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Kelly S, Kaehny M, Powell MC. Learning from Nursing Home Infection Prevention and Control Citations During the COVID-19 Pandemic. J Gerontol Nurs 2023; 49:36-42. [PMID: 36719658 DOI: 10.3928/00989134-20230106-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The devastating effects of coronavirus disease 2019 (COVID-19) highlight the critical need for effective infection prevention and control (IPC) practices in nursing homes. Nursing management and infection preventionists should be cognizant of the most common reasons underlying federal IPC citations during the pandemic. Analysis of IPC citation data from the first 7 months of the public health emergency identified that adherence to personal protective equipment (PPE) and mask use, appropriate transmission-based precautions, and hand hygiene were the most common reasons for COVID-19-related F880 citations, including those that placed a person at immediate risk for serious injury or death. More specific staff practices and other factors leading to a citation are also highlighted. Although nursing homes may have limited control over factors such as PPE supply and staffing resources, nursing management and infection preventionists can use these results to help ensure that operational mechanisms, staff training, and adherence monitoring efforts effectively address the areas most associated with COVID-19 IPC noncompliance. [Journal of Gerontological Nursing, 49(2), 36-42.].
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Festa N, Throgmorton KF, Heaphy N, Canavan M, Gill TM. Association of Nursing Home Exposure to Hurricane-Related Inundation With Emergency Preparedness. JAMA Netw Open 2023; 6:e2249937. [PMID: 36607635 PMCID: PMC9856665 DOI: 10.1001/jamanetworkopen.2022.49937] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/16/2022] [Indexed: 01/07/2023] Open
Abstract
Importance Whether US nursing homes are well prepared for exposure to hurricane-related inundation is uncertain. Objectives To estimate the prevalence of nursing homes exposed to hurricane-related inundation and evaluate whether exposed facilities are more likely to meet Centers for Medicare & Medicaid Services (CMS) emergency preparedness standards. Design, Setting, and Participants This cross-sectional study included CMS-certified nursing homes in Coastal Atlantic and Gulf Coast states from January 1, 2017, to December 31, 2019. The prevalence of facilities exposed to at least 2 feet of hurricane-related inundation used models from the National Hurricane Center across coastal areas overseen by 5 CMS regional offices: New England, New York metropolitan area, Mid-Atlantic region, Southeast and Eastern Gulf Coast, and Western Gulf Coast. Critical emergency preparedness deficiencies cited during CMS life safety code inspections were identified. Main Outcomes and Measures The analysis used generalized estimating equations with binomial and negative binomial distributions to evaluate associations between exposure status and the presence and number of critical emergency preparedness deficiencies. Regionally stratified associations (odds ratios [ORs]) and rate ratios [RRs]) with 95% CIs, adjusted for state-level fixed effects and nursing home characteristics, were reported. Results Of 5914 nursing homes, 617 (10.4%) were at risk of inundation exposure, and 1763 (29.8%) had a critical emergency preparedness deficiency. Exposed facilities were less likely to be rural, were larger, and had similar CMS health inspection, quality, and staffing ratings compared with unexposed facilities. Exposure was positively associated with the presence and number of emergency preparedness deficiencies for the nursing homes within the Mid-Atlantic region (adjusted OR, 1.91 [95% CI, 1.15-3.20]; adjusted RR, 2.51 [95% CI, 1.41-4.47]). Conversely, exposure was negatively associated with the number of emergency preparedness deficiencies among facilities within the Western Gulf Coast (aRR, 0.55 [95% CI, 0.36-0.86]). The associations for the number of emergency preparedness deficiencies remained after correction for multiple comparisons. Conclusions and Relevance The findings of this cross-sectional study suggest that the association between exposure to hurricane-related inundation and nursing home emergency preparedness differs considerably across the Coastal Atlantic and Gulf regulatory regions. These findings further suggest that there may be opportunities to reduce regional heterogeneity and improve the alignment of nursing home emergency preparedness with surrounding environmental risks.
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Affiliation(s)
- Natalia Festa
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- National Clinician Scholars Program at Yale University, New Haven, Connecticut
| | - Kaitlin F. Throgmorton
- Harvey Cushing/John Hay Whitney Medical Library, School of Medicine, Yale University, New Haven, Connecticut
| | - Nora Heaphy
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut
| | - Maureen Canavan
- Department of Internal Medicine, Cancer Outcomes and Public Policy and Effectiveness Research, Yale School of Medicine, New Haven, Connecticut
| | - Thomas M. Gill
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Dunbar P, Keyes LM, Browne JP. Determinants of regulatory compliance in health and social care services: A systematic review using the Consolidated Framework for Implementation Research. PLoS One 2023; 18:e0278007. [PMID: 37053186 PMCID: PMC10101495 DOI: 10.1371/journal.pone.0278007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 03/13/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The delivery of high quality care is a fundamental goal for health systems worldwide. One policy tool to ensure quality is the regulation of services by an independent public authority. This systematic review seeks to identify determinants of compliance with such regulation in health and social care services. METHODS Searches were carried out on five electronic databases and grey literature sources. Quantitative, qualitative and mixed methods studies were eligible for inclusion. Titles and abstracts were screened by two reviewers independently. Determinants were identified from the included studies, extracted and allocated to constructs in the Consolidated Framework for Implementation Research (CFIR). The quality of included studies was appraised by two reviewers independently. The results were synthesised in a narrative review using the constructs of the CFIR as grouping themes. RESULTS The search yielded 7,500 articles for screening, of which 157 were included. Most studies were quantitative designs in nursing home settings and were conducted in the United States. Determinants were largely structural in nature and allocated most frequently to the inner and outer setting domains of the CFIR. The following structural characteristics and compliance were found to be positively associated: smaller facilities (measured by bed capacity); higher nurse-staffing levels; and lower staff turnover. A facility's geographic location and compliance was also associated. It was difficult to make findings in respect of process determinants as qualitative studies were sparse, limiting investigation of the processes underlying regulatory compliance. CONCLUSION The literature in this field has focused to date on structural attributes of compliant providers, perhaps because these are easier to measure, and has neglected more complex processes around the implementation of regulatory standards. A number of gaps, particularly in terms of qualitative work, are evident in the literature and further research in this area is needed to provide a clearer picture.
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Affiliation(s)
- Paul Dunbar
- Health Information and Quality Authority, Mahon, Cork, Ireland
| | - Laura M Keyes
- Health Information and Quality Authority, Mahon, Cork, Ireland
| | - John P Browne
- School of Public Health, University College Cork, Cork, Ireland
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Crnich CJ. Reimagining Infection Control in U.S. Nursing Homes in the Era of COVID-19. J Am Med Dir Assoc 2022; 23:1909-1915. [PMID: 36423677 PMCID: PMC9666375 DOI: 10.1016/j.jamda.2022.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 11/18/2022]
Abstract
Residents of nursing homes (NHs) are susceptible to infection, and these facilities, particularly those that provide post-acute care services, are high-risk settings for the rapid spread of communicable respiratory and gastrointestinal illnesses, as well as antibiotic-resistant bacteria. The complexity of medical care delivered in most NHs has increased dramatically over the past 2 decades; however, the structure and resources supporting the practice of infection prevention and control in these facilities has failed to keep pace. Rising numbers of infections caused by Clostridioides difficile and multidrug-resistant organisms, as well as the catastrophic effects of COVID-19 have pushed NH infection control resources to a breaking point. Recent changes to federal regulations require NHs to devote greater resources to the facility infection control program. However, additional changes are needed if sustained improvements in the prevention and control of infections and antibiotic resistance in NHs are to be achieved.
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Affiliation(s)
- Christopher J Crnich
- School of Medicine & Public Health, University of Wisconsin-Madison, Madison, WI, USA; William S. Middleton Veterans Hospital Geriatric Research Education and Clinical Center, Madison, WI, USA.
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5
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Walters MS, Prestel C, Fike L, Shrivastwa N, Glowicz J, Benowitz I, Bulens S, Curren E, Dupont H, Marcenac P, Mahon G, Moorman A, Ogundimu A, Weil LM, Kuhar D, Cochran R, Schaefer M, Slifka KJ, Kallen A, Perz JF. Remote Infection Control Assessments of U.S. Nursing Homes During the COVID-19 Pandemic, April to June 2020. J Am Med Dir Assoc 2022; 23:909-916.e2. [PMID: 35504326 PMCID: PMC8983607 DOI: 10.1016/j.jamda.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/23/2022] [Accepted: 03/30/2022] [Indexed: 11/30/2022]
Abstract
Background Nursing homes (NHs) provide care in a congregate setting for residents at high risk of severe outcomes from SARS-CoV-2 infection. In spring 2020, NHs were implementing new guidance to minimize SARS-CoV-2 spread among residents and staff. Objective To assess whether telephone and video-based infection control assessment and response (TeleICAR) strategies could efficiently assess NH preparedness and help resolve gaps. Design We incorporated Centers for Disease Control and Prevention COVID-19 guidance for NH into an assessment tool covering 6 domains: visitor restrictions; health care personnel COVID-19 training; resident education, monitoring, screening, and cohorting; personal protective equipment supply; core infection prevention and control (IPC); and communication to public health. We performed TeleICAR consultations on behalf of health departments. Adherence to each element was documented and recommendations provided to the facility. Setting and Participants Health department–referred NHs that agreed to TeleICAR consultation. Methods We assessed overall numbers and proportions of NH that had not implemented each infection control element (gap) and proportion of NH that reported making ≥1 change in practice following the assessment. Results During April 13 to June 12, 2020, we completed TeleICAR consultations in 629 NHs across 19 states. Overall, 524 (83%) had ≥1 implementation gap identified; the median number of gaps was 2 (interquartile range: 1-4). The domains with the greatest number of facilities with gaps were core IPC practices (428/625; 68%) and COVID-19 education, monitoring, screening, and cohorting of residents (291/620; 47%). Conclusions and Implications TeleICAR was an alternative to onsite infection control assessments that enabled public health to efficiently reach NHs across the United States early in the COVID-19 pandemic. Assessments identified widespread gaps in core IPC practices that put residents and staff at risk of infection. TeleICAR is an important strategy that leverages infection control expertise and can be useful in future efforts to improve NH IPC.
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Affiliation(s)
- Maroya Spalding Walters
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Christopher Prestel
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lucy Fike
- Northrop Grumman Corporation, Falls Church, VA, USA
| | - Nijika Shrivastwa
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Janet Glowicz
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Isaac Benowitz
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sandra Bulens
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emily Curren
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Hannah Dupont
- CDC COVID-19 Healthcare Infection Control Team, Atlanta, GA, USA
| | - Perrine Marcenac
- CDC COVID-19 Healthcare Infection Control Team, Atlanta, GA, USA
| | | | - Anne Moorman
- CDC COVID-19 Healthcare Infection Control Team, Atlanta, GA, USA
| | - Abimbola Ogundimu
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lauren M Weil
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - David Kuhar
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ronda Cochran
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Melissa Schaefer
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kara Jacobs Slifka
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alexander Kallen
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph F Perz
- Division of Healthcare Quality Promotion, US Centers for Disease Control and Prevention, Atlanta, GA, USA
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Arnedo-Pena A, Romeu-Garcia MA, Gascó-Laborda JC, Meseguer-Ferrer N, Safont-Adsuara L, Prades-Vila L, Flores-Medina M, Rusen V, Tirado-Balaguer MD, Sabater-Vidal S, Gil-Fortuño M, Pérez-Olaso O, Hernández-Pérez N, Moreno-Muñoz R, Bellido-Blasco J. Incidence, Mortality, and Risk Factors of COVID-19 in Nursing Homes. EPIDEMIOLOGIA 2022; 3:179-190. [PMID: 36417250 PMCID: PMC9620907 DOI: 10.3390/epidemiologia3020014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/14/2022] Open
Abstract
During the period from March 2020 to January 2021, we performed an analysis of incidence, mortality, and risk factors of COVID-19 in nursing homes (NHs) in two health departments (HDs) of Castellon (Spain) 2021 through epidemiological surveillance and an ecological design. Laboratory-confirmed COVID-19 cases, cumulative incidence rate (CIR), and mortality rate (MR) of 27 NHs were collected. Information of residents, staff, and facilities was obtained by questionnaire. Multilevel Poisson regression models were applied. All NHs in the HDs participated with 2229 residents (median: 83 years old, 67.3% women) and 1666 staff. Among residents, 815 cases (CIR: 34.8 per 100) and 202 deaths (MR: 8.7 per 100, case fatality 21.0%) were reported and, among staff, 296 cases (CIR: 19.2 per 100) without deaths. Residents' CIR and MR increased with staff CIR, age of the building, residents/staff ratios, occupancy rate, and crowding index; CIR increased with private NH ownership, large NH size, large urban area, and the percentage of women residents; and MR was associated with residents' severe disabilities. In conclusion, several risk factors of COVID-19 incidence and mortality can be prevented by improving infection and quality controls, ameliorating residents/staff ratios, improving structural facilities, and increasing NH public ownership to avoid new outbreaks.
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Affiliation(s)
- Alberto Arnedo-Pena
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
- Public Health and Epidemiology (CIBERESP), 28029 Madrid, Spain
- Department of Health Science, Public University of Navarra, 31006 Pamplona, Spain
| | - Maria Angeles Romeu-Garcia
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | - Juan Carlos Gascó-Laborda
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | - Noemi Meseguer-Ferrer
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | - Lourdes Safont-Adsuara
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | - Laura Prades-Vila
- Health Programs, Public Health Center, 12003 Castelló de la Plana, Spain; (L.P.-V.); (M.F.-M.)
| | - Matilde Flores-Medina
- Health Programs, Public Health Center, 12003 Castelló de la Plana, Spain; (L.P.-V.); (M.F.-M.)
| | - Viorica Rusen
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
| | | | - Susana Sabater-Vidal
- Microbiology Laboratory, Universitary General Hospital, 12004 Castelló de la Plana, Spain; (M.D.T.-B.); (S.S.-V.)
| | - Maria Gil-Fortuño
- Clinical Analysis and Microbiology Laboratory, Universitary Hospital de la Plana, 12540 Vila-Real, Spain; (M.G.-F.); (O.P.-O.); (N.H.-P.)
| | - Oscar Pérez-Olaso
- Clinical Analysis and Microbiology Laboratory, Universitary Hospital de la Plana, 12540 Vila-Real, Spain; (M.G.-F.); (O.P.-O.); (N.H.-P.)
| | - Noelia Hernández-Pérez
- Clinical Analysis and Microbiology Laboratory, Universitary Hospital de la Plana, 12540 Vila-Real, Spain; (M.G.-F.); (O.P.-O.); (N.H.-P.)
| | - Rosario Moreno-Muñoz
- Department of Epidemiology, School of Medicine, Jaume I University, 12006 Castelló de la Plana, Spain;
| | - Juan Bellido-Blasco
- Epidemiology Division, Public Health Center, 12003 Castelló de la Plana, Spain; (M.A.R.-G.); (J.C.G.-L.); (N.M.-F.); (L.S.-A.); (V.R.); (J.B.-B.)
- Public Health and Epidemiology (CIBERESP), 28029 Madrid, Spain
- Department of Epidemiology, School of Medicine, Jaume I University, 12006 Castelló de la Plana, Spain;
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Baker NR, Dunn D, Greenberg SA, Shaughnessy M. Infection Control in Long-Term Care: An Old Problem and New Priority. J Am Med Dir Assoc 2021; 23:321-322. [PMID: 34953783 PMCID: PMC8694653 DOI: 10.1016/j.jamda.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Natalie R Baker
- University of Alabama at Birminngham School of Nursing, Birmingham, AL, USA
| | - Deborah Dunn
- Madonna University Graduate School and Center for Research, Livonia, MI, USA
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Nursing Home Profit Margins and Citations for Infection Prevention and Control. J Am Med Dir Assoc 2021; 22:2378-2383.e2. [PMID: 33930318 PMCID: PMC8079226 DOI: 10.1016/j.jamda.2021.03.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Recent rampant spread of COVID-19 cases in nursing homes has highlighted the concerns around nursing homes' ability to contain the spread of infections. The ability of nursing homes to invest in quality improvement initiatives may depend on resource availability. In this study, we sought to examine whether lower profit margins, as a proxy for lack of resources, are associated with persistent infection control citations. DESIGN We conducted a retrospective study. SETTING AND PARTICIPANTS Medicare-certified nursing homes in the US with financial and facility characteristics data (n = 12,194). METHODS We combined facility-level data on nursing home profit margins from Medicare Cost Reports with deficiency citation data from Nursing Home Compare (2017-2019) and facility characteristics data from LTCFocus.org. We descriptively analyzed infection control citations by profit margins quintiles. We used logistic regressions to examine the relationship between profit margin quintiles and citations for infection prevention and control, adjusting for facility and market characteristics. RESULTS About three-fourths of all facilities received deficiency citations for infection prevention and control during 1 or more years from 2017 to 2019 with about 10% of facilities cited in all 3 years. Facilities in the highest profit margin quintile had 7.6% of facilities with citations for infection prevention and control in each of the 3 years compared with 8.1%, 10.0%, 10.7%, and 13.7% for facilities in the fourth, third, second, and first quintiles of profit margins, respectively. Multivariable regressions showed that facilities with the lowest profit margins (first quintile) had 54.3% higher odds of being cited in at least 1 year and 87.6% higher odds of being cited in each of the 3 years compared with facilities with the highest profit margins (fifth quintile). CONCLUSIONS AND IMPLICATIONS Our findings indicate that nursing homes may need more resources to prevent citations for infection prevention and control.
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Loomer L, Grabowski DC, Yu H, Gandhi A. Association between nursing home staff turnover and infection control citations. Health Serv Res 2021; 57:322-332. [PMID: 34490625 DOI: 10.1111/1475-6773.13877] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 08/20/2021] [Accepted: 08/29/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe the association between nursing home staff turnover and the presence and scope of infection control citations. DATA SOURCES Secondary data for all US nursing homes between March 31, 2017, through December 31, 2019 were obtained from Payroll-Based Journal (PBJ), Nursing Home Compare, and Long-Term Care: Facts on Care in the US (LTC Focus). STUDY DESIGN We estimated the association between nurse turnover and the probability of an infection control citation and the scope of the citation while controlling for nursing home fixed effects. Our turnover measure is the percent of the facility's nursing staff hours that were provided by new staff (less than 60 days of experience in the last 180 days) during the 2 weeks prior to the health inspection. We calculated turnover for all staff together and separately for registered nurses, licensed practical nurses (LPNs), and certified nursing assistants. DATA COLLECTION/EXTRACTION METHODS We linked nursing homes standard inspection surveys to 650 million shifts from the PBJ data. We excluded any nursing home with incomplete or missing staffing data. Our final analytic sample included 12,550 nursing homes with 30,536 surveys. PRINCIPAL FINDINGS Staff turnover was associated with an increased likelihood of an infection control citation (average marginal effect [AME] = 0.12 percentage points [pp]; 95% confidence interval [CI]: 0.05, 0.18). LPN (AME = 0.06 pp; 95% CI: 0.01, 0.11) turnover was conditionally associated with an infection control citation. Conditional on having at least an isolated citation for infection control, staff turnover was positively associated with receiving a citation coded as a "pattern" (AME = 0.21 pp; 95% CI: 0.10, 0.32). Conditional of having at least a pattern citation, staff turnover was positively associated with receiving a widespread citation (AME = 0.21 pp; 95% CI: 0.10, 0.32). CONCLUSIONS Turnover was positively associated with the probability of an infection control citation. Staff turnover should be considered an important factor related to the spread of infections within nursing homes.
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Affiliation(s)
- Lacey Loomer
- Department of Economics and Health Care Management, Labovitz School of Business and Economics, University of Minnesota Duluth, Duluth, Minnesota, USA
| | - David C Grabowski
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Huizi Yu
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Ashvin Gandhi
- UCLA Anderson School of Management, Los Angeles, California, USA
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Aliyu S, Travers JL, Heimlich SL, Ifill J, Smaldone A. Antimicrobial Stewardship Interventions to Optimize Treatment of Infections in Nursing Home Residents: A Systematic Review and Meta-Analysis. J Appl Gerontol 2021; 41:892-901. [PMID: 34075829 DOI: 10.1177/07334648211018299] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988-2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran's Q = 166,837.8, p < .001, I2 = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.
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Affiliation(s)
| | - Jasmine L Travers
- New York University Rory Meyers College of Nursing, New York City, USA
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