Infection Preventionist Called on to Rescue Nursing Homes Hit by Omicron

The Omicron variant of COVID-19 presents yet another challenge to nursing homes and other long-term care facilities (LTCFs) which have borne the brunt of the pandemic since the beginning. More than 40,000 LTCF residents tested positive last week for COVID-19, according to the Centers for Disease Control and Prevention (CDC). That’s nearly a 10-fold increase since last November. COVID-19 has been infecting nursing home personnel, as well as residents, from the beginning, and that seems to be the case with Omicron as well. About 67,000 LTCF staff tested positive for COVID-19 the first week of January, according to the CDC. And while COVID-19 vaccinations and booster shots now available have kept the mortality rates at LTCFs lower than they were during initials surges, this population remains vulnerable nonetheless.

Linda Spaulding, RN-BC, CIC, CHEC, CHOP, a member of Infection Control Today^®’s (ICT^®’s) Editorial Advisory Board, and a consultant, will make an emergency trip to Hawaii later this week to help her LTCF clients in that state deal with the current crisis.

“Each facility has its own unique challenges,” says Spaulding, who has written extensively about problems at LTCFs for ICT^®, including a cover story in 2020 about how nursing homes can adopt cost-effective methods to improve infection prevention and control efforts.

Some advice Spaulding will give her LTCF clients in Hawaii includes the need to closely monitor COVID-19 infection among staff with an eye on getting them back on the job as quickly as possible. “Their goal should be to keep residents from getting COVID-19,” says Spaulding. “They have to move from a task-based operation to only providing the basic care if they are short staffed. Instead of daily bathing they may provide weekly bathing. Instead of residents sitting together in common areas they may have to sit in their room next to their bed.”

COVID-19 has killed 862,494 individuals in the United States, according to CDC. An analysis by the Kaiser Family Foundation says that by the end of 2021, over 195,000 deaths, or about 24% of the US total, occurred at LTCFs as of that point.

Remedies have been proposed including legislative efforts that would mandate that a fulltime infection preventionist (IP) be on staff at nursing homes, and the allocation of $2.1 billion going to infection prevention efforts, about $500 million of which is earmarked for LTCFs.

It could be said that the cavalry is on the way, but it seems to be moving at a trot rather than a gallop, Spaulding indicated in a in a Q&A with ICT^® last September. When asked about the promised extra federal funding for nursing homes and other LTCFs, Spaulding adopted a stance not uncommon among those who follow the legislative goings on in Washington, D.C.: She’ll believe it when she sees it. Spaulding said that “nobody’s talking about it. Somebody in the government needs to start talking about why they’re not funding them to be better prepared. Like they are the hospitals, yet they’re holding them [LTCFs] to the same standard as they’re holding hospitals.”

Spaulding also said in the interview last September that improvements to LTCFs need to be done when the pandemic settles down. “The time to hold nursing homes accountable is not the time when everything’s falling apart, and they don’t know what to do, and there’s nobody there to guide them,” Spaulding said.

She said that her advice to LTCFs in Hawaii will include keeping cubicle curtains closed between each resident to decrease the spread of COVID-19. “Stop staff meetings for a while so more concentration is spent at the bedsides instead of meetings,” said Spaulding. “Staff need to be offered incentives to work extra shifts until sick staff can be brought back to work. Thinking out of the box is necessary right now. Everyone has to be creative in handling shortage of staff because there doesn’t seem to be any help coming to nursing homes. The National Guard is going to the aid of acute care facilities. No one is coming to the aid of nursing homes.”