More than any incident in modern history, the coronavirus pandemic has emphasized the need for widespread infection control within all facets of healthcare.
While preventing the spread of viruses and bacteria is always the goal within a healthcare setting, the sheer contagiousness of COVID-19 has exposed all the possible gaps that exist, laying bare those areas that have slipped our attention or that have simply fallen by the wayside because there wasn’t a major need.
Now, everyone in the healthcare sphere has to consider some of the most aggressive and all-encompassing infection control procedures. All it takes is one case to slip through the gaps and viral containment can falter and a new outbreak can begin.
In this environment, post-acute care (PAC) providers are having to embrace additional infection control procedures that, due to previous protocols and treatment capabilities, may not have been in place. These procedures are particularly important in PAC facilities now because the people within are the very same demographics most susceptible to complications deriving from COVID-19, particularly seniors in nursing homes and others whose underlying health conditions necessitate post-acute care.
We want to share some resources PACs can utilize in order to bolster their infection control efforts. Please note: The organizations that have put out this information are constantly revisiting best practices as we learn more and more about the coronavirus, and you and your facility should continue to check back often in order to make sure you’re following the latest and most heavily vetted policies and procedures.
The CDC’s Guidance
One of your first stops for developing policies related to infection control should be the Centers for Disease Control and Prevention (CDC). This government organization has already put out (and updated) a number of resources your team can use, everything from checklists to best practices and links to some of the most hot-button issues facing post-acute care facilities.
Perhaps the best starting point when sifting through the CDC’s many resources is their page entitled “Preparing for COVID-19: Long-term Care Facilities, Nursing Homes.” As you might guess from the title, this acts as an indispensable guide to some of the basic precautions you ought to take in order to mitigate the threat of infection.
But it’s not necessarily just Long-Term Acute Care facilities (LTACs) and nursing homes that can benefit from this information. The guide’s preparedness checklist is a fantastic starting point for anyone whose care organization might come into contact with a COVID-19 patient or that might be preparing to take on this responsibility in order to deal with escalating demand. And subsections with titles like “Things Facilities Should Do Now” and “Policies and Procedures for Visitors” really do an excellent job outlining precautions.
That’s far from the only CDC web resource you can consult in order to guide your actions. Here are a few others PACs may find useful:
- Infection Control – Guidance for safely caring for confirmed and suspected COVID-19 patients, collecting post-mortem specimens and guidance related to personal protective equipment (PPE).
- Infection Prevention Training - Online coursework you can take and share with team members in order to ensure everyone at your organization is prepared for the additional infection control responsibilities expected of them.
- Prevention Tools – Checklists you can follow to improve your infection control methods, core elements of infection prevention in nursing homes specifically and links to a variety of other tools that will help you in your progress.
Please remember, of course, that these are guidelines and should really act as a base effort to your infection control efforts, and that the CDC has many additional resources you can and should consult.
Understand the New Normal
We’re seeing many rules swept away as our nation’s healthcare agencies get creative in addressing the challenges posed by the COVID-19 pandemic.
On March 30, the so-called “hospitals without walls” program was unveiled by the Centers for Medicare & Medicaid Services (CMS). This paved the way for hospitals to essentially expand their ability to provide acute services to facilities that previously would have been prohibited from offering that level of care.
As part of this rule, it’s conceivable that LTACs, rehab centers and other non-acute settings may soon find themselves being asked to work with hospitals to establish acute capabilities. This poses additional infection control challenges that need to be addressed, and it will be up to PAC stakeholders, staff members and their hospital counterparts to work together to figure out the contours of these potential new partnerships.
But even among those PACs that aren’t expected to provide hospital-like care, you may soon see an influx of COVID-19 patients that have to be sectioned off from the rest of your population. Even this requires a substantial rethink of current processes. The Advisory Board has an excellent resource tackling this very topic among nursing homes, and we’d recommend consulting it for tips on infection control and coordinating with hospitals.
All of this provides an opportunity for post-acute organizations to accept more patients and fill beds that otherwise might sit empty, but it certainly requires a substantial time and resource commitment. If your organization is in this situation, it’s important to stay versed in the latest rules.
Reach out to your most common hospital referrers to gauge their current case load as well as when they may start sending patients your way. Ask what protocols they require and what volume you can expect. This will make for a good starting point when putting together the prep work you need to start accepting patients during the new normal.
In these unprecedented times, communication absolutely has to be stellar between hospitals, skilled nursing facilities, home health care agencies and all other PACs, with the lines of communication open at all times. With the risk as high as it is right now, keeping in touch and knowing where your facility partners stand is of paramount importance.
Staff Infection, Staff Ejection
Finally, the Advisory Board has put together another great resource tackling one of the biggest challenges confronting nursing homes (and, indeed, all manner of PACs): staffing.
As they point out, staffing challenges unique to PACs actually have the potential to make infection risks more prevalent. These challenges are manifold, having to do with heightened direct care staff turnover in comparison with a hospital environment and a greater presence of unlicensed team members.
But even these challenges can be addressed with the right mindset and a willingness to tackle the issue. Perhaps the most important thing you can do is ensure you have a strict training regimen that all personnel are subjected to. This should go hand in hand with the provision of viable protective equipment (after all, training won’t suffice if it isn’t paired with the tools necessary to prevent further contagion).
It’s also worth pointing out what might be Advisory Board’s best point: to lean on your hospital partners for assistance. During this pandemic, we’re all learning as we go along, and hospitals today are dealing with the volume and challenges that PACs will confront tomorrow. They’ll be able to offer insights, best practices and lessons learned, which you can then apply to your own processes.
One other thing to note, and something that’s also mentioned in the CDC’s aforementioned resource guide: even though consistency and licensure of staff may be one of your facility’s greatest challenges, the drive to shore up staff must also be paired with vigilance toward the care of those same staff members.
You should be open with team members and have policies in place that allow them to stay away from the PAC facility when they themselves begin to exhibit symptoms of COVID-19. If a team member feels pressured to work, either for financial reasons or something else, and they show up for a shift, they can make an already precarious situation substantially worse, particularly if that staff member is around non-COVID patients.
It’s certainly a balancing act, but one we must all work on to prevent the further spread of this virus.
We hope the above resources provide a good start, and there’s plenty more where they came from, with the CDC and others updating their guidance frequently. The Agency for Healthcare Research and Quality has another excellent guide on infection prevention for long-term care staff which you can check out as well, and some of the other leading resources, entities like the WHO, CMS and more, are only a click away.
This is a huge shift in thinking for all providers, and we all have to think differently about our everyday workflows to keep patients and staff safe. With that in mind, we’ll continue to update this as time goes on and we learn more and more about the virus and the medical community’s response to it. Stay safe out there.