Only 11% of infection-prevention leads at 3,700 Florida nursing homes and assisted-living facilities (ALFs) said their facility requires influenza vaccination for healthcare workers despite the high risk to residents, shows a survey published last week in the American Journal of Infection Control.
From December 2022 to February 2023, a team led by researchers from the University of Florida College of Public Health and Health Professions in Gainesville collected responses to a needs-assessment survey of professionals responsible for infection prevention and control (IPC) at 3,690 long-term care facilities (LTCFs) in Florida. The state has the United States' fourth most LTCFs and ranks second in the percentage of residents aged 65 years and older.
High risk for infection, antibiotic resistance
Respondents worked at ALFs (37.5%), skilled-nursing facilities (SNFs; 36.1%), and nursing homes (21.7%) and included infection preventionists (IPs), administrators, and nursing directors.
The 90-question survey was a modified version of the Centers for Disease Control and Prevention's (CDC's) 2016 Infection Prevention and Control Assessment Tool for Long-Term Care Facilities.
"Residents of LTCFs have multiple risk factors for acquiring infections, including underlying medical conditions and treatments that may suppress the immune system, indwelling devices, and open wounds," the researchers noted. "Infections and colonization with multidrug-resistant organisms (MDRO) are particularly problematic in LTCF."
To address these issues, the Centers for Medicare and Medicaid Services in 2016 published a final rule mandating that LTCFs establish IPC programs.
Low flu vaccine uptake
While survey responses indicated good compliance with recommended hand hygiene, sharps safety, and staff training, only 11.2% of the 304 respondents said their facility mandates flu vaccination.
The low uptake of influenza vaccination among Florida's LTCF workers, despite recommendations, suggests a need for more robust vaccination policies and educational campaigns.
"Unfortunately, there did not seem to be widespread uptake of flu vaccine among health care workers (HCW) in the state, with only 31% of health care personnel vaccinated in skilled nursing facilities in 2022-2023, which ranked 48th among 50 states and the District of Columbia," the authors wrote. "The low uptake of influenza vaccination among Florida's LTCF workers, despite recommendations, suggests a need for more robust vaccination policies and educational campaigns."
Nearly a third (30%) of those surveyed reported shortages of registered nurses, licensed practical nurses, and certified nursing assistants, but only 5% said supplies of personal protective equipment were limited.
SNFs and nursing homes were more likely than ALFs to have gloves in or near every room and to have N95 respirators available (98.5% vs 81.6% and 100% vs 91.9%, respectively). SNFs and nursing homes were also more likely to perform N95 fit-testing (86.2% vs 54.3%).
Of the 155 respondents from LTCFs, 47.7% had at least 40 hours dedicated to IPC activities each week, 36.8% had 20 to 38 hours, and 15.5% had 1 to 15 hours. Most (82.1%) delivered staff education as in-person in-services, 56.6% used online materials, 25% used live online group training, and 5.4% used other training methods.
Findings will inform tailored education
Among IPs, 81.0% reported 5 or fewer years of experience in IPC, and 83% said they had been in their current position for no more than 3 years.
"While this relatively inexperienced workforce may reflect burnout among more experienced IPs, it may also indicate high turnover and short employment periods for newer IPs in LTCFs," the researchers wrote. "More importantly, this highlights the urgent need for enhanced training and support systems, such as continuous professional development opportunities, and peer mentorship."
The limited knowledge among respondents about HVAC and air purification systems points to a gap in IPC training, necessitating comprehensive education on these systems to maintain a safe care environment.
When asked to rank their knowledge of the Certification Board in Infection Control and Epidemiology's IPC core competencies, except for surveillance and epidemiologic investigation, more than half of the respondents said they were knowledgeable in all domains.
Responses suggested that participants had little knowledge about their facility's heating, ventilation, and air conditioning (HVAC) systems, with most not knowing what type of filter was used in the HVAC system.
"The limited knowledge among respondents about HVAC and air purification systems points to a gap in IPC training, necessitating comprehensive education on these systems to maintain a safe care environment," the researchers wrote. "Knowledge of these systems is essential, as they play a vital role in limiting the spread and transmission of infectious agents among residents and HCW."
The authors said the survey results will inform the establishment of tailored educational opportunities for infection preventionists in Florida nursing homes.
