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Implementation of COVID-19 infection control best practices in nursing homes amid the pandemic
Gail C D'Souza1, Jennifer L Kraschnewski2,3, Erica Francis4
1Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States of America.
Background:
The COVID-19 pandemic has claimed around 170,000 lives among nursing home residents and staff in the United States through April 2023. In a cluster randomized controlled trial (RCT) with 136 nursing homes, we delivered training to improve COVID-19 infection control best practices. We sought to assess the implementation of infection control practices in participating nursing homes.
Methods:
Concurrent with the delivery of the RCT (January-November 2021), we surveyed nursing home administrators (NHAs, n = 38) at baseline and 6-month follow-up. Using validated items from the Centers for Disease Control and Prevention (CDC), the surveys inquired about 80 infection control best-practice activities (yes/no). The survey also asked seven scales corresponding to inner setting factors that may have impacted implementation. We assessed changes in infection control practices and inner setting factors between baseline and 6-month follow-up.
Results:
Overall, the implementation of 11 best practices changed over time. NHAs reported an increase in the availability of informational materials for residents and families (84% vs. 100%, p = 0.031), the use of alcohol-based hand sanitizer over soap (76% vs. 97%, p = 0.008), and the development of contingency plans for increased postmortem care (53% vs. 82%, p = 0.013). The implementation of four best-practice visitation policies and three communal restrictions decreased between baseline and 6-month follow-up (all p < 0.05). Regarding inner setting factors, only culture stress (perceived strain, stress, and role overload) increased between surveys (mean scores: 3.14 vs. 3.58, p = 0.004).
Conclusion:
This study was among the first to report changes in implementing COVID-19 infection control best practices in nursing homes amid the pandemic. Culture stress was an important inner setting factor that may have impacted implementation activities.
Trial Registration:
NCT04499391 DATE OF REGISTRATION: August 3rd, 2020.
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