The tool uses existing evidence to form recommendations for staffing ratios in long-term care, acute and ambulatory care settings. All of the recommendations are based on key risk factors.

“We are excited to provide this tool to the infection prevention field,” Patricia Jackson, RN, president of APIC, said in a statement. “APIC members have been asking for a resource to help quantify staffing needs for years, and now we can begin to deliver on that promise. With member input, we will be able to provide a robust, accurate staffing tool that will help IP leaders make the case for adequate staff and resources to protect patients.”

The introductory version of the staffing calculator is an “exploratory approach,” APIC says. That is, it’s intended to provide a basic calculation of staffing needs and will collect data that can be used for creating a more rigorous algorithm in the future. 

Data gathered from healthcare facilities that use the tool will be utilized to update it so the tool improves over time. In the next year, an updated version will be released to reflect the accumulated data. In addition to updating the tool as it rolls out, APIC said that it will produce annual reports summarizing data to drive deeper insights into its effectiveness.

The news comes as more organizations are hiring chief infection prevention officers (CIPOs). An article published Dec. 7 in Infection Control Today shared details on this executive role that supports operational positions through the lens of preventing infection.

As sobering as this finding is, COVID-19 is far from the only infection threat facing long-term care facility residents. For example, studies have also shown that C. difficile — identified by the Centers for Disease Control and Prevention (CDC) as a threat level “urgent” pathogen — affects one out of every 50 residents and leads to 29,000 deaths every single year. 

On a broader scale, the 2004 National Nursing Home Survey (2004 was the most recent year that the CDC conducted this survey) revealed that the approximately 1.5 million people who live in long-term care facilities experience, on average, about two million infections per year.

The data is clear: infections are one of the most pervasive threats facing nursing home residents. To help protect their vulnerable populations, facilities must prioritize implementing infection prevention and control (IPC) best practices. These tips are especially important as we enter the holiday season all while influenza, COVID-19, and RSV continue to circulate in our communities. 

One of the easiest and most effective ways to help protect your residents from infection is to educate every individual who walks into your building about the role they play in reducing the spread of communicable and infectious diseases. For example, this signage can describe when visitors should wear a mask or avoid visiting their loved ones (when they are ill). Placing this education where it can be easily seen when entering the facility can go a long way toward keeping your residents safe. 

To be the most effective, signage should also be accompanied by relevant personal protective equipment (PPE). In other words, if you post education advising individuals to wear a mask, ensure there are masks available right next to it. If your sign is about hand hygiene, make sure it’s near an alcohol-based hand sanitizer dispenser (and that the dispenser is fully stocked).

The CDC also has posters you can print out for free that can be hung outside of resident living quarters indicating what precautions people should take when entering and exiting a resident room. All visitors need to be made aware of what transmission-based signage means when it is posted on a resident’s door. 

This typically indicates that specific PPE needs to be worn before entering the resident’s room. It is important to have a restocking process in place so that there is always an adequate supply of PPE. If the bins are empty, individuals may go into the resident’s room without PPE which increases the transmission risk. Consider assigning this role to the environmental service employees as they enter each resident room every day. They can check the PPE bins before entering the rooms. In addition, you could consider assigning it to the other staff who may conduct frequent stocking of supplies. Consider avoiding assigning it to one individual such as the infection preventionist as they are not always in the facility.

This approach is far better than taking the stance that keeping PPE stocked is “everybody’s responsibility.” Too often, that leads to nobody checking PPE, because everyone assumes someone else will take care of it. Assigning people to handle this task is a simple way to avoid this problem.

Finally, one of the best ways that visitors can protect their loved ones during the holidays is to stay up to date on all recommended vaccinations. This can include COVID-19, influenza and Tdap vaccinations. It is important to remember that long-term care residents are a vulnerable population and that outbreaks spread rapidly within this congregate healthcare setting. Everyone who enters a facility has the potential to protect or infect this community. 

Taking measures like these will help reduce and prevent infections among your facility’s vulnerable population. Reminding everyone who comes into the facility of the importance of hand hygiene — which is demonstrably one of the most important elements of effective IPC — and giving them access to alcohol-based hand sanitizer, for example, can reduce rates of bacterial and viral infections. 

Placing informational signs, keeping relevant PPE within easy sight and access to visitors for at-risk or infected resident rooms, and staying current with all recommended vaccinations can similarly reduce the spread of pathogens and mitigate the risk of infection outbreaks among other residents and staff. 

Ultimately, these IPC best practices are highly effective and can be part of every facility’s IPC program. They don’t require a large investment or time and can be put into practice today. 

Buffy Lloyd-Krejci, DrPH, CIC, is the founder of IPCWell. Drawn to action to improve the infection prevention landscape for these communities, she utilized her over two decades of experience in the healthcare field and her doctorate in public health (DrPH) to launch IPCWell. She and her team have provided training, education, and technical assistance (both in person and virtually) to hundreds of congregate care facilities throughout the COVID-19 pandemic.

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.

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An article published Dec. 7 in Infection Control Today highlights the concept of having a chief infection prevention officer (CIPO). This executive role supports operational roles through the lens of preventing infection. The concept is gaining popularity in hospitals and other healthcare organizations and could influence the long-term care segment. 

This executive position oversees and enacts infection prevention and control activities for an entire organization. The person has to collaborate with administrative, board members, quality management, clinical microbiology, clinical engineering, nursing, materials management and environmental services personnel. The CIPO essentially supervises other infection preventionists, whether they’re at the same location or multiple facilities, the article noted. The CIPO also has to be able to represent the concerns and practices of infection control personnel and initiatives to executive level officers.

“Hospital epidemiologists play a vital role in orchestrating the efforts to prevent the emergence and transmission of infection within a hospital,” Shira Doron, MD, the chief infection control officer at Tufts Medicine, and a hospital epidemiologist, said in the article. “[CIPOs] … serve in that same role at a health system level, coordinating those efforts across multiple entities and various health care settings. As a hospital epidemiologist and CIPO, I have years of formal and on-the-job training that is highly specialized at the intersection of epidemiology, infectious diseases, public health, and clinical research methods.”

“As hospitals and other healthcare entities consolidate into larger health systems, having someone responsible for infection control oversight at the system level is critical,” Doron said.

A recent article in Infection Control Today summed up how scrubs can help prevent infections. According to the author, the fabric for most scrubs is tightly woven, so it can stop pathogens from reaching your body. The material that scrubs are made of also can absorb or repel fluids and can stop the transfer from one patient or resident to another. Polyester-cotton materials and similar blends have been able to guard against infections and are easy to clean. Some scrubs are marketed with antimicrobial properties such as copper or silver nanoparticles; those can stop bacteria from growing and prevent infections from spreading, according to the article.

Even though workers at nursing homes may not be at risk for heavy interaction with personal fluids, the materials are equipped to handle it — a plus because nursing home workers never quite know what they’re going to deal with during a shift.

When purchasing scrubs, seek out those that are certified by organizations like the Association for Advancement of Medical Instrumentation, the author recommends. 

Taking care of scrubs as per the directions is key to ensure the garments maintain their viability for protection. They must be washed with hot water and detergent and dried at a high temperature, so look for materials that can handle high temperatures from frequent washing and drying.

Finding the right fit also is important if you’re looking for medical scrubs. Pockets can be useful, but too many folds or pockets in the scrubs can become hazardous or encourage the buildup of germs. Go for a fit that is not too loose and not too tight, as the fit also can play a role in the protective value of the tops and bottoms.

The report was published in this month’s edition of The Lancet Health Longevity.

It details a study performed by researchers with the University of Michigan Medical School, who wanted to look at what characteristics were linked to nursing home contamination with VRE.

Most long-term care communities try to stop the spread of VRE and pathogens like it; facility leaders promote hand hygiene and other practices. The researchers wanted to see whether they could stop VRE transmission by pinpointing the factors that may make it more likely for residents to shed and spread VRE. 

The team collected data from 245 participants at six nursing homes in the United States. The researchers evaluated cultures from their bodies and their rooms during multiple visits. Of the participants, VRE was present in 49 of the people, and environmental contamination was found for 36 of the people.

According to the analysis, men and people taking antibiotics were more prone to environmental contamination from other residents with VRE. People who were more physically dependent had a reduced risk for environmental contamination.

“Our results support a model of VRE transmission in nursing homes whereby colonized residents with sufficient physical independence can contaminate their environment via their hands, which is likely to increase the chance of a resident with an antibiotic-disrupted microbiota acquiring VRE colonization, either directly from the contaminated environment or via a health-care worker intermediate,” the authors wrote in the paper.

Nursing home leaders and other infection prevention professionals may want to target hand hygiene and antibiotic stewardship practices as a way to try and lower VRE contamination and transmission, the authors said.

Nursing home residents are at an increased risk for infection, hospitalization and colonization with multidrug-resistant organisms. Finding effective agents is key to keeping them protected. Researchers conducted a cluster-randomized trial of universal decolonization with the agents, comparing the outcome to routine-care bathing. 

Data came from an 18-month-long baseline period and then an 18-month span when the staff used the decolonization intervention. Decolonization involved using chlorhexidine for all routine bathing and showering. The researchers evaluated data from 28 nursing homes in Los Angeles and Orange counties in California spanning 28,956 residents.

The residents took nasal povidone–iodine twice daily for the first five days after admission and then twice a day for five days every other week. The researchers looked at how many of the residents were then transferred to the hospital for infections, as well as being transferred to the hospital for any reason. 

Of people moved to a hospital who received routine care, 62.2% (the mean across all of the nursing homes) developed infections during the baseline period and 62.6% acquired infections during the intervention period. In the intervention group, 62.9% got infections during the baseline period while 52.2% got infections during the time of the intervention. 

Among the people sent to the hospital in the routine care group, 36.6% were transferred to a hospital for any reason during the baseline period and 39.2% went during the intervention period. In the intervention group, 35.5% went to a hospital due to any cause during the baseline period, while 32.4% went for any reason during the intervention period. 

The study was published Thursday in The New England Journal of Medicine.

The draft of the Isolation Precautions Guideline was released to the public on Nov. 2. The CDC accepted feedback on it until the end of the day Monday, which gave the public five days to comment. The rules haven’t been updated in 16 years. 

The guidance specifies infection control practices for healthcare facilities in the country. It refers to healthcare workers directly, not employers. The NNU said the guidance “inappropriately” shifted responsibility and risk to individual workers to protect corporate profits. 

“The focus of HICPAC’s draft is almost exclusively on personal protective equipment, and it fails to make strong recommendations on other essential measures, such as ventilation and patient screening and isolation,” the NNU stated.

“HICPAC’s draft is permissive and weak and seeks not just to maintain existing practice — which has been shown to be inadequately protective — but even rolls back the use of some important measures, such as airborne infection isolation rooms,” Zenei Triunfo-Cortez, RN, president of the NNU, said in the statement. “This draft guidance will only further degrade the already dangerous working conditions of nurses and other health care workers and further contribute to high rates of moral distress, which will only serve to drive more nurses away from the bedside and further deepen the staffing crisis in health care.”

“HICPAC is missing the perspective of frontline nurses, other health care workers, our unions,” Triunfo-Cortez said.

Triunfo-Cortez said research shows that healthcare workers need multiple measures to deal with viruses. The standards should include ventilation, PPE, screening and isolation, exposure notification, and other measures.

The NNU sent a letter to the CDC in July asking the federal agency to meet and discuss the the concerns about the rules; they also created a petition urging the CDC to recognize aerosol transmission of SARS-CoV-2 and other respiratory pathogens to strengthen the agency’s Isolation Precautions guidance. In September, nearly 2,000 experts in public health, infectious disease and industrial hygiene sent a follow-up letter to the CDC director asking for the CDC “to involve key experts and all stakeholders in the development process” and hold public meetings, the organization noted in its statement.

The study, a double-blind, superiority, placebo-controlled trial that looked at data from people who took antibiotics and had hip or knee surgeries in Australia, was published Wednesday in the New England Journal of Medicine. Many people recovering from joint replacements receive short-term rehab in skilled nursing facilities. 

Doctors have debated whether or not to add vancomycin in surgical patients to prevent infection. But the increase in antibiotic resistant bacteria has left them in need of a definitive verdict. In Australia, many medical facilities give cefazolin and vancomycin to people who had knee or hip surgeries — without knowing if doing so was truly beneficial.

Vancomycin is commonly used for methicillin resistant Staphylococcus aureus (MRSA), which is also known as “golden Staph.”

The researchers examined data from 4,239 people who didn’t have a history of MRSA. The study participants were in 11 hospitals across Australia. The people all received cefazolin. Then they were put into two groups; they either got vancomycin or a placebo. The infection rate in the vancomycin group was 5.7%; it was 3.7% in the placebo group. 

“Given the number of joint replacements performed in Australia and globally, our trial has answered the important [question] about whether more antibiotics are better for our patients having joint replacement surgery: with the definitive answer being ‘no.’ This trial will have a significant impact on practice,” Trisha Peel, from the Monash University Central Clinical School, said in a statement.

“A lot of things seem to make sense, but we don’t really know for sure until they are tested in a clinical trial,” Peel said. “This is one of those cases — more antibiotics weren’t better, and in some people might have actually been worse.” 

Post-surgical infections are rare, and affect anywhere from 1% to 5% of people who undergo the operations, according to the statement.