Opinion: Full-Time Infection Preventionist a Must

Nursing homes are always “putting out fires.”  That excuse is often used to avoid addressing critical issues.  There’s a reason that the federal Requirements of Participation recognize the need to have a person in a nursing home tasked with infection control. That person is designated as the Infection Preventionist, or IP.  Who normally does that job?  It might be an RN or an LVN.  It is often the Director of Staff Development, or DSD.  Infection control is usually one task among many for the person typically designated to be the IP.  How does that work? Is it enough?

I don’t want to wait to find out.  The last thing any of us want to see is what we’ve seen happen at the Washington state nursing home.  When this is over, it will be useful to go back and look at what infection control measures were taken prior to the outbreak there.  In the meantime, we all need to be looking forward, not backward.  Every nursing home with at least 99 beds should focus a full FTE on IP duties.  We will hear complaints about staffing issues, and the ability to fill the role.  I’m not suggesting hiring more personnel.  Facilities are already required to have a designated IP.  I’m recommending that we dedicate that person full time to the work that they already MUST do.  Anything less will be inadequate in the current situation.

There isn’t a lot of room for error when it comes to the battle with COVID-19.  The IP needs to be the designated General who is leading the facility’s troops in the fight!  Their full attention needs to be focused on the key issues that we all understand to be important when it comes to limiting the spread of this virus in nursing homes. 

All staff MUST be monitored.  Aside from the restrictions based on recent travel and contacts, we must have a heightened sensitivity to any staff who might be coming to work sick.  COVID-19 can be spread prior to symptoms, so at the very least, we must be diligently monitoring staff for early symptoms.  Every employee must have their temperature taken when they come to work.  It has even been suggested that this be repeated midway through their shift.  Hand hygiene for everyone in the facility is perhaps our greatest defense against this virus (in addition to cleaning commonly used surfaces every four hours).  The IP should spend most of their day rounding through the facility, promoting hand hygiene.  For anyone worried about adequately staffing this role, there is an ongoing education and training aspect to doing this.  Everyone will benefit from it!

The IP needs to make sure that there is large signage in plain sight for all staff and visitors.  There can not be too much signage right now!  The IP also needs to make sure that visitor restrictions and limitations are being adhered to.  No one should be entering the facility without having had their temperature taken and being asked about any symptoms (as well as the questions about recent travel and contact).  

We all know that frail older adults can demonstrate unusual symptoms in the face of an infectious disease.  They aren’t always capable of mounting a fever response.  The IP should make sure that every change of condition is being evaluated by clinicians with the expertise to recognize that the change might be secondary to an infection.

For Medical Directors, this is a great opportunity to support your IP.  Make sure that you are regularly communicating with them.  Let them know to tell you if they are being pulled away from their IP responsibilities onto other duties.  You then have the responsibility to support the need for them to be given the time to do their job. 

For NHA’s and DON’s, make sure that everyone in the facility knows that the IP is your General in the fight against COVID-19 and will follow their orders!  The lives of our residents depend on it!

Michael Wasserman, MD, CMD
CALTCM President
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