Major article
State focus on health care-associated infection prevention in nursing homes

https://doi.org/10.1016/j.ajic.2013.11.024Get rights and content

Background

Despite increased focus on health care-associated infections (HAI), between 1.6 and 3.8 million HAI occur annually among the vulnerable population residing in US nursing homes (NH). This study characterized state department of health (DOH) activities and policies intended to improve quality and reduce HAI in NH.

Methods

We created a 17-item standardized data collection tool informed by 20 state DOH Web sites, reviewed by experts in the field and piloted by 2 independent reviewers (Cohen's κ .45-.73). The tool and corresponding protocol were used to systematically evaluate state DOH Web sites and related links.

Results

Three categories of data were abstracted: (1) consumer-directed information intended to increase accountability of and competition between NH, including mandatory HAI reporting and NH inspection reports; (2) surveyor training for federally-mandated NH inspections; and (3) guidance for NH providers to prevent HAI and monitor incidence. Only 5 states included HAI reporting in NH with differing HAI types and reporting requirements.

Conclusion

State DOH information and activities focused on NH quality and reducing HAI were inconsistent. Systematically characterizing state DOH efforts to reduce HAI in NH is important to interpret the effects of these activities.

Section snippets

Methods

This original investigation was conducted as part of Prevention of Nosocomial Infections and Cost Effectiveness in Nursing Homes study (National Institutes of Nursing Research, R01NR013687), which was previously approved by the Institutional Review Board of Columbia University Medical Center.

Consumer-directed information

Table 1 provides an overview of the information on state DOH Web sites to help potential residents and their caregivers assess NH quality and choose a NH. For consumers choosing a NH, 74.5% of states provided at least 1 link to a NH checklist. Of the states with checklists, 39% had created them, and 55.3% used the list provided by Medicare (http://www.medicare.gov/Pubs/pdf/02174.pdf, data not shown). Four other state DOH provided a checklist from either AARP (//assets.aarp.org/www.aarp.org_/promotions/text/life/NursingHomeChecklist.pdf

Discussion

This study demonstrates high variability in state activities and policies focused on NH and reducing HAI incidence in NH. The vast majority of states provided consumer-directed information for assessing NH quality intended to help consumers make informed decisions when considering residence in one of these facilities. Overall, Florida, Maryland, Massachusetts, Minnesota, Ohio, and Rhode Island provided the greatest number of consumer-directed activities and venues of information. These states

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Cited by (4)

  • Support of nursing homes in infection management varies by US State Departments of Health

    2020, Journal of Hospital Infection
    Citation Excerpt :

    Indeed, with UTIs being the most common HAIs among NH residents across states, it is surprising these materials were least represented. Cohen et al. [20] was the only other identified study that collected and categorized state-level initiatives [20] on HAI reduction in NHs. Our finding that 57% of state DOHs (29/51) provided HAI reduction training represents a significant decrease from the 86% (44/51) found six years earlier in 2012–2013 [20].

  • Nurses' knowledge, behaviour and compliance concerning hand hygiene in nursing homes: A cross-sectional mixed-methods study

    2019, BMC Health Services Research

  • Infection prevention and control in nursing homes: A qualitative study of decision-making regarding isolation-based practices

    2015, BMJ Quality and Safety

  • Nursing homes in states with infection control training or infection reporting have reduced infection control deficiency citations

    2015, Infection Control and Hospital Epidemiology

Supported by the National Institute of Nursing Research (R01NR013687).

Conflicts of interest: None to report.

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