In “normal” times, your skilled nursing facility staff should be taking all necessary steps to prevent and control infections throughout the facility. As the current COVID-19 pandemic continues to unfold, it’s safe to say these are anything but normal times.

Fortunately, skilled nursing facilities here in the U.S. up to now haven’t had to deal with major outbreaks beyond seasonal flu. Unfortunately, that has partly caused too many skilled nursing and senior care organizations to overlook basic steps that help prevent and control infections throughout a facility.

Media coverage, and to a large extent, governmental efforts, have been focused on hospital infections, because that’s where the majority of active COVID-19 cases are treated. But other bad bacteria and viruses still could be passed around in hospitals, skilled nursing facilities and pretty much everywhere else. So, even when this current crisis subsides, the need for infection prevention and control will remain vitally important. And realistically, expectations around infection prevention and control will almost certainly rise among residents, loved ones, regulators and even staff. This compels skilled nursing facilities to take action now.

The Elephant in the Room – Little or No Personal Protective Equipment (PPE)

It’s easy to believe that any infection prevention and control measures could be compromised or even negated by the current lack of PPE in many skilled nursing facilities. After all, PPE plays a big role in keeping residents and nursing staff safe. Without it, or with inadequate PPE, safety is put at risk.

There’s no doubting that lack of PPE such as gowns and face masks is an enormous problem right now; according to a recent McKnight’s Long-Term Care News flash survey, “…more than 77% of respondents said their facilities were experiencing personal protective equipment (PPE) shortages. Nearly 3 in 5 (59%) said their locations were using homemade or improvised PPE, or reusing it. Masks, gowns, gloves and shoe covers are just some of the infection control products falling under the PPE label. In addition, nearly half of the respondents (48%) said they have workers “calling in sick due to or exhibiting signs of COVID-19.” This is on top of normal staffing concerns that leave many facilities scrambling to fill open shifts.”

Yet, even with inadequate PPE, infection prevention and control measures must be taken throughout skilled nursing facilities. So what should your facility be doing to step up its efforts?

1. Commit to practicing optimal hand hygiene and respiratory hygiene. It’s basic protocol, but when it comes to doing it properly – or sometimes at all – many facilities still come up short. In fact, according to several recent surveys tracked by the Centers for Medicare and Medicaid Services (CMS), more than one-third of facilities still don’t follow proper hand washing guidelines, and one fourth don’t use PPE properly. 
   Proper hand washing is about frequency as well as technique. Skilled nursing staff should thoroughly wash their hands after touching a resident, after touching linens, and before and after eating.
   As for respiratory hygiene, it’s as simple as using the crook of your elbow to cough into, rather than your hands.
   One other hygienic practice that nursing staff should adhere to: Don’t apply makeup during a work shift. By doing so, nurses and staff are touching their eyes, mouth and other facial areas that could cause infections to themselves or others.
2. Properly don and doff PPE. At Richter, our skilled nursing facility consultants recommend that facilities adopt CDC guidelines for putting on and removing PPE.  
3. Wear a mask – even a simple one if necessary. Doing so isn’t as much about protecting the nursing staff as much as it is protecting residents, staff and others in one’s immediate physical sphere. Experts now say the coronavirus can be airborne for up to 2-3 hours; while a mask does offer the wearer some protection, the more vital function it serves is protecting others from aerosolized droplets in the surrounding air.
4. Leverage creativity – the circumstances demand it. At this point, assume PPE will run in short supply for the foreseeable future, so empower everyone on your staff to make ingenuity their friend. Think outside the box to devise practical and useful ways to protect residents and staff.
5. Revisit your facility’s disaster prevention plan – and make sure it includes outbreak plans and policies. Such plans often revolve around a natural disaster. Yet, as we’re now seeing, pandemics are their own special breed of disaster, and they require mitigation plans of their own.

Realistically, COVID-19 could be active for another 12-18 months until a vaccine is developed and made widely available. Until the current crisis finally begins to subside, many people will be hyperaware of potential infections and will demand that hospitals, skilled nursing facilities and other acute-care facilities have policies and procedures in place to prevent and control infections, including policies around PPE inventory. The time to devise and deploy those in your facility is now.

To aid you in promoting infection prevention and control and other issues surrounding COVID-19, we have developed a COVID-19 Resource Center for skilled nursing facilities which will be regularly updated with the latest information.  

Contact Richter’s Skilled Nursing Facility Consultants

Do you have questions about infection prevention and control in your skilled nursing facility, or other LTPAC clinical challenges? Call Richter’s skilled nursing facility consultants at 866-806-0799 to schedule a free consultation.

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