How to Perform an Infection Prevention Gap Assessment

How to Perform an Infection Prevention Gap Assessment

More than 5 million Americans are admitted to or reside in a range of long term care and assisted living facilities each year. These patients and residents consider this facility their home and rely on it for their well being and safety. But the typical demographic makeup of long term care, nursing home, and assisted living facilities present unique challenges to infection prevention. Older residents, along with those that likely have underlying health concerns, require more protection from pathogens that cause life-threatening illness. Infections in this population are associated with increased mortality, extended stays at the hospital, and considerable healthcare costs.

According to the CDC, 1 to 3 million serious infections occur every year in these facilities. Infections are a major cause of hospitalization and death; as many as 380,000 people die of the infections in LTCFs every year. Now more than ever it is critical that long term care facilities ensure that infectious diseases do not spread within their facilities. The foundation for effective infection prevention is a strong IP plan; the first step of that plan is performing an IP gap assessment.

Elements of an Effective LTCF Infection Prevention Plan

An infection prevention plan should provide sufficient detail, but it does not need to be a lengthy document. The plan should have three key points:
• The IP problem you are addressing (gaps)
• The proposed solutions
• The estimated cost and overall ROI of that solution

An IP plan for long term care or assisted living facilities should be developed specifically for the unique needs of the location and its population. The threat of harmful pathogens is found throughout any long term care facility. To fight these pathogens, all disinfection strategies need to reach throughout the entire facility as well. It is vital to come up with a bundled facility disinfection plan that incorporates multiple infection prevention tools, is easy to implement, is comprehensive, and effective.

Focus on LTCF’s Biggest Culprits

While there are many areas to consider, your gap assessment should focus on areas of highest concern and the highest possibility of mitigation. Pneumonia is very common in long term care and assisted living facilities whose populations are older and have more underlying health conditions. Other infections include urinary tract infection, diarrheal diseases, antibiotic-resistant staph infections, C. difficile infections, and of course respiratory infections including the SARS-CoV-2, the virus that causes COVID-19. When looking at your organization’s gaps, focus on these health concerns, the areas in the LTCF in which they most often occur, and the residents who are most at risk. It might be necessary to have representation from various departments, including facilities and environmental services, to better understand their unique IP process so you can identify areas for improvement.

One additional consideration not often considered in an analysis of top concerns and mitigation responses is the ease of use and efficiency of any selected infection prevention strategies. LTCF IP tools are only as good as those that use them so ensuring new IP methods are easy to learn, easy to deploy, and easy to measure is a critical component of your gap analysis. While learning proper handwashing might be a good first step, consider how more advanced IP tools will be adopted by your team. For instance deploying a UVC system that is easily repositioned to address the more difficult-to reach parts of the room saves time while still ensuring effective disinfection.

It’s likely that the gaps you uncover through the IP group’s work will focus on relatively few areas. By quantifying the risks (both health and financial) of those gaps and deploying solutions that address the majority of them in the most efficient and effective way, you’ll be able to lower LTCF infection rates with one comprehensive plan.

Identify Gaps in Staff Training & Resident Information Dissemination

All long term care teams – facilities, direct care, and leadership – play a critical role in infection control efforts. Administrators are responsible for establishing disinfection protocols and providing the tools and resources to get the job done efficiently. Facilities teams are on the front lines to deploy infection prevention measures that reduce spread through cleaning and disinfection measures. Resident program staff can make a significant impact by working with residents to educate and monitor sanitation practices that reduce the spread of diseases. Incorporating training gaps and ways to address them for the entire LTCF staff should be a critical component in your IP plan. Make sure these plans include training for new IP equipment being purchased and ask your partner if they include training as part of your onboarding. Long term care facility staff that handles specialized equipment, such as UVC disinfection systems, should be properly versed in their use to maximize their effectiveness.

The residents in your facility should not be overlooked when developing an IP gap analysis. There are numerous ways to support residents in their own hygiene and cleaning efforts to stave off infection spread. Understand what materials should be disseminated and how to measure compliance in a resident-focused way.

The CDC offers many resources for long term care and assisted living staff training and resident support:

Identify Solutions with Proven Efficacy

The first step toward a better IP plan is increased awareness. However, choosing tools that offer proof of efficacy is a critical component to your overall IP plan. Quantifiable results and proof of compliance is needed in this time of increased IP need and public scrutiny. The American Journal of Infection Control notes that combining UVC technology with manual cleaning is one of the most effective ways to significantly decrease the pool of harmful pathogens that cause infection. Exposure to UVC light for a specific length of time and intensity kills dangerous microorganisms so deploying them in a long term care facility can combat the spread of dangerous infections, leading to better resident care and long-term saving for the facility.

The right UVC system will:
• Expand upon manual cleaning efforts to reduce the pool of pathogens present in the residential environment
• Lessen the human error factor by delivering proven, measured doses of UV light to eradicate pathogens
• Proactively reduce the costs incurred with treating resident infections and diseases
• Reduce post-infection cleaning service costs by preventing infection spread vs. addressing an outbreak
• Improve resident care and loved ones’ confidence in the facility

The RD UVC system can be deployed throughout long term care, nursing home, and assisted living facilities. It can supply proper dosing to all points of interest in both common and personal resident spaces. In addition, RD UVC is the only UVC disinfection system that measures, records and reports the UVC dosage delivered— in real-time—ensuring you have the proof of compliance data needed for potential government reporting and communication to residents and their families. RD UVC uses proven, patented remote sensors throughout a room that measure and ensure delivery of published UVC doses at all points of disinfection every time.

Evaluate Costs & Calculate ROI

According to Infection Control Today, deaths from infections in LTCF cost between $673 million to $2 billion each year. Although infections and resulting illnesses are typically reported in terms of resident outcomes, facilities need also look at mitigation costs to determine ROI for their eventual IP plan. Including this analysis and calculation in a gap assessment should help LTCF leadership prioritize and budget for the costs associated with increased IP activities. The business case and the case for return on investment by implementing new infection control measures are clear. Facilities must keep in mind the total cost of not effectively dealing with infections – not only treatment costs, but the cost of lost revenue because beds are occupied by infected patients, as well as the public perception and its overall negative impact on your organization’s reputation. If you need help calculating your overall HAI costs, organizations like the Association for Infection Control and Epidemiology (APIC) provide free cost calculators that address your facility-specific needs and costs.