ICAP aims to help long-term care facilities

Long before COVID-19 came on the scene, a team from UNMC and Nebraska Medicine were in talks with long-term care facilities across the state about ways to improve their infection control programs.

Today that team is seeing the fruits of their work.

“The pandemic has hit long-term care facilities particularly hard,” said Muhammad Salman Ashraf, M.B.B.S., associate professor of internal medicine at UNMC and medical director of the Nebraska Infection Control Assessment and Promotion Program (Nebraska ICAP).

“If you compare Nebraska to other states, you would see that less than 1% of the nursing home population in our state has succumbed to COVID-19, where more than 10% of the nursing home population have died in other states,” Dr. Ashraf said. “We believe the lower numbers we see in our state are a direct result of the impressive infection control measures and practices of the nursing homes and the educational efforts of the Nebraska ICAP.”

Nebraska ICAP offers a no cost, peer-to-peer infection control assessments and recommendations based on site visits, consultations and online training.

The team includes experienced infection preventionists, infectious disease-trained medical directors and professional educators.

The program was launched in 2015 through a grant from the Centers for Disease Control and Prevention provided to the Nebraska Department of Health and Human Services.

The goal of the grant is to assess infection control activities in a variety of health care facilities across the state, including critical access hospitals, nursing homes, outpatient and surgical centers, and dialysis centers.

Nebraska ICAP also partners with the Nebraska Antimicrobial Stewardship Assessment and Promotion Program to help sites develop programs for reducing unnecessary antibiotic use with the goal of preventing antibiotic resistance.

Since the start of the program, the team has conducted site visits at more than 155 locations and provided ongoing support where needed. In addition, they have collaborated with Nebraska Infection Control Network, a local not-for-profit educational organization, to develop a certificate training program for infection preventionists working in long-term care facilities. To date they have trained 81 nursing home infection preventionists through this program.

Dr. Ashraf said the team found a number of recurring gaps during their visits, including suboptimal hand hygiene practices, a lack of auditing and feedback programs focused on improving infection control practices and a lack of competency-based infection control training for staff.

Once the gaps were discovered, the Nebraska ICAP team were able to provide the resources the facilities needed to make the necessary changes.

“These facilities are doing their best, often with limited resources. Our job is to help them efficiently use those resources in a way that allows them to continue to ensure the safety of their residents and patients,” Dr. Ashraf said.

Because of the work of the Nebraska ICAP, Dr. Ashraf said that when the pandemic did hit, everyone already was engaged in conversation before the first case was identified in Nebraska.

“This program is meant to help these facilities prevent any kind of infection transmission, whether that is just one individual infection transmitted to one other person or a wide-spread outbreak like this pandemic,” he said. “Once you have a program in place, you are ready at all times and can deal with a pandemic like we face today.”