Abstract

Background: Nursing homes (NHs) provide care in a congregate setting for residents at high risk of severe outcomes from SARS-CoV-2 infection. In spring 2020, NHs were implementing new guidance to minimize SARS-CoV-2 spread among residents and staff.

Objective: To assess whether telephone and video-based infection control assessment and response (TeleICAR) strategies could efficiently assess NH preparedness and help resolve gaps.

Design: We incorporated Centers for Disease Control and Prevention COVID-19 guidance for NH into an assessment tool covering 6 domains: visitor restrictions; health care personnel COVID-19 training; resident education, monitoring, screening, and cohorting; personal protective equipment supply; core infection prevention and control (IPC); and communication to public health. We performed TeleICAR consultations on behalf of health departments. Adherence to each element was documented and recommendations provided to the facility.

Setting and participants: Health department-referred NHs that agreed to TeleICAR consultation.

Methods: We assessed overall numbers and proportions of NH that had not implemented each infection control element (gap) and proportion of NH that reported making ≥1 change in practice following the assessment.

Results: During April 13 to June 12, 2020, we completed TeleICAR consultations in 629 NHs across 19 states. Overall, 524 (83%) had ≥1 implementation gap identified; the median number of gaps was 2 (interquartile range: 1-4). The domains with the greatest number of facilities with gaps were core IPC practices (428/625; 68%) and COVID-19 education, monitoring, screening, and cohorting of residents (291/620; 47%).

Conclusions and implications: TeleICAR was an alternative to onsite infection control assessments that enabled public health to efficiently reach NHs across the United States early in the COVID-19 pandemic. Assessments identified widespread gaps in core IPC practices that put residents and staff at risk of infection. TeleICAR is an important strategy that leverages infection control expertise and can be useful in future efforts to improve NH IPC.

Keywords: SARS-CoV-2; infection control; nursing home.

Fig. 1

Comparison of telephone and video findings during remote infection control consultations for nursing homes in 16 states—United States, April–June 2020, n = 123. Affirmative answers to questions posed by telephone were compared to observations during video portions of the assessment. Concordance was calculated as the percentage of facilities where the video confirmed answers given by telephone. Numbers in the bars represent the number of facilities with concordant (green) and nonconcordant (gray) information. EPA, Environmental Protection Agency; Environmental Protection Agency; HCP, health care personnel.