Implementing Infection Prevention and Control Protocols in Nursing Home Amidst Covid-19
Regine Roy
NSG6999: Graduate Project in Nursing
Dr. Nancy Galyon
South University
July 19, 2020
Implementing Infection Prevention and Control Protocols in Nursing Homes Amidst COVID-19
Novel Coronavirus diseases (COVID-19) has presented a new challenge regarding infection control and prevention strategies and their implementation. Since the first case was detected in December 2019 in China, the disease has spread worldwide, infecting people of all ages, color, and religion. Of the millions that have been infected and died, the majority of them have been people with chronic diseases like diabetes, respiratory diseases, and the old. (Applegate & Ouslander, 2020). With the onset of COVID-19, the Centers for Disease Control and Prevention (CDC) developed public health measures to curb the spread of the pandemic that include social distancing, wearing of masks in public, and washing hands for 20 seconds. According to the CDC, the number of COVID-19 cases as of July 26th was at 2.5 million, with deaths of more than one hundred and twenty thousand. The majority of these deaths are attributed to nursing homes. By their provision of long-term skilled care and the resident population being served, nursing homes are at a higher risk of serious respiratory infections like COVID-19 infection. CDC (2020) notes that emergence of infectious diseases in these facilities can be due to the fact that the residents of these nursing homes are susceptible to infections, the residents share the same resources like air, food, and water with the general population that can lead to transmission of infections and that visitors and practitioners that can introduce and facilitate transmission if the interaction is not limited (Lai et al., 2020). Lai et al., (2020) argues that the likelihood of high morbidity and mortality in these institutions is repetitive, and any outbreak of the disease in these facilities can be of serious concern. Considering these, infection control remains an essential component in reducing the spread of COVID-19 in these nursing homes. Therefore, this article aims at discussing the development and implementation of infection control protocols in a nursing home related to covid-19.
According to CDC statistics of 2016, there were 15,600 nursing homes in the United States, with a total resident population of 1.4 million people, with a bed capacity of approximately 1.7 million. These nursing homes. The majority of these personnel are frail older people depending on Medicaid and Medicare support (National Center for Health Statistics, 2019). These facilities have clients with different needs that include chronic diseases, physical conditions, degenerative disorders, and mental issues. The number of working personnel includes administrators, skilled nursing providers, physiotherapists, educators, and ancillary services providers, among others who regularly visit these centers. Some centers also offer daycare services. All these increase the chances of introducing infection agents in these institutions, and therefore, the need for strict adherence to protocols (Kunz & Minder, 2020).
Target population
The protocol targets the staff and the visitors to the nursing homes as well as those clients who operate on a day to day basis. CDC (2020) recommends that nursing homes have personnel assigned to undertake the responsibility of ensuring the development and implementation of infection prevention protocol, enhance source control measures like wearing masks by healthcare providers and visitors, and restrict the number of visitors to their institutions. Under these protocols, healthcare providers and other support staff will be provided with the necessary training recommended by the CDC. Additionally, the staff will be provided with personnel protective equipment and visitors will be required to undergo disinfection process like handwashing. The clients, both daycare and residents, will be provided with information on infection control and provided with masks to reduce the chances of a person to person transmission.
Needs assessment
Clients of nursing homes are at a greater risk of developing infections as compared to the general population admitted in a general hospital (Herzig et al., 2016). Herzig et al. (2016) argues that due to the fact that these elderly, fragile and extremely sick people are susceptible to infectious agents, the infection control protocols are necessary as it serves to lower the risk of infections, reduce transmission of the infectious agents between the clients and the service providers, increase the quality of life of patients in in nursing homes, as well as lower the cost of provision of care. It also serves to reduce the duration of hospitalization of some patients.
Medicaid is the largest single payer of nursing home expenditures accounting for 45-65% of the expenditures and spent approximately $55 billion in 2015 in nursing homes (Henry Kaiser Family Foundation, 2017). The Congressional Budget Office notes expenditures by Medicaid to cover the nursing home budgets accounted for the fifteen percent of the fifty billion of the federal support to the Medicaid programs in 2018, and these expenses together with the Medicare and Social Security, are postulated to increase to the 9.8% of the total GDP by 2029 (Buntin & Graves, 2020). The implementation of infection prevention and control is therefore one of the ways of reducing the overhead costs.
Addition to the design and implementation of protocols during the COVID-19 era in nursing homes is an essential step that will not only see reduction of infections and expenditures but will also ensure seamless delivery of the vital healthcare services to those in need of long-term care. Therefore, the need for establishment and implementation of infection prevention and control for nursing homes as provided by the CDC is needed. These protocols will be designed to gather for the patients-both residents and visitors, healthcare providers and the visitors.
Theoretical framework
In implementing the protocols for the infection control in nursing homes amidst COVID-19, Icek Ajzen’s theory of planned behavior can be examined to guide the process. Theory of planned behavior serves to predict the intention of an individual to indulge in behavior at a given time and place (Conner, 2020). This theory explains the behaviors over which a person has the ability to exert self-control. It postulates that a behavior of a person to undertake a behavior is predicted by a person’s attitude towards that behavior as well as the subjective norms regarding that behavior. Subjective norms are description of behaviors of healthcare workers, patients and community. Positive attitude and subjective norms lead to a greater control and higher likelihood of intentions controlling behavior change. Theory of behavior change is a valuable tool in predicting the behaviors of people, planning and implementing the health promotion and preventive measures.
Through this model, it helps predict the willingness of clients and health workers and their adherence to observing social distance, undertake hand washing as well as wearing face masks. The CDC’s recommendation on the COVID-19 preventive measures is purely behavioral changes and thus this is the most suitable model for the study. People will be given lessons on social distancing, its practicability and importance. This will be done through lectures, presentations and print pamphlets after which a period of observation. Also, the target hand washing techniques for at least 20 seconds will be given and observations made. The wearing of face masks will be made a mandatory requirement when entering in the nursing home. All these observations will be made, and subjective description given describing the attitudes, behavioral intention and their ability to control their behavior will be identified and discussed.
References
Applegate, W. B., & Ouslander, J. G. (2020). COVID‐19 presents high risk to older persons. Journal of the American Geriatrics Society, 68(4), 681.
Buntin, M. B., & Graves, J. A. (2020). How The ACA Dented The Cost Curve: An analysis of whether or not the Affordable Care Act reduced the annual rate at which total national health care costs increased and brought per capita health spending growth rates down. Health Affairs, 39(3), 403-412.
CDC(a) (2020) Preparing for COVID-19 in Nursing Homes. https://www.cdc.gov/coronavirus/2019-ncov/hcp/long-term-care.html
CDC(b) (2020, April 14) Applying COVID-19 Infection Prevention and Control Strategies in Nursing Homes https://emergency.cdc.gov/coca/calls/2020/callinfo_061620.asp
CDC (c) Coordinating and Aligning COVID-19 Nursing Home Infection Control Practice Assessment Activities https://scdhec.gov/sites/default/files/media/document/COVID-19- NURSING-HOME-IPC-ASSESSMENT-ACTIVITY_4.10.2020.pdf
Conner, M. (2020). Theory of planned behavior. Handbook of Sport Psychology, 3.
Herzig, C. T., Stone, P. W., Castle, N., Pogorzelska-Maziarz, M., Larson, E. L., & Dick, A. W. (2016). Infection prevention and control programs in US nursing homes: results of a national survey. Journal of the American Medical Directors Association, 17(1), 85-88.
The Henry Kaiser Family Foundation (June 20, 2017). Medicaid’s role in Nursing Home Care. https://www.kff.org/infographic/medicaids-role-in-nursing-home-care/
Kunz, R., & Minder, M. (2020). COVID-19 pandemic: palliative care for elderly and frail patients at home and in residential and nursing homes. Swiss Medical Weekly, 150(1314).
National Center for Health Statistics. (2019). Long-term care providers and services users in the United States, 2015-2016.
Lai, C. C., Wang, J. H., Ko, W. C., Yen, M. Y., Lu, M. C., Lee, C. M., & Hsueh, P. R. (2020). COVID-19 in long-term care facilities: An upcoming threat that cannot be ignored. Journal of Microbiology, Immunology, and Infection, 53(3), 444.