When I write or speak about our long-term care industry, I often do just that – refer to “the industry.” Whether it be challenges “the industry” faces, solutions “the industry” needs, or data or statistics from “our industry,” I find myself wondering if the humanity gets lost.
Are we remembering that there are human beings behind every data point or statistic? Are we looking at residents and healthcare workers as “residents and healthcare workers,” or are we seeing them as our mothers, fathers, sisters, brothers, sons, daughters, our friends and our neighbors?
I know what I see every time I’m in the field, in a nursing home, but I wanted to learn more – I wanted to put myself in the shoes of a long-term care infection preventionist (IP) – people who take on the responsibility of leading the IPC program in a facility every single day. I recently had a video conference with three IPs to get the real scoop.
I began by asking them what a typical day looked like for them in their facility. First and foremost, they all agreed that every single day was different. The feeling though, was not one of joyous wonderment but rather one of anxious unease to never know what they were walking into. These IPs had plenty on their plate; however, they were often pulled in many different directions to put out other fires or fill in elsewhere. It was as if the role of the IP was secondary to whatever else needed to be completed, not the priority.
This was surprising given the Centers for Medicare & Medicaid Services requirement that all CMS-certified nursing homes have at least a part-time dedicated Infection Preventionist on staff. Given the challenges the three IPs had even getting buy-in for the prioritization of their role, I wonder if this “part-time” designation is even sufficient.
The Centers for Disease Control and Prevention recommend that a facility have “at least” one full-time infection preventionist if that facility has more than 100 residents. The California Department of Public Health requires every facility to have a full-time IP.
In our video conference, one full-time IP spoke of how she would only spend two of her eight hours each day completing IP work, and during the other six, she was just another clinical member of the staff. This led to her staying late to catch up with work or taking eight hours of IP work and trying to fit them into two hours. Does this sound like a sustainable situation? One even spoke of doing just enough to stay within compliance so that the facility wouldn’t get fined – because one owner repeatedly asked her, “Are you going to pay the fines?”
Never being able to catch up on infection prevention and control duties means the job is no longer about prevention – it’s about control. It means prioritizing prevention efforts is impossible, which ultimately means harms and deaths due to infections are not being mitigated. Imagine the frustration of an IP that knows infections and harm can be prevented yet is unable to dedicate time to these efforts.
We can compare it to an engineer hired to build a dam to prevent flooding yet is only allowed to haul sandbags to the shore. Given the time to properly complete the job, the flooding could be prevented in the first place.
One of the IPs described how, when completing a chart review, she found a resident that was on an antibiotic long after the required course of treatment. The physician missed it, nurse managers missed it, her supervisor missed it. When she found it by completing her surveillance, she was appalled at this oversight. This is only one small example of how critical it is for the IP to be afforded the appropriate time to perform their job.
Each Infection Preventionist I spoke with told specific stories of trying to play catchup, always being behind, uncertainty, and staving off burnout – or burning out. According to the National Consumer Voice for Quality Long-Term Care, nursing homes continue to experience 52% staff turnover. The reason? Studies continue to point toward high workloads, inadequate training, poor management and poor pay to name a few.
Quoting another IP – “I was completely alone in the infection control practices…” The company was putting profit over protocol. Her building had residents that should have been on isolation precautions, including separate rooms, but was told by management that they couldn’t adhere to this until they hit their numbers with admissions. She said this was less than six months into her position, and already she was completely exhausted and burned out. Who could blame her?
The simplest way to think about this is if we want healthy and safe residents, we need healthy and safe staff. This is not a groundbreaking stance. We need to invest in the infection preventionist. Not as secondary or for compliance only.
If we have learned anything from the global COVID-19 pandemic, it should be the high prioritization of infection prevention measures within our long-term care facilities, including the staff to implement evidence-based measures.
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. Dr. Buffy 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.
