Hospital and Skilled Nursing Facility Collaboration Reduces Infections: September 24, 2019

By Fischer, Cathy; Drake, Jaime | American Nurse Today, September 2019 | Go to article overview

Hospital and Skilled Nursing Facility Collaboration Reduces Infections: September 24, 2019


Fischer, Cathy, Drake, Jaime, American Nurse Today


IN RESPONSE to healthcare challenges presented by antibiotiresistant infections, increasingly more complex patients, and patient transfers from hospitals into long-term care facilities, the Centers for Medicare and Medicaid (CMS) is requiring that all federally supported skilled nursing facilities (SNFs) have a trained infection preventionist (IP) on staff by November 2019. Surveyors will require written infection prevention and control policies based on current evidence-based practice guidelines. This mandate provides an opportunity to create infection prevention strategies throughout the continuum of care.

In 2017, the infection prevention department at CarolinaEast Medical Center (a 350-bed, not-forprofit, full-service community hospital) began a collaborative journey that stopped an outbreak of deadly super-bugs in two SNFs, reduced surgical site infections (SSIs) in a third, and ultimately improved outcomes in a community of healthcare facilities.

Call to action

Approximately 12% of the overall discharges from CarolinaEast Medical Center go to SNFs. The medical center's laboratory performs all of the cultures for the community SNFs, and the three hospital IPs (all RNs) monitor culture results as part of routine surveillance. In 2017, a pan-resistant Acinetobacter baumannii infection emerged at one of the SNFs and a multidrug-resistant A. baumannii, sensitive only to meropenem, emerged at another. Carbapenem-resistant Enterobacteriaceae was identified in both facilities. A third SNF experienced an SSI outbreak in orthopedic patients discharged for rehabilitation. On readmission interviews, patients reported and demonstrated improper bathing techniques or lack of skin cleansing at the SNF.

The combination of the SSI outbreak and the new multidrug-resistant organisms (MDROs) was a call to action for the hospital IPs. Even though the patients weren't in the hospital, they might be admitted or readmitted and potentially transmit these organisms.

The hospital IPs contacted the Statewide Program for Infection Control and Epidemiology (SPICE), the North Carolina Department of Health and Human Services, and area health education consultants to brainstorm and assist in developing a collaborative process that would include local post-acute healthcare facilities. SPICE infection control assessment and response (ICAR) results were presented, and a targeted education plan was developed based on those results. (See About SPICE.) The education program would be provided by the hospital IPs free of charge to all local SNFs, and the SNF IPs would be recruited to partner with hospital IPs for a successful education program and strategy implementation.

Existing relationships between hospital acute care discharge planners and SNF staff provided an avenue to establish initial contact. At their scheduled monthly meeting, an invitation was extended to all those attending to participate in a collaborative project to examine best practices, reduce infections, and improve the continuum of care. ICAR data were shared, and an improvement proposal presented. One SNF was immediately motivated to participate and was instrumental in developing the process change. Four months later, a second facility came on board followed by a third after another 4 months.

In North Carolina, the Statewide Program for Infection Control and Epidemiology (SPICE) conducts on-site infection control assessment and response (ICAR) evaluations across the state in a variety of healthcare settings, including long-term care. ICAR, which is funded by the Centers for Disease Control and Prevention and North Carolina Division of Public Health, Communicable Disease Branch, is also available online for use when an on-site evaluation can't be conducted.

The goal of ICAR evaluations is to identify opportunities for improving infection prevention practices across the continuum of healthcare. When evaluations are completed, facilities are provided with:

* a written report of the findings

* recommendations for improvement. …

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