healthcare-associated infections (HAI) program

Establishing an Effective Infection
Prevention and Control Program

About

A SNF infection prevention (IP) program includes evidence-based practices to prevent healthcare-associated infections (HAI) and provide safe, quality resident care.

What makes an effective SNF IP program?

An effective IP program must be managed by a trained infection preventionist who ensures that written infection prevention policies and procedures are adhered to by healthcare providers (HCP). Active administrative support and an engaged staff are essential to an effective IP program.

What elements should be included in a SNF IP program?

A SNF IP program includes but is not limited to:

Element	Includes:
Visible, tangible leadership support for IP	Leadership accountable for the success of infection prevention activities Sufficient resources allocated so that infection prevention practice adherence is feasible Individual with infection prevention training assigned to manage the program is given support and authority
A written annual risk assessment	Numbers of HAI in the facility over the past year Gaps in infection prevention care practices such as hand hygiene, Standard and Transmission-based precautions, environmental cleaning and disinfection Community rates of infectious disease such as tuberculosis (TB) and influenza Review local public health reports for these data Sample annual risk assessment (EXCEL)
A written IP plan based on the annual risk assessment	The role of the Infection Preventionist Infection prevention goals for the year HAI surveillance to be conducted, such as incidence of C. difficile infections (CDI), urinary tract infections (UTI), pneumonia, scabies, etc. How infections will be recorded and reported Policies and procedures to prevent transmission of infection How and where adherence monitoring will be performed How feedback will be given to HCP Sample annual IP program plan (PDF)
IP policies and procedures based on current, evidence-based recommendations	Standard and Transmission-based precautions Respiratory hygiene/cough etiquette Cleaning and disinfection of the environment and resident care equipment, including “who cleans what” Use of Environmental Protection Agency (EPA)-approved cleaning agents according to manufacturer instructions Evidence-based methods to prevent infection for residents with invasive devices such as urinary catheters, ventilators or intravascular devices Vaccination for residents and HCP Screening and work restrictions to prevent HCP with a communicable illness from working with residents while ill or infected
Adherence monitoring and feedback	Standardized tools and definitions to monitor HCP adherence to infection prevention practices Prompt, regular performance feedback to HCP and leadership CDPH Adherence Monitoring Tools and References for SNF
HCP education	Job-specific infection prevention training New hire and annual training on hand hygiene, Standard and Transmission-based precautions, bloodborne pathogen exposure, environmental cleaning, linen handling, and hazardous waste disposal Additional training when gaps in care practice adherence or increased infection rates noted
Patient, family, caregiver education	Appropriate infection prevention education to patients, family members, visitors, and others included in the caregiving network Include: How infections are spread How they can be prevented What signs and symptoms should prompt evaluation Instructional materials that address varied levels of education, language, comprehension, and cultural diversity
Occupational health	Vaccines (influenza) Respirator fit testing TB testing Infectious disease exposure investigations Post-exposure management Counseling Infectious disease exposure risk Work restriction Latex allergies Compliance with CA regulation Bloodborne Pathogen Standard Airborne Transmissible Disease Standard (PDF)
Antibiotic Stewardship Program	Element 1: Leadership commitment Element 2: Accountability of leader for ASP outcomes Element 3: Drug expertise access Element 4: Action to implement at lease one intervention to improve antibiotic use Element 5: Tracking antibiotic use practices and outcomes Element 6: Reporting antibiotic use to physicians, nurses and relevant staff Element 7: Education for clinical providers and nursing staff on rationale and goals

What makes an IP program effective throughout the facility?

An effective IP program must engage participation from multiple disciplines facility wide, including Administration, Nursing, Environmental Services, Pharmacy, Dietary, Engineering, and other ancillary departments.

What practices must all HCP follow for every care encounter?

Use Standard Precautions to care for all patients in all settings.

Practice	Activities:
Standard Precautions	Hand hygiene Alcohol hand rub is acceptable for hand hygiene unless hands are visible soiled, or during a C. difficile or norovirus outbreak Use soap and water when hands are visible soiled Environmental cleaning and disinfection Injection and medication safety Assess the risk of transmission in task to be performed to select appropriate personal protective equipment (PPE) including gloves, gowns, face masks Minimize potential exposures through respiratory hygiene and cough etiquette Reprocessing reusable medical equipment between each patient and when soiled
Transmission-based Precautions, as necessary (PDF)	Additional precautions needed for patients with documented or suspected diagnoses where contact with the patient, their body fluids, or their environment presents a transmission risk despite adherence to Standard Precautions Include the use of appropriate PPE specific to the mode of pathogen transmission: Contact, Droplet, and Airborne precautions
Early, prompt removal of invasive devices	During each healthcare encounter, assess the medical necessity of any invasive device to identify the earliest opportunity for safe removal Vascular catheter Indwelling urinary catheter Feeding tube Ventilator Surgical drain

What is interfacility communication?

Interfacility communication between healthcare facilities, such as SNF, hospitals, and outpatient clinics, provides critical patient information to inform the receiving facility of appropriate infection prevention precautions upon arrival. All healthcare facilities may use or adapt the CDPH Healthcare Facility Transfer Form (PDF) and learn more about interfacility communication on the Interfacility T ransfer Communications Guide webpage.

What are the education requirements for the SNF Infection Preventionist, and what educational courses are available?

The SNF infection preventionist requires additional education to understand her/his unique function and role. In addition, the Centers for Medicare and Medicaid Services (CMS) requires (§483.95(e) PDF) the SNF IP to complete an infection prevention course (PDF).

CDPH HAI Program Basics of Infection Prevention 2-day Course (temporarily not offering in-person training due to COVID-19).
An introduction to infection prevention and control practices, including a track for skilled nursing facilities (CEU available).
SNF Online Infection Prevention Course
A 14-hour self-paced course is designed for healthcare professionals to work around their schedule and does not have to be completed in one session.
CMS/CDC Specialized Infection Prevention and Control Training for Nursing Home Staff in the Long-Term Care Setting.
A comprehensive two-day course that meets the CMS mandate for training SNF Infection Prevention and Control Officers (CEU available).
APIC Infection Prevention in Long-Term Care Certificate Series
Online classes addressing skilled nursing facility issues. Completion of the course can lead to an Infection Prevention in Long-Term Care Certificate.
APIC New York City LTC: IP Plan, Risk Assessment and Isolation Recommendations (PDF)
Recommendations for a strong IP Plan template for long-term care facilities.
Infection Prevention & Control Resources (IPCR) IPC Boot Camp for Long-Term Care Facility Infection Preventionists.
Consulting service providing training in infection prevention and control specific to long-term care.