QAPI 102 - Comparing Infection Prevention and Control Program Gaps During the COVID-19 Pandemic with Pre-pandemic Assessments in Critical Access Hospitals

Background: Little is known about infection prevention and control (IPC) program gaps subsequent to the COVID-19 pandemic. The Centers for Disease Control and Prevention (CDC) Infection Prevention and Control Assessment and Response (ICAR) tool is used to assess gaps in IPC programs.

Methods: The ICAR tool was used to assess 36 critical access hospitals (CAHs) between 2015-2017 and 6 CAHs in 2022. For analysis the same 80 best practice recommendations (BPRs) across 11 IPC domains were analyzed between the two time periods. Responses were either recorded as yes (suggesting best practice is in place), no, or in-progress. The IPC gaps (defined as a percentage of no and in-progress responses to a BPR) were compared.

Results: The largest gaps in 2022 by domain were injection safety (71%) and environmental cleaning (60%). The largest gaps in 2015-2017 by domain were injection safety (85%) and the prevention of central line-associated bloodstream infection (CLABSI) (76%). Comparing 2015-2017 to 2022, the most regression occurred in the IPC program and infrastructure domain (17% vs. 47% respectively), with most notable gaps in the qualification and training of the infection preventionist (IP) and performing an annual facility risk assessment. The other domain with the most regression was environmental cleaning (49% vs. 60%), with most notable gaps in having clearly defined responsibilities for non-critical equipment cleaning and disinfection and having protocols ensuring personnel can identify when equipment is ready for next patient use. The most improvement occurred in the CLABSI domain (76% vs. 48%), with most notable improvement in the routine auditing and feedback for central line insertion.

Conclusions: Recognizing the small sample size, this analysis highlights some increasing IPC gaps during the COVID-19 pandemic especially impacting IPC program infrastructure. Future efforts should focus on education and retention of IPs and supporting them with resources for overall program implementation.