Infection control and the culture of safety

Long-term care (LTC) facilities incur somewhere between 1 million and 4 million infections annually, and those infections may be responsible for up to 380,000 deaths per year. No one is exactly sure, because nursing homes aren’t required to report infection rates at the federal level like hospitals are. Tackling infection prevention is as much an operations process issue as it is a clinical one, according to a panel presentation hosted today by The Joint Commission.

Urinary tract infections are the most commonly reported and treated infections in nursing homes, whereas pneumonia is responsible for the most hospitalizations and deaths for those over age 65. Influenza, Clostridium difficile and wound/skin infections also are significant contributors to the infection mix in LTC settings.

F-Tag 441: Infection prevention

For the past few years, the Centers for Medicare & Medicaid Services (CMS) has been in full-court press to reduce infection rates. The emergence of the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination in 2009 set the stage for increased efforts to combat infections beyond hospital settings.

Getting healthy surveyors’ marks and avoiding deficiencies under F-Tag 441 takes more than good hand hygiene. CMS surveyors look for strong infection prevention protocols and surveillance on a consistent basis, not just when members of the community acquire an infection, said Diana Murray, RN, MSN, associate director of the Joint Commission’s Nursing Care Center Accreditation.

The most successful infection-reduction initiatives involve all departments, from nursing to housekeeping. They also recognize the impacts that staffing levels can have on the process, especially when short-staffed shifts may be tempted to rush through protocols, skip a hand-washing or forget to change gowns. Instead of blaming nurses and direct-care staff, involve them in the process of improving the situation, Murray said.

Education, not blame

Above all, nursing home staff—clincial and non-clincial—need proper training and education, Murray said.

Creating strong programs can help facilities take action while maintaining processes to monitor and report infections. Quality improvement programs identify risks, establish goals, develop and implement prevention plans and provide methods to evaluate effectiveness, explained Ed Smith, RN, MSN, associate director of the Joint Commission’s standards interpretation group. Advancing Excellence and QAPI are just two of the quality improvement initiatives under way, in addition to a nationwide movement toward adopting the values of person-centered care. Likewise, many organizations have made great strides in reducing infections through outreach programs that involve residents and their families, including vaccination initiatives to guard against influenza and pneumonia, Smith added.

Safety-focused programs all have things in common, including a personalized approach to care, leadership engagement, staff empowerment and ongoing efforts toward improvement, Murray said. Organizations that are serious about improvement recognize the important of committed leaders who don’t allow shortcuts in the process. "It’s not enough for supervisors to be just walking around," Murray said. "They should be purposefully looking at processes and looking for potential weaknesses."

Bringing infection prevention under the safety culture in long-term care also means fostering staff respect, encouraging staff to report infection events without pointing fingers of blame. "An infection should be considered an error in care," Murray added. Therefore, an organization’s safety culture should "be built on a staff that is empowered to report errors and near-misses, and [a process] that allows them to participate in solutions to make things better."


Infection prevention and HAI portal:

High Reliability Resource Center:

Joint Commission high reliability in LTC tool kit:

Crosswallk to Quality Assurance Performance Improvement (QAPI):

Nursing Home Data Compendium:


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