Stronger Ties With Hospitals Might Help Nursing Homes Fight Infections

Health care professionals who work at NHs are all too aware of the rates for urinary tract infections (UTIs) and catheter-associated UTIs (CAUTIs) at those institutions, according to study results1 unveiled last month at the APIC annual conference. What they’re not so aware of is how well (or not so well) NH employees practice good hand hygiene and properly don and doff gowns and gloves as ways to lower rates of infection.

“While awareness of UTI and CAUTI rates is high, process measures like hand hygiene rates and gown/glove use are not evaluated consistently,” state the study investigators, who are from the University of Michigan. “Hand hygiene and use of personal protective equipment have [had] heightened priority during the COVID pandemic. NHs have made significant progress operationalizing many evidence-based infection prevention practices, but gaps exist.”

In Michigan, 56 NHs (of 58 asked) agreed to participate in a 5-year survey in which investigators sought to learn if better relations between NHs and hospitals might help foster better infection prevention in NHs. “A 36-question survey on IPC [infection prevention and control] characteristics was distributed … for [the] years 2018-2020,” the study states. “All surveys were completed prior to March 2020, when the first case of COVID-19 was identified in Michigan. Surveys were completed by IPs, directors of nursing, and/or NH administrators.”

The respondents at 93% of the NHs were aware of their institution’s UTI rates, and 87% were aware of its CAUTI rates. Policies were in place at the NHs regarding catheter insertion and care, as well as other methods to prevent UTI/CAUTI infection. Those methods include hydration, discontinuing the catheter use, stop orders, and electronic alerts.

Staff training at the NHs was uneven, however. “Less than half (44%) were aware of their hand hygiene rates; 35% were aware of gown/glove use,” the study authors state, adding that “100% shared infection data with NH leadership, 69% with bedside nursing staff, and 26% with residents and families.”

Among the study authors is Karen Jones, MPH, RN, CIC, who works in the Department of Internal Medicine at the University of Michigan. She tells ICT® that face-to-face meetings between NH and hospital officials were originally supposed to be a major part of the third year of the project. Because of COVID-19, though, those meetings had to be held virtually. The data reported in the APIC conference abstract reflect a 3-year period of surveys. An enrollment year was considered to be from March 1 to February 28.

“Our third year…was challenged due to COVID,” Jones tells ICT®. “We anticipate enrolling another cohort of NHs for this project this summer. We had to adjust the planned enrollment year due to the chaos COVID caused. The entire project is 5 years.”

Jones says it was good that the meetings in the third year of the project were held—even if they had to be virtual—because “it was even more important during that time of COVID to build those relationships, to have open lines of communication, especially when it came to things like personal protective equipment allocation, visitation, and staff education. It benefited everyone to have those relationships strengthened during [that] COVID year.” For an additional 1 or 2 years, continues Jones, the team will continue to collect the same kinds of data that were presented at this year’s APIC conference.

Still, Jones and colleagues detected a disturbing trend: Even NHs that had IPs had trouble keeping them.

“The NHs that we surveyed had almost two-thirds of their IPs turn over in the course of just 12 months,” Jones tells ICT®. “Keeping someone in that role is very, very important: They need to be properly educated and to have the time not only to get education but [also] to set up their program and properly run it and not to be pulled in many different directions [at once] at work. If they’re an IP, they need to focus on [infection prevention]. They should not also be responsible for all the different tasks in the [facility].”

Reference:

1. Jones KM, Mantey J, Mody L. Current practices in infection prevention: a 3-year survey of Michigan nursing homes’ urinary tract infection prevention strategies. Presented at: Annual Conference of the Association for Professionals in Infection Control and Epidemiology; June 28, 2021; remote.