1207. Coronavirus Disease, 2019 (COVID-19) in Long-Term Care Facilities (LTCF): One Large County’s Response, California 2020-2021

Infection Prevention and Control (IPC) describes a set of practices that aim to prevent the spread of infections, including health care–associated infections (HAIs) and emerging infectious diseases—like COVID-19—in health care facilities and other congregate settings. IPC includes hand hygiene, use of personal protective equipment (PPE), safe injection practices, and proper environmental cleaning. The National Association of County and City Health Officials' (NACCHO) IPC Champion recognition aims to highlight the IPC achievements of local health departments (LHDs) and honor the staff leading this work. NACCHO IPC Champions are passionate, well-versed, and respected individuals working in local public health who are advancing infection prevention and control capacity, activities, guidelines, and engagement. They are knowledgeable and enthusiastic about infection prevention and control. They promote and lead HAI prevention initiatives by educating colleagues and partners, preventing and responding to outbreaks, solving problems, and leveraging lessons learned to improve policies and practices. IPC champions: Build and strengthen partnerships between local public health and facilities (health care and other congregate settings) in their communities to build trust and to develop a reputation as a community IPC resource; Facilitate communication between and across facilities to identify and stop interfacility transmission; Identify and respond to outbreaks in facilities of HAIs, including COVID-19; Strategize to proactively prevent infections and improve IPC efforts; Engage and educate internal staff and external partners to increase their buy-in and awareness of IPC; Apply lessons learned to improve policies and practices in their community—and potentially, across the state/country; and Speak up to illustrate the needs of LHDs in this work and to share experiences and insights. To date, NACCHO has featured the IPC work of health departments in Mobile County, Alabama, Prince George's County, Maryland, Fairfax County, Virginia, and DuPage County, Illinois. Individual spotlights have also recognized Dr Stephanie R. Black, Medical Director of the Communicable Disease Program at the Chicago Department of Public Health; Dr Matt Zahn, Medical Director for the Epidemiology, Assessment, and Immunization Program at the Orange County Health Care Agency in California; and Dr Dawn Terashita, Associate Director for the Acute Communicable Disease Control Program at the Los Angeles County Department of Public Health, for their impact promoting IPC practices in their community and beyond. Mobile County Health Department During the height of the COVID-19 pandemic, the Mobile County Health Department's (MCHD) Infection Prevention Team (IPT) utilized a community-centered approach to combat the spread of the virus in Alabama. They partnered with community organizations, local health care providers, K-12 schools, and other high-risk congregate settings to better understand the needs of underserved communities and provide essential epidemiological resources (eg, case investigations, contact tracing, data entry and surveillance, outbreak testing, and infection prevention education resources). They also worked with county-employed dentists to provide IPC information to facility partners early in the pandemic to support nursing homes and other congregate care settings. The IPT conducted more than 30 community-wide outreach events, which included the provision of more than 2500 rapid COVID-19 tests, as well as lodging and food for 700 COVID-positive members of the homeless community when local shelters were unable to provide isolated facilities. When staffing shortages, testing, and personal protective equipment (PPE) resource scarcity impacted long-term care facilities (LTCFs), the Mobile County stepped in to provide PPE and utilized their partnership with an ambulance service to provide tests. In addition to responding once an outbreak occurred, Mobile County's IPT worked to help LTCFs prepare more proactively for outbreaks by keeping regular contact on guidance updates, supply needs, and reporting regulations. Their efforts to strengthen relationships in this way have allowed partner facilities to request and receive support more frequently from the MCHD. Prince George's County Health Department The Fostering Local Infection Prevention Control & Capacity (FLIP-CC) Project Team was established as a cross-collaborative effort across the Health and Wellness Division, the Communicable and Vector-borne Disease Control Program, and the Public Health Emergency Preparedness Team at Prince George's County Health Department in Maryland. They credit the resultant diversity in skills and experiences with IPC as a major factor in their success mitigating the impact of the COVID-19 pandemic within their community. Throughout the pandemic, the FLIP-CC Team provided high-risk facilities with ongoing assessments, facilitated frequent meetings and communications, reviewed data to inform outbreak status protocols, and provided customized technical assistance on IPC for frontline workers. FLIP-CC also worked with the LHD's strike team to improve vaccination rates for the most vulnerable populations in their community, resulting in remarkable decreases in COVID-19 case rates and hospitalizations. Another significant accomplishment was the low to zero bloodstream infection rates reported from local dialysis facilities during this time, indicating that IPC practices communicated by FLIP-CC were in place and being followed properly. In utilizing direct feedback from local health care teams in dialysis, nursing homes, and assisted living facilities, the FLIP-CC Team was able to design specialized technical assistance and capacity-building activities. Facility directors also became more aware of the services provided by the LHD and viewed them as a reliable and trusted source of information that they could request resources from. Fairfax County Health Department In collaboration with state and national partners, the Fairfax County Health Department's Acute Communicable and Emerging Diseases (ACED) Program strategically built and maintained partnerships with local care facilities to disseminate IPC resources and guidance in Virginia. These partnerships fostered peer-to-peer sharing of best practices and lessons learned in Fairfax County such that they could inform and advise state-level stakeholders on measures to optimize IPC measures within their health care facilities. During the COVID-19 pandemic response, ACED's interactions with facilities expanded to include surveillance and reporting, more frequent site visits with an emphasis on ensuring compliance with mitigation measures, assessment of PPE use and other infection prevention measures, outbreak investigations, and support for tests and vaccinations. In addition to on-site communication, they expanded outreach to include monthly webinar meetings with LTCF partners to provide COVID-19, HAI, and antimicrobial resistance updates. The team's IPC work has also expanded to include collaborations and consultations with the County's correctional facility, homeless services programs, and shelters. The results of their efforts include improved disease reporting from LTCFs, resulting in the investigation of cases and prevention of further infection. The ACED Program's investment in building partnerships has also led to greater success in collecting data from local facilities. These partnerships have resulted in improved collaboration and involvement with activities such as Infection Control Assessment and Response visits, PPE training, and respiratory fit testing. LTCF staff and residents in Fairfax County also exceeded the national rates for early COVID-19 first-dose vaccination coverage as reported by the Centers for Disease Control and Prevention (CDC) in a Morbidity and Mortality Weekly Report released on February 5, 2021. DuPage County Health Department The DuPage County Health Department's HAI team was established in 2012 with support from NACCHO and the CDC to better identify and understand the impact of HAIs, multidrug-resistant organisms, and extensively drug-resistant organisms within their jurisdiction. Since then, they have had extensive on-site and remote engagement with local LTCFs to conduct point-prevalence surveys, infection control audits, and follow-up visits and provide educational support and infection prevention guidance resources in conjunction with the Illinois Department of Public Health staff. When the COVID-19 pandemic arose, the HAI team quickly shifted and expanded their focus to COVID-19 surveillance, investigation, and prevention and control activities in congregate health care facilities, educational settings, and business/workplaces in DuPage County, Illinois. They have improved relationships and responsiveness through regular outreach efforts and by continuing to identify partners and their team roles (eg, medical director, infection prevention designee, director of nursing, environmental services) in their consultation and outreach efforts toward multidisciplinary engagement. Internally, DuPage County Health Department functioned as a hub to receive and provide PPE to facilities in their jurisdiction, particularly LTCFs that experienced extreme PPE shortages for several months. Beyond infection prevention and control challenges, the DuPage County Health Department is also committed to addressing health inequities. The DuPage County COVID-19 Health Equity and Access Response Team (HEART) was established through a partnership between the DuPage Health Coalition, DuPage Federation for Human Services Reform, Impact DuPage, and the DuPage County Health Department. HEART provides a countywide voice for health equity and access, ensuring that all residents of DuPage County reach the highest level of health possible. Their most recent priorities include supporting and coordinating vaccination clinics through community outreach, multilingual COVID-19 vaccine surveys to assess COVID-19 vaccine hesitancy and build confidence, and the recruitment of Health Ambassadors for public service announcements, interviews, and town hall meetings. These LHDs serve as role models for their innovative approaches to reduce the burden of infectious disease in their communities. For more information on characteristics of NACCHO's IPC Champions, or to nominate yourself or a colleague for consideration, visit https://www.naccho.org/programs/community-health/infectious-disease/infectious-disease-prevention-and-control/infection-prevention-and-control-champions.

Background: The novel coronavirus (COVID-19) pandemic has caused significant morbidity and mortality in California: 2,218,000 cases and 24,598 deaths had occurred by December 31, 2020. Deaths at skilled nursing facilities (SNFs) and assisted living facilities (ALFs) comprise 26.2% of deaths in California; the fatality rate (299 per 10,000 SNF and ALF residents) in such facilities is nearly 50 times the statewide COVID-19 mortality rate (6.4 per 10,000 California residents). For healthcare facility (SNF, ALF, acute-care hospitals) and correctional facility outbreak management, the California Department of Public Health (CDPH) Healthcare-Associated Infections (HAI) Program deployed trained infection preventionists (IPs) to perform on-site infection prevention and control (IPC) assessments and to provide recommendations to staff and local health departments (LHDs). We describe the number and distribution of visits across the state and common IPC challenges identified. Methods: From February 1, 2020, to December 31, 2020, CDPH IP visits were requested directly by facilities, coordinated through LHDs and other state agencies, or prompted by a facility’s increasing case count on twice weekly review of the daily California healthcare facility data survey (Survey 123). Deployed IPs evaluated facility COVID-19 IPC protocols, assessed facility staff adherence using a standardized assessment tool, and provided verbal feedback followed by written summary reports and recommendations. We categorized visits geographically into 5 California Health Officer Association regions and by month, and we reviewed visit reports for common findings. Results: In total, 623 visits were performed for 489 outbreaks at 465 distinct facilities across 46 LHDs; 71 facilities received ≥2 visits. Southern California facilities received 292 visits (46.9%), San Joaquin region facilities received 138 visits (22.2%), Bay Area facilities received 131 visits (21%), Greater Sacramento facilities received 54 visits (8.7%), and Rural North facilities received 8 visits (1.3%) (Figure 1). The highest number of visits per month occurred in December (n = 143, 22.9%), followed by July (n = 87, 13.9%), and April (n = 83, 13.3%). Common IPC challenges included inappropriate resident cohorting practices, improper use of personal protective equipment, and lapses in physical distancing, and source control in breakrooms. Conclusions: On-site visits by CDPH IPs during the COVID-19 pandemic in California, though resource-intensive, provided substantial technical support for healthcare facilities during outbreaks and identified key areas for IPC improvement. Ongoing CDPH HAI guidance and training materials for facility-based IP staff are now being informed by these IPC challenges.Funding: NoDisclosures: None

Background: Skilled nursing facilities (SNFs) face many challenges implementing robust infection prevention and control (IPC) programs. The Philadelphia Department of Public Health (PDPH) partnered with APIC Consulting Services, a wholly owned subsidiary of The Association for Professionals in Infection Control and Epidemiology (APIC), to provide IPC mentoring to Philadelphia SNFs. The objective of the program was to strengthen IPC capacities by providing an in-depth IPC assessment followed by an action plan and longitudinal infection preventionist (IP) support to mitigate identified gaps. Methods: A health equity framework based on area deprivation index (ADI), percent of residents on Medicaid, and Centers for Medicare & Medicaid (CMS) star rating was developed to identify priority SNFs for recruitment into the voluntary program. Participating SNFs received a three-day onsite IPC assessment with an expert IP consultant using an expanded version of the Centers for Disease Control Infection Control Assessment and Response (ICAR) tool. Assigned consultants provided mentorship and education for the SNF IP for up to six months. Each facility identified 4-5 focus areas and co-developed an action plan with the consultant. SNF assessment data collected July 2023 -May 2024 were analyzed to assess IPC gaps across facilities. Results: Participants included 11/46 (24%) Philadelphia SNFs, including 8/18 (44%) priority facilities. Median facility size was 189 beds and median census was 164 residents. Program completion rate was 73%. Consultants performed 66 onsite visits and 26 remote visits, totaling over 1,752 hours of support. Median number of IPC gaps identified was 79 (IQR: 57-84), most frequently within the domains of environmental cleaning and disinfection (13%); water management (10%); and training, auditing, and feedback (9%). Common facility-chosen action plan focus areas included disease surveillance (24%), antibiotic stewardship (16%), and hand hygiene (13%). Main barriers to program completion included lack of leadership support (18%) and staff turnover (9%). Conclusions: Expert-driven longitudinal support can be an effective strategy for enhancing IPC capacity within low resourced SNFs and a data-based health equity framework can be used to prioritize facilities for support. Through targeted mentorship, this program identified and addressed gaps in IPC practices and fostered a culture of safety. Most common action plan focus areas selected by the facilities did not align with IPC topic areas where most recommendations were given, highlighting potential SNF IPC program areas that may be challenging for facilities to address and where further education and resources are needed.

Cultural determinants of infection control behaviour: understanding drivers and implementing effective change

Infection prevention and control, lessons from the COVID-19 pandemic and what happens next?

Background Europe's population is ageing. Long-term care facilities (LTCFs) for this vulnerable population are often relatively homelike with low staff-to-resident ratios. In 2016-2017, ECDC coordinated its third point prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in European long-term care facilities (LTCFs). It included collection of data on structure and process indicators (SPIs) of infection prevention and control (IPC) and antimicrobial stewardship, to support countries' identification of national and local interventions in LTCFs. Methods In each country, national contacts recruited a convenience sample of LTCFs. National/LTCF PPS teams used a standard protocol that included case definition algorithms (adapted US CDC/SHEA definitions) applied to each resident with signs/symptoms of infection on the PPS day, and questions for LTCF staff on SPIs of IPC and antimicrobial stewardship activities. Denominators indicate the number of responses available for analysis. Results 3,052 LTCFs in 24 EU/EEA countries were recruited, with 102,301 residents included. The prevalence of HAIs (residents with ≥1 HAI) was 3.7%. Although 1,524/1,623 (94%) LTFS had a hand hygiene (HH) protocol, only 1,046/1,585 (66%) LTCFs had organised ≥1 HH training session for care professionals during the previous year. 1,185/1,561 (76%) LTCFs reported IPC training of nursing and paramedical staff. Only 340/1,639 (21%) of LTCFs reported training on appropriate prescribing and 493/1,623 (30%) LTCFs had provided feedback to GPs on antimicrobial consumption. On the PPS day, annual antimicrobial consumption data were available to only 530/1,623 (32%) LTCFs. Conclusions Even in LTCFs with the capacity to perform this PPS, IPC training was non-ubiquitous and antimicrobial stewardship activities, including training, were rarely reported. ECDC encourages EU/EEA countries to recruit LTCFs to participate in future PPSs, to allow them to benchmark HAI rates and practices. Key messages The prevalence of healthcare-associated infections in European long-term care facilities (LTCFs) highlights their requirement for infection prevention and control (IPC) and antimicrobial stewardship. This multi-national point prevalence survey (PPS) indicates that European countries can consider reinforcing IPC, antimicrobial stewardship practices and participation in PPSs in LTCFs.

Looking back to move forward

A Look Into LTC's Future: Inspector General's 2012 Work Plan Foreshadows Enforcement

Background: In 2021, the California Department of Public Health Healthcare-Associated Infections Program developed new infection prevention and control (IPC) training for skilled nursing facility (SNF) certified nursing assistants (CNAs), as part of the CDC Project Firstline. CNAs comprise approximately one-third of SNF healthcare personnel (HCP) nationwide; ~50,000 CNAs are employed in California SNFs. Despite making up a large proportion of direct care HCP, CNAs can frequently lack understanding of fundamental IPC practices, including hand hygiene and appropriate personal protective equipment use. We conducted a learning needs assessment for SNF can and leadership to understand and design our program to mecanCNA IPC training needs and preferences. Methods: We distributed the learning needs assessment via SurveyMonkey in English and Spanish with questions regarding current IPC practices and challenges, as well as preferred training delivery methods and posttraining support. We leveraged partnershipscanth CNA-affiliated organizations to engage CNAs throughout California. Results: Of 193 respondents, 80 (41%) were CNAs and 113 (59%) were leadership staff, representing 97 SNFs in 41 local health jurisdictions. Among CNAs, 34 (43%) believed that they had to do workarounds in their IPC practice and 18 (23%) stated that they would benefit from one-on-one question-and-answer sessions with an infection prevention expert. Also, 50 (63%) selected visual learning, 34 selected (43%) in-person learning, and 30 (38%) selected live or online trainings as their preferred learning style and training method. Most CNAs stated that they were most comfortable listening and speaking (73%) and reading (76%) in English only, followed by listening and speaking (16%) and reading (13%) in English and Spanish. For posttraining support, CNAs preferred access to online training materials (75%), digital materials (68%), virtual office hours with IPC educators (53%), and regular webinars (49%). Conclusions: The results of our learning needs assessment confirm the need for accessible IPC training and materials and continued engagement with posttraining support for CNAs. We will continue to provide online training and resources, access to IPC experts including an ‘AskBox’ for CNAs to e-mail IPC questions or request one-on-one support, and monthly office hours. Even though most CNAs are comfortable with training in English only, we will translate curricula into Spanish to support our bilingual Spanish-canaking CNA population. We are developing a tool kit to support SNFs and local health jurisdictions interested in providing their own training using our materials, and we will offer icanerson CNA training. We will use our experience from this process in future learning needs assessments to inform other frontline HCP training, including for SNF environmental services staff.Funding: NoneDisclosures: None

BackgroundLegionnaires’ disease (LD) causes significant morbidity and mortality to hospital patients and residents of skilled nursing facilities (SNF). In California, LD is reportable to local health departments via the California Reportable Disease Information Exchange (CalREDIE) surveillance system. Cases are classified as suspected or confirmed using Centers for Disease Control and Prevention (CDC) definitions. The California Department of Public Health (CDPH) Healthcare-Associated Infections (HAI) Program maintains a database of healthcare-associated LD (HA-LD) and consults with local public health departments for single cases and outbreaks.MethodsWe described characteristics of confirmed HA-LD cases in 2015–2017. We classified HA-LD as definite if patient had continuous exposure in a facility for 2–10 days prior to symptom onset and possible if patient had overnight exposure in a facility for a portion of 2–10 days prior to symptom onset.ResultsFrom 2015 to 2017, 125 (8%) of 1,554 confirmed LD cases were HA-LD. Of these, 73 (58%) were definite HA-LD and 52 (42%) were possible HA-LD. The majority of HA-LD cases (N = 99, 79%) occurred in southern California. SNF were associated with 57 cases (46%) and hospitals with 44 cases (35%); 23 cases (18%) had exposures in both SNF and hospitals during the incubation period. Among the definite HA-LD cases, 50 cases (68%) had exposures in a single SNF. The median age of patients with HA-LD was 77 years. The HAI Program consulted with 15 local public health agencies on 33 HA-LD investigations, including 7 outbreaks and 26 single-case investigations.ConclusionHA-LD represented a small but important percentage of LD in California; the majority occurred in SNF. To prevent HA-LD, California hospitals and skilled nursing facilities should implement water management programs, as recommended by CDC and required by the Centers for Medicare and Medicaid Services (CMS) since June 2017. Public health agencies should respond rapidly to investigate HA-LD cases and control outbreaks.DisclosuresAll authors: No reported disclosures.

In resource-constrained healthcare settings such as in India, effective infection prevention and control (IPC) practices are essential for reducing healthcare-associated infections (HAIs) and enhancing patient outcomes. This study aimed to evaluate a customized IPC model implemented in Indian hospitals to address these challenges and improve patient safety. The model was designed to be replicable by other hospitals with similar objectives. The multicenter pre-post quality improvement study was conducted across 11 Indian private tertiary hospitals from January 2022 to June 2023, with a 6 months preintervention phase (January-June 2022) and a 12 months intervention phase (July 2022-June 2023). Following the World Health Organization (WHO) guidelines, the study employed a stepwise methodology, including induction, HAI data collection, baseline assessments using WHO's Infection Prevention and Control (IPC) Assessment Framework (IPCAF) tool to evaluate IPC level, team formation, training, surveillance, and audit protocols. The intervention phase focused on comprehensive IPC training, virtual courses, and IPC surveillance. The project utilized the IPC model to enhance the methodology of implementing IPC, enabling transition over an 18-month duration. Significant improvements were observed in IPC assessment scores, hand hygiene compliance, and adherence to IPC care bundles during the intervention phase. IPC assessment scores remarkably improved from a median of 78-97% (p = 0.004), with hospitals remaining in the advanced IPC level both pre and post intervention. Compliance toward hand hygiene improved from a median of 65% in the preintervention phase to 88% in the postintervention phase (p = 0.004). Significant improvement in compliance with IPC care bundles were observed for CAUTI (p = 0.016), CLABSI (p = 0.004), SSI (p = 0.010), and VAP (p = 0.037).Overall, HAI incidence rates remained consistently low during the study period with no statistically significant difference (p > 0.05) between preintervention and postintervention rates; however, variability across individual hospitals highlights differences in settings and indicates further strengthening and standardization of IPC practices. This quality improvement initiative highlights that a structured, WHO-aligned IPC approach can be practically adopted across Indian hospitals and can strengthen key IPC practices such as hand hygiene and care bundle compliance. With HAI rates already low at baseline and remaining stable over the study period, the findings primarily highlight the feasibility and scalability of such IPC programs across diverse healthcare settings.

Background: Infection prevention and control (IPC) programs are important to control the Lassa Fever (LF) outbreak. We reported IPC's status at the Federal Medical Centre, Owo, southwest Nigeria, before and after implementing the IPC program during a surge in the LF outbreak.
 Methods: We conducted a longitudinal observational study among five health care professionals at the Federal Medical Centre, Owo, between February 2019 and May 2019 using the IPC Assessment Framework (IPCAF). The tool has eight core components with a score of 0-100 per component and provided a baseline assessment of the IPC program and evaluation after three months. We interviewed relevant unit heads and IPC committee members in the first phase. In the second phase, we designed and implemented the IPC program, and in the third phase, we conducted a repeat interview similar to the first phase. The program initiated included training healthcare workers and providing relevant IPC items according to identified gaps and available funding.
 Results: We interviewed five health care professionals, two female nurses, and three male doctors responsible for organizing and implementing IPC activities at the Federal Medical Centre, Owo, with an in-depth understanding of IPC activities. The overall IPC level score increased from 318.5 at baseline to 545 at three months later. IPC improvements were reported in all the components, with IPC education and training [baseline (20), final (70)], IPC guidelines [baseline (50), final (92.5)] and monitoring/audits of IPC practices and feedback [baseline (40), final (82.5)] recording the highest improvements. Healthcare-associated infection [baseline (10), final (25)], and built environment, materials, and equipment for IPC [baseline (43.5), final (55)] had the least improvement. Poor motivation to adopt recommended changes among hospital staff were major issues preventing improvements.
 Conclusion: Promotion of IPC program and activities should be implemented at the Federal Medical Centre, Owo.
 
 References
 
 World Health Organization, WHO. Lassa fever. Available from: https://www.who.int/health-topics/lassa-fever/#tab=tab_1. [Accessed on 11 October 2020]
 Nigeria Centre for Disease Control. Lassa fever. Available from: https://ncdc.gov.ng/diseases/factsheet/47. [Accessed on 11 October 2020].
 World Health Organization, WHO. Lassa fever. Available from: https://www.who.int/news-room/fact-sheets/detail/lassa-fever. [Accessed on 11 October 2020].
 Ijarotimi IT, Ilesanmi OS, Aderinwale A, Abiodun-Adewusi O, Okon IM. Knowledge of Lassa fever and use of infection prevention and control facilities among health care workers during Lassa fever outbreak in Ondo state, Nigeria. Pan Afr Med J. 2018; 30:1-13. https://doi.org/10.11604/pamj.2018.30.56.13125
 Mateer EJ, Huang C, Shehu NY, Paessler S. Lassa fever–induced sensorineural hearing loss: A neglected public health and social burden. PLoS Negl Trop Dis. 2018;12(2):1-11. https://doi.org/10.1371/journal.pntd.0006187
 Ijarotimi I., Oladejo J., Nasidi A, Jegede O. Lassa fever in the State Specialist Hospital Akure, Nigeria: Case report, Contact tracing and outcome of hospital contacts. Int J Infect Trop Dis. 2016;3(1):20-28. https://doi.org/10.14194/ijitd.3.1.4
 Ireye F, Ejiyere H, Aigbiremolen AO, Famiyesin OE, Rowland-Udoh EA, Ogeyemhe CO, Okudo I, Onimisi AB. Knowledge, attitude and infection prevention and control practices regarding Lassa fever among healthcare workers in Edo State, Nigeria. Int J Prev Treat. 2019;8(1):21-27. https://doi.org/10.5923/j.ijpt.20190801.03
 World Health Organization. Infection prevention and control assessment framework at the facility level. 2018; 2016:1-15. Available from: https://www.who.int/infection-prevention/tools/core-components/IPCAF-facility.PDF?ua=1 [Accessed on 11 October 2020].
 World Health Organization, WHO. Communicable disease surveillance and response systems - Guide to monitoring and evaluating. Epidemic and pandemic alert and response. Published online 2006:90. doi: rr5305a1 [pii]
 Ousman K, Kabego L, Talisuna A, Diaz J, Mbuyi J, Houndjo B, et al. The impact of Infection Prevention and control (IPC) bundle implementation on IPC compliance during the Ebola virus outbreak in Mbandaka/Democratic Republic of the Congo: A before and after design. BMJ Open. 2019;9(9):1-6. https://doi.org/10.1136/bmjopen-2019-029717
 Nzinga J, Mbindyo P, Mbaabu L, Warira A, English M. Documenting the experiences of health workers expected to implement guidelines during an intervention study in Kenyan hospitals. Implement Sci. 2009;4(1):1-9. https://doi.org/10.1186/1748-5908-4-44.
 Ataiyero Y, Dyson J, Graham M. Barriers to hand hygiene practices among health care workers in sub-Saharan African countries: A narrative review. Am J Infect Control. 2019 May;47(5):565-573. https://doi.org/10.1016/j.ajic.2018.09.014.
 Gilbert GL, Kerridge I. The politics and ethics of hospital infection prevention and control: a qualitative case study of senior clinicians’ perceptions of professional and cultural factors that influence doctors’ attitudes and practices in a large Australian hospital. BMC Health Serv Res. 2019; 19(212). https://doi.org/1186/s12913-019-4044-y.
 

The COVID-19 pandemic exposed the lack of infection prevention and control (IPC) infrastructure among long-term care facilities (LTCFs) in the United States; the situation in Alabama is particularly dire with LTCFs receiving some of the lowest quality ratings in the country. Alabama's LTCFs continue to be challenged by frequent staff turnover, vaccine hesitancy, and reluctance to embrace new Centers for Disease Control and Prevention (CDC) recommendations such as enhanced barrier precautions. However, the American Rescue Plan of 2021 made funds available to states through a CDC Epidemiology and Laboratory (ELC) Cooperative Agreement to promote IPC system improvement, including the creation of the Alabama Nursing Home and Long-Term Care Strike Team (LTC Strike Team). In this article, we reviewed preliminary data from Alabama for the first year of the 2-year cooperative agreement cycle (2022--2023). Data included activity tracking by Infection Preventionists (IPs) and evaluations submitted voluntarily by LTCFs upon completion of trainings and/or direct services provided by the LTC Strike Team. Results indicated a significant need for IPC training among LTCFs and a high level of satisfaction with the services provided by IPs. Despite successes, it is unclear if future funding will be available to support long-term sustainability efforts.

Hospitalizations among skilled nursing facility (SNF) residents in Detroit increased in mid-March 2020 due to the coronavirus disease 2019 (COVID-19) pandemic. Outbreak response teams were deployed from local healthcare systems, the Centers for Disease Control and Prevention (CDC), and the Detroit Health Department (DHD) to understand the infection prevention and control (IPC) gaps in SNFs that may have accelerated the outbreak. We conducted 2 point-prevalence surveys (PPS-1 and PPS-2) at 13 Detroit SNFs from April 8 to May 8, 2020. The DHD and partners conducted facility-wide severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing of all residents and staff and collected information regarding resident cohorting, staff cohorting, and personnel protective equipment (PPE) utilized during that time. Resident cohorting had been implemented in 7 of 13 (58.3%) SNFs prior to point-prevalence survey 1 (PPS-1), and other facilities initiated cohorting after obtaining PPS-1 results. Cohorting protocols of healthcare practitioners and environmental service staff were not established in 4 (31%) of 13 facilities, and in 3 facilities (23.1%) the ancillary staff were not assigned to cohorts. Also, 2 SNFs (15%) had an observation unit prior to PPS-1, 2 (15%) had an observation unit after PPS-1, 4 (31%) could not establish an observation unit due to inadequate space, and 5 (38.4%) created an observation unit after PPS-2. On-site consultations identified gaps in IPC knowledge and cohorting that may have contributed to ongoing transmission of SARS-CoV-2 among SNF residents despite aggressive testing measures. Infection preventionists (IPs) are critical in guiding ongoing IPC practices in SNFs to reduce spread of COVID-19 through response and prevention.

BackgroundThe core components (CCs) of infection prevention and control (IPC) from World Health Organization (WHO) are crucial for the safety and quality of health care. Our objective was to examine the level of implementation of WHO infection prevention and control core components (IPC CC) in a developing country. We also aimed to evaluate health care-associated infections (HAIs) and antimicrobial resistance (AMR) in intensive care units (ICUs) in association with implemented IPC CCs.MethodsMembers of the Turkish Infectious Diseases and Clinical Microbiology Specialization Association (EKMUD) were invited to the study via e-mail. Volunteer members of any healt care facilities (HCFs) participated in the study. The investigating doctor of each HCF filled out a questionnaire to collect data on IPC implementations, including the Infection Prevention and Control Assessment Framework (IPCAF) and HAIs/AMR in ICUs in 2021.ResultsA total of 68 HCFs from seven regions in Türkiye and the Turkish Republic of Northern Cyprus participated while 85% of these were tertiary care hospitals. Fifty (73.5%) HCFs had advanced IPC level, whereas 16 (23.5%) of the 68 hospitals had intermediate IPC levels. The hospitals’ median (IQR) IPCAF score was 668.8 (125.0) points. Workload, staffing and occupancy (CC7; median 70 points) and multimodal strategies (CC5; median 75 points) had the lowest scores. The limited number of nurses were the most important problems. Hospitals with a bed capacity of > 1000 beds had higher rates of HAIs. Certified IPC specialists, frequent feedback, and enough nurses reduced HAIs. The most common HAIs were central line-associated blood stream infections. Most HAIs were caused by gram negative bacteria, which have a high AMR.ConclusionsMost HCFs had an advanced level of IPC implementation, for which staffing was an important driver. To further improve care quality and ensure everyone has access to safe care, it is a key element to have enough staff, the availability of certified IPC specialists, and frequent feedback. Although there is a significant decrease in HAI rates compared to previous years, HAI rates are still high and AMR is an important problem. Increasing nurses and reducing workload can prevent HAIs and AMR. Nationwide “Antibiotic Stewardship Programme” should be initiated.