McKesson : Improving Infection Prevention in Long-Term Care Facilities

Nearly 400,000 patients in long-term care facilities die from healthcare-association infections (HAIs) each year. New federal patient safety requirements now require facilities to do more than ever to get that number under control.

Complying with the new requirements and implementing effective infection control measures were the subject of a recent webinar from McKesson Medical-Surgical and Pathway Health, a Lake Elmo, Minn.-based long-term care consulting firm.

Susan LaGrange, Pathway Health's director of education, was the lead presenter during the webinar, 'Infection Prevention and Control: Updates, Antibiotic Stewardship and Quality Results.'

During her presentation, LaGrange discussed the important takeaways from the new requirements, which are part of the Centers for Medicare & Medicaid Services' new survey process for long-term care facilities. The CMS mandated the new survey process through the agency's final Reform of Requirements for Long-Term Care Facilities regulations issued in November 2016.

The most important thing long-term care facilities need to remember is 'must means must,' LaGrange repeatedly said during her presentation. When the CMS says facilities 'must' do something to comply with the new requirements, it's not optional, she emphasized.

New or updated performance measures focus on infection prevention and control

LaGrange said long-term care facilities should train their sights on six new or updated 'F-Tags' that CMS surveyors will use during their new survey process. The survey results determine a facility's eligibility to accept and care for Medicare and Medicaid patients. F-Tags are criteria by which the surveyors measure a facility's ability to provide safe, high-quality care to residents.

The six new or updated F-Tags that LaGrange said are associated with infection control are:

• F880: Infection Control
• F881: Antibiotic Stewardship Program
• F882: Infection Preventionist
• F883: Influenza and Pneumococcal Immunizations
• F690: Urinary Incontinence
• F757: Unnecessary Drugs

Updates to infection control requirements expand facilities' responsibilities

LaGrange said the CMS updated F880, the primary infection control measure, in at least four significant ways that will affect long-term care facilities:

1. A facility must establish an infection prevention and control program, not just an infection control program. By adding 'prevention' to the F-Tag requirement, the CMS is making facilities responsible for stopping infections before they start, not simply stopping them from spreading after they start.

2. A facility's system for preventing and controlling infections must be based on a facility-wide assessment, not just a limited assessment of specific physical areas, types of patients, practices or caregivers. The system needs to cover every aspect of a facility's operations, from residents to staff to visitors.

3. A facility must have a system for recording incidents under its infection prevention and control program and the corrective actions taken in response. Facilities must document when infections occur and what facilities did to prevent them in the future. Surveyors will be looking at that documentation as part of their review.

4. A facility must conduct an annual review of its expanded infection prevention and control program. It should evaluate the effectiveness of the program. And it should modify or update the program as necessary based on that annual evaluation.

The intent of the updates to F880, according to LaGrange, is to 'prevent, recognize and control the onset of infection to the extent possible.'

Antibiotic stewardship required as part of infection prevention protocols

Another major change facing long-term care facilities is antibiotic stewardship, according to LaGrange. Under F881, facilities are now required to have antibiotic stewardship programs as components of their expanded infection prevention and control programs.

The Association for Professionals in Infection Control and Epidemiology defines antibiotic stewardship as 'a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.'

At a minimum, the new safety rules require long-term care facilities to have protocols in place to guide antibiotic use and to have a system in place to monitor antibiotic use.

To comply with the requirement and build a comprehensive antibiotic stewardship program, LaGrange said, facilities should adopt and adhere to the seven core elements of an antibiotic stewardship program for nursing homes, as defined by the Centers for Disease Control and Prevention:

• Leadership commitment
• Accountability
• Drug expertise
• Action
• Tracking
• Reporting
• Education

Leadership commitment means adopting policies and procedures, writing and assigning job descriptions, identifying and executing an effective communication system and leading culture change, LaGrange said.

'All of these efforts assist the facility with oversight of proper and safe antibiotic use,' she said.

Leadership strategies to improve compliance with the new infection control requirements

LaGrange cited a number of actions long-term care leaders can take to help their facilities comply with the new and updated infection prevention and control requirements.

According to LaGrange, long-term care leaders should:

• Know and use the best national tools to help them identify opportunities to improve their facilities' quality-of-care and compliance systems
• Know and use the appropriate state-specific infection control resources, including memos, directives, communicable disease reporting requirements and health department contacts
• Conduct a comprehensive review of their current infection prevention and control programs, including policies and procedures, forms and systems, tracking mechanisms, surveillance documentation and training for staff, residents and visitors
• Create a core, interdisciplinary team responsible for infection prevention and control, including representatives from nursing, dietary, housekeeping, laundry, maintenance and social services
• Meet regularly with medical directors and pharmacy consultants to review and discuss regulations, policies and procedures, practitioner education, hospital admissions and transfers and diagnostic concerns

Long-term care leaders who follow these practices will put their facilities in a position to not only comply with all the new requirements, but also deliver safer care to patients and reduce the number of HAIs and HAI-related deaths suffered by residents.

Related: Learn more about McKesson's infection prevention resources and products for extended-care facilities