A recent audit by the Office of the Inspector General (OIG) has uncovered significant compliance issues regarding infection prevention practices in for-profit nursing homes. The findings suggest that about one in four of these facilities may have needed to adhere to federal requirements, raising concerns about the safety and well-being of residents.
Non-Compliance with Infection Prevention Training
The OIG audit sampled 100 for-profit nursing homes and found that 17 of them potentially needed to comply with the federal requirement mandating specialized training for infection preventionists before they assumed their role. Additionally, seven facilities still need to designate infection prevention, which is a critical oversight in maintaining proper infection control measures.
OIG Recommendations for CMS Action
In response to these findings, the OIG has recommended that the Centers for Medicare & Medicaid Services (CMS) take action to address these gaps. Specifically, the OIG suggests that CMS should instruct state survey agencies to follow up with the 24 nursing homes identified in the audit to ensure they have implemented corrective measures.
The audit also recommends that CMS share these findings with state survey agencies, urging them to prioritize oversight on verifying that nursing homes not only designate an infection preventionist but also ensure that these individuals complete the necessary specialized training before taking on the role. CMS has agreed to these recommendations, signaling a commitment to improving infection control standards in nursing homes.
Calls for Stronger Infection Prevention Measures
While the OIG’s recommendations are a step in the right direction, experts believe they may not go far enough. Tania Bubb, president of the Association for Professionals in Infection Control and Epidemiology (APIC), expressed concerns that current laws are insufficient.
“With current laws that don’t require dedicated infection preventionists in nursing homes and don’t require routine surveillance of healthcare-associated infections, we are in the dark on the overall rates of infection in these facilities,” Bubb stated.
Bubb emphasized the need for dedicated infection prevention rather than assigning the role as an additional duty to already overburdened staff. “Without someone dedicated to the job of infection prevention, the job remains ‘other duties as assigned’ for existing overburdened nursing home staff,” she added.
Challenges in Infection Prevention Staffing
The OIG audit also highlighted the challenges nursing homes face in hiring and retaining experienced and qualified infection preventionists. High turnover rates in administrators and ownership, combined with pandemic-related demands, have exacerbated these challenges. Many facilities needed help to ensure their infection preventionists completed specialized training promptly, further complicating compliance.
Access to training, whether in-person, statewide, or online, has also been a significant issue, according to the OIG. The pandemic has only intensified these challenges, with many facilities grappling with the high costs of infection control, especially in light of reduced funding for infection prevention efforts post-COVID-19.
Widespread Non-Compliance in the Industry
Based on the audit’s sample size, the OIG estimates that approximately 2,568 for-profit nursing homes nationwide likely did not comply with federal infection prevention requirements. This is particularly concerning given that these regulations were established well before the COVID-19 pandemic.
In 2016, CMS implemented new regulations requiring nursing homes to establish and maintain an infection prevention and control program (IPCP). This program includes systems for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases. Additionally, the IPCP requires an antibiotic stewardship program to monitor antibiotic use and a system for recording incidents and corrective actions related to infection control.
Responsibility for Infection Control Compliance
Ultimately, the responsibility for ensuring compliance with infection prevention standards lies with nursing home management and staff. As the OIG audit underscores, nursing homes must develop, maintain, and implement a robust IPCP to safeguard the health and safety of residents and staff.
“Management and staff at a nursing home are ultimately responsible for ensuring the safety and well-being of residents and staff and for complying with federal, state, and local regulations,” the OIG emphasized in its report.
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