Supporting the Infection Preventionist in Skilled Nursing Facilities: Why Required Education Is Only the Tip of the Iceberg

Abstract

BACKGROUND In November 2019, Centers for Medicare & Medicaid Services (CMS) will require skilled nursing facilities (SNFs) to have an infection preventionist (IP) with “specialized training.” Meeting this requirement may prove difficult for many SNFs due to staff turnover, lack of resources and increasing patient acuity. The purpose of this study was to better understand SNF readiness for meeting the challenges ahead. METHODS In 2018, data were collected through a survey administered to 12 SNFs. These SNFs participated in the pilot phase of larger project designed to reduce healthcare-associated infections (HAIs) by enhancing relationships between SNFs and hospitals. The survey included facility-based questions of services provided and their current infection prevention program; IP experience and education; and communication between SNFs and hospitals. Following the survey, qualitative data were collected through semi-structured interviews at 4 SNFs and analyzed using a descriptive approach. RESULTS The 12 SNFs varied in size and services provided. Over half of the 12 IPs had “five years or less” experience in infection prevention. All of the IPs had other responsibilities such as staff education/development, occupational health, or assistant director of nursing. Ten months into the 12-month pilot year, 7 of the 12 IPs had left their IP position. The SNFs remained enrolled in the project, with the project team engaging the SNF IP in their new role and acquainting them to project-related resources. Our qualitative analysis revealed that these meetings met a critical need for new IPs. One of the interviewees noted that the “mentorship” offered by the project was vital to continue existing IP efforts at the SNF. CONCLUSIONS Limited IP experience and turnover will pose a significant challenge for SNFs in trying to meet CMS mandates. Strategies should encourage relationships with experienced IPs to assist SNFs in training and retaining IPs.