PHHP 94 - Modifying the Cdc's 2016 Long-term Care ICAR Tool to Identify a Broader Scope of Infection Control Gaps

Wednesday, June 28, 2023

9:45 AM – 10:45 AM

Presenter(s)

Bethany L. Lavender, RN, MPH (she/her/hers)

Infection Prevention Epidemiologist
Indiana Department of Health
Tucson, Arizona, United States

Co-Author(s)

Jennifer Spivey, MSN, RN, CIC, LTC-CIP, FAPIC

IP Consultant
Jennifer K. Spivey FAPIC, IP Consulting, LLC, and Indiana State Department of Health
Fishers, Indiana, United States

Co-Author(s)

Janene Gumz-Pulaski, MBA, BSN, RN, CIC, LTC-CIP

Assistant Program Manager and Infection Preventionist District 1
Indiana Department of Health
Laporte, Indiana, United States

Disclosure(s):

Bethany L. Lavender, RN, MPH: No financial relationships to disclose

Jennifer Spivey, MSN, RN, CIC, LTC-CIP, FAPIC: No financial relationships to disclose

Janene Gumz-Pulaski, MBA, BSN, RN, CIC, LTC-CIP: No financial relationships to disclose

Background: The Center for Disease Control and Prevention (CDC) created a set of Infection Control Assessment and Response (ICAR) tools in 2016, however, the tools are not comprehensive nor regularly updated. The Indiana Department of Health’s (IDOH) Infection Preventionist (IP) team modified the long-term care (LTC) tool with questions related to infection control practices not addressed by the CDC tool to complete more thorough assessments of infection prevention programs in Indiana.

Methods: Sections focusing on kitchen/food-handling, laundry, and COVID-19 infection control practices were added in April 2021 to create an IDOH ICAR tool. Sections for sepsis, catheter-associated urinary tract infections (CAUTIs), and wound care were added to the tool in July 2022. The new questions were developed using guidance from the Centers for Medicare & Medicaid Services (CMS), Agency for Healthcare Research and Quality (AHRQ), state regulations, and the CDC, including the CDC tele-ICAR tool. IDOH’s IP team used the IDOH ICAR tool to complete 1,086 ICARs with the 2021 sections and 353 ICARs with the 2022 sections in state-regulated skilled nursing facilities and assisted livings between April 2021 and November 2022. The IPs entered each assessment into a Research Electronic Data Capture (REDCap) form. The data for this cross-sectional study was analyzed using Microsoft Excel and SAS 9.4.

Results: Infection control practice gaps were identified in 72/353 (20.4%) ICARs for sepsis, 80/353 (22.7%) ICARs for wound care, 104/353 (29.5%) ICARs for CAUTIs, 116/1086 (10.7%) ICARs for kitchen/food-handling, 142/1086 (13.1%) ICARs for laundry, and 243/1086 (22.4%) ICARs for COVID-19.

Conclusions: While the CDC tool is a great starting point, it does not cover all relevant areas of LTC facilities’ infection control programs, potentially leaving important infection control gaps unidentified. IPs using the CDC tool to complete assessments should be aware of other potential infection control risks beyond the CDC ICAR.

Learning Objectives:

Create ICAR questions that identify potential gaps beyond what is provided in the CDC tool, using guidance from various nationally recognized sources such as CMS, CDC, and AHRQ.
Conduct infection control assessments that encompass important topics like HAIs, COVID-19, kitchen safety, and linen safety.
Identify gaps in infection control practices in long-term care facilities that go beyond the CDC ICAR tool.