Reimagining Infection Control in U.S. Nursing Homes in the Era of COVID-19

Abstract

Residents of nursing homes (NHs) are susceptible to infection, and these facilities, particularly those that provide post-acute care services, are high-risk settings for the rapid spread of communicable respiratory and gastrointestinal illnesses, as well as antibiotic-resistant bacteria. The complexity of medical care delivered in most NHs has increased dramatically over the past 2 decades; however, the structure and resources supporting the practice of infection prevention and control in these facilities has failed to keep pace. Rising numbers of infections caused by Clostridioides difficile and multidrug-resistant organisms, as well as the catastrophic effects of COVID-19 have pushed NH infection control resources to a breaking point. Recent changes to federal regulations require NHs to devote greater resources to the facility infection control program. However, additional changes are needed if sustained improvements in the prevention and control of infections and antibiotic resistance in NHs are to be achieved.

Keywords: COVID-19; Infection prevention and control; healthcare-associated infection; outbreak.

Fig. 1

NH infection control program work system. The NH infection control program is responsible for monitoring and effecting several facility practices (process measures) that influence the likelihood of different adverse outcomes (outcome measures) that can affect facility staff and residents. The facility infection preventionist (IP) is an important but small piece of the infection control program work system that must be reimagined in order to better prevent and control the spread of infections in NHs. POC, point-of-care.