Skilled Nursing News’ Alex Zorn weighs in with Dr. Buffy on Infection Preventionists in nursing homes.

Infection preventionists are more than just an afterthought for nursing homes in 2022.

The important role they play in day-to-day operations for skilled nursing facilities is one of the many lessons operators have learned over the course of Covid.

But as staffing shortages continue to hurt the industry, operators have had to get creative with how they fill the position and comply with industry standards.

Furthermore, the workloads of IPs have seen a dramatic increase over the course of Covid as many have faced new demands to help more with patient care — while also seeing the need for their tasks expand.

The Centers for Medicare & Medicaid Services (CMS) back in 2016 issued requirements that stated nursing homes needed to designate an individual as an infection preventionist. Since then, operators have been looking for more clarification on how to meet this guidance.

CMS laid out new requirements for IPs in its updated guidance to surveyors for nursing homes to participate in Medicare and Medicaid released last week, requiring facilities to have at least a part-time IP on-site.

This came months after the White House’s nursing home reform package calling for CMS to clarify and increase the standards for nursing homes moving forward.

CMS’s further guidance stipulates that each facility should have an IP with specialized training to effectively oversee its infection prevention and control program. This includes having the IP work physically onsite and offering specialized training for infection control and prevention.

For some, a part-time infection preventionist may not be enough.

“I think it’s really difficult to say that a part-time infection preventionist is going to cut it,” Karen Jones, clinical research coordinator at the University of Michigan told Skilled Nursing News. “Personally, I don’t think that having somebody there for 20 hours a week is going to be enough to be effective, especially when Covid or another pandemic infectious disease breakout happens.”

Jones has been studying the infection preventionist role both before and during the pandemic.

While the requirement is to have at least a part-time IP, CMS states the IP must meet the needs of the facility.

Dr. Buffy Lloyd-Krejci, founder of consulting firm IPCWell, said that nursing homes need to adjust accordingly. She thinks one way to make it more “doable” for operators is by spreading out the duties to the entire staff.

“To me, part-time isn’t even enough and most IPs that I talked to have told me that part-time isn’t enough because the role is so large,” she told SNN. “There’s so much that’s involved in this role.”

Jones has seen turnover in this role climb to 40% during the pandemic.

Even before the pandemic, a study published in 2019 in the American Journal of Infection Control found that 54.7% of long-term care facilities had at least one reported turnover at the position.

Similarly to MDS coordinators, Jones said part of the problem is that IPs are called to work on the nursing home floor and help out with patient care which can present challenges — especially for nursing homes with just a part-time IP. 

While the American Health Care Association/National Center for Assisted Living (AHCA/NCAL) is pleased to see CMS acknowledge that many staff play important roles in infection prevention and control, as well as antibiotic stewardship, the guidance does not change the fact that most often infection preventionists in nursing homes are nurses and the industry is in the midst of a nationwide nursing shortage.

“Our members have been eager for CMS to release the interpretive guidance for this infection preventionist requirement that took effect three years ago,” AHCA/NCAL said in a statement to SNN. “ We are pleased to see CMS acknowledge that the designated facility infection preventionist hours per week, while at least part-time, can vary based on the facility and its resident population.”

Lloyd added that many of the new infection preventionists in the industry “are very green,” creating more problems with retention and turnover. 

“They don’t have a lot of training and it’s an enormous role, it’s specialized and so without the proper training or mentoring, it can be very overwhelming,” she said. “If someone steps into this role and they don’t have what they need, many of them don’t last very long.” 

One solution she’s seen operators take is to have multiple people working on infection prevention to “ease the burden” on just one person. 

However, CMS’s guidance requires the infection preventionist to be at least part-time and onsite. 

“One facility I was working in had one person doing all the Centers for Disease Control and Prevention’s National Healthcare Safety Network reporting, one person doing testing and education and spreading it around to make it less burdensome for one individual,” Lloyd said. “I think that’s probably a model that’s more sustainable, especially given our shortages and burnout right now.”

Lloyd thinks the industry in general needs to rethink what it means to be an IP. 

The California Department of Public Health required in 2019 that every nursing home facility have a full-time infection preventionist. However, as per a provision effective on Jan. 1, 2021, the role may be shared by two staff members if the total time dedicated to the IP role is equivalent to one full-time staff member. The IP must also be a registered nurse or licensed vocational nurse, and the IP hours cannot be included in the 3.5 direct care service hours per patient day required in a SNF. 

Lloyd also encourages the industry to look at expanding the role to more than just nurses.

“I’ve met somebody with a physical therapy background who is in the role of infection preventionist, which is something I have never seen in four years of doing this work,” Jones said.  

She said that the individual assisted the organization with Covid screening and reporting, gaining confidence and interest in the IP role before asking if she could train for the position. 

“I think it’s really important for nursing homes to think outside of the box of the traditional nurse role for infection prevention,” she added.

See the Skilled Nursing News article here: