The COVID-19 pandemic is devastating the healthcare community with unprecedented severe illness and mortality. Facilities are navigating evolving guidance through staffing shortages and turnover. The state health department (SHD) has deployed a network of dedicated infection preventionists to bolster public health response efforts.
From March 2020 through October 2021, the SHD performed 374 infection control assessments. Assessments were performed using the Nursing Home COVID-19 Infection Control Assessment and Response (ICAR) Tool designed by the Centers for Disease Control and Prevention, versions 1.0 (N=254) and 2.0 (N=120). Infection control domains were assessed for gaps, including personal protective equipment, environmental services, and SARS-CoV-2 testing. Visits included visual assessment including the designated COVID-19 patient care area.
Within available data, facility-reported challenges were staff burnout and compliance (18%), staffing shortages (17%), and resident compliance (13%). Only 56% of facilities reported that staff were fit tested for the type of respirator being used, and of those, 12% reported no medical clearance. Facilities reported using disposable respirators for up to 5 shifts. Practices of extended use (56%) and reuse (38%) were noted. Approximately 16% of facilities reported not discarding disposable gowns after doffing at point of use. Additionally, gowns were worn outside of resident rooms by staff in 25% of facilities assessed. Approximately 49% of facilities report having alcohol-based hand rub inside each resident room. Disinfectant product contact time was known by 87% of staff representatives. Only 18% of individuals tasked with infection prevention and control at their facilities reported having no other job duties. Designated COVID-19 care units were present at 71% of facilities.
Gaps noted in infection prevention and control are consistent among facilities. Consistent high rates of staff turnover and staffing shortages contribute to lapses in practice. Self-reported challenges were consistent across facilities and will continue to contribute to future outbreaks within facilities.