Senior Living Articles

Image of a stethoscope with other healthcare related images.

Assisted Living Providers Face Mounting Infection Control Challenges

November 10, 2020

Residents of senior living communities outside the nursing home world have long enjoyed generally good health relative to their age. They have fewer chronic illnesses – and among those who do – access to fitness and wellness and effective medication therapy are usually successful in keeping it that way.

Yet for young, old and in-between, the one thing no one is immune from is infection. It is blind to socioeconomic status. Even all of the accoutrements of retirement life are powerless to keep it at bay.

Consider what happened at a Springfield, VA assisted living facility in the summer of 2019. More than 20 residents were reportedly hospitalized and among them, three later died. Two of the deceased had been hospitalized with pneumonia and at least 60 more residents were sickened by “respiratory symptoms.”

Fairfax County Health Department officials, who said the deceased residents had “complex medical problems” and were unsure whether pneumonia contributed to their deaths, praised the CCRC’s efforts to fully cooperate in its outbreak investigation. A facility spokesperson said it had implemented “proven infection control strategies” immediately following the incident.

Health officials described the outbreak different from the typical ones that annually affect 5-10 among vulnerable, older adult populations during the winter flu season.

A specific cause for the illnesses has yet to be identified. By late July, the Centers for Disease Control and Prevention had been unable to determine a cause after testing 17 specimens from sick residents, according to news reports.

An uphill battle

According to the Centers for Disease Control and Prevention, up to 3 million serious infections happen each year in senior living settings. These include nearly every conceivable issue, the most common of which include pneumonia, urinary tract infections, diarrheal diseases and antibiotic-resistant staph infections. And nearly 400,000 seniors die every year from the infections they contract in long-term care settings of all kinds.

Other stubborn bugs that hound senior living providers include harmful bacteria and germs like E. coli, Methicillin-Resistant Staphylococcus Aureus (MRSA) and Legionella, which find their ways into breathing orifices via bath surfaces and pipes. The germs aren’t visible on otherwise beautifully appointed baths, but they inflict horrible damage in otherwise healthy seniors.

One of the most prevalent infectious diseases that troubles assisted living facilities year after year is influenza. And as McKnight’s Senior Living recently reported, even the flu vaccine cannot prevent all cases of the respiratory illness. Health officials have called for more targeted flu vaccines for seniors who are more likely to show severe types of influenza.

Still, providers are baffled why vaccine rates are not higher for the general senior population. According to the Clover Health Flu Shot Monitor, 25% of people aged 80 or more years, 34% of those aged 70 to 79, and 44% of adults aged 60 to 69 have not been vaccinated so far this year.

Meanwhile, assisted living providers grapple each year with prevention measures aimed at staving off infections. Providers of all kinds are facing growing rates of antibiotic resistant organisms and are continuously seeking better measures for keeping residents healthy. Under the so-called “Final Rule,” their skilled nursing counterparts are required to establish antibiotic use protocols, develop systems to monitor antibiotic use, designate an infection preventionist and perform ongoing influenza and pneumococcal vaccine measures.

Still, non-skilled settings like assisted living continue to suffer from a lack of resources many say are needed to combat the rising threats from infectious disease, officials from the Association for Professionals in Infection Control and Epidemiology announced recently at their annual convention in Portland, OR. A recent multi-state study led one researcher to note, for example, that assisted living to infection control may be even more limited than they are in nursing homes.

Researchers with a joint public health initiative found that many infection control officers had little to no formal training and lacked foundational skills for proper infection prevention, Senior Living reported. Researchers also discovered high turnover rates, with facilities challenged in retaining consistent, qualified workers to manage their infection control programs.

Staffing challenges

Assisted living providers are equally affected by many of the same workforce issues that plague skilled nursing, and most center around inadequate training, self-awareness issues and downright complacency.

Many caregivers also simply fail to follow long-established standards of practice around infection control prevention.

One recently published study in the American Journal of Infection Control found that more than 80% of ambulatory care nurses do not adhere to all of the standard precautions for infection prevention, potentially putting themselves and those for whom they care at risk. One of the study’s authors told McKnight’s Senior Living that community owners and operators employing nurses or welcoming them into their communities to care for residents should ensure that all nurses have undergone compliance training to reinforce the risks associated with blood-borne pathogen exposure and the importance of adhering to all infection prevention precautions.

Many caregivers fail to exercise proper hygiene and unwittingly pass on opportunistic infections during daily or weekly rounds in assisted living apartments by casually touching bathroom surfaces and doorknobs or even dispensing medications, infection control experts say.

A wound care specialist at Gentell estimates – for example – that as many as 62% of men and 40% of women in general do not wash their hands after using the toilet.

Alarming numbers of long-term caregivers (around 30%) also are skipping annual flu shots. In skilled settings alone, more than 7,000 residents die each year from influenza, according to a study published in the American Journal of Infection Control.

In August 2019, Louisville, KY-based Signature HealthCARE, one of the country’s largest providers, passed a comprehensive new mandatory influenza vaccination policy that could set the standard nationwide, according to McKnight’s Senior Living. The policy applies to all 17,000 employees, including home health employees, across 10 states (including vendors) at the company’s more than 100 assisted living, memory care, skilled nursing and rehabilitation facility locations.

Experts agree that poor or inadequate training handicaps so many assisted living providers’ efforts to mitigate or avoid the spread of infectious viruses and bacteria across their resident populations.

For those assisted living communities with onsite laundries, there are plenty of vulnerabilities for opportunistic infections to take hold. Improperly disinfected and cleaned textiles like bed and personal care linens contaminated with infectious body fluids and skin can actually spread disease, as some providers have discovered the hard way.

Parting advice

Following is sound advice for providers seeking to upgrade their efforts to fight infections.

Understand your facility or community’s vulnerabilities for opportunistic infections. Establish air and water management plans. This includes routinely inspecting water pipes and HVAC and protecting against air and waterborne pathogens. Basics include:

  • Regular cleaning and disinfection.
  • Following manufacturers’ recommendations.
  • Conducting infectious disease assessments.
  • Using proper cleaning chemicals.
  • Considering disposables when practical.

Establish a community infection control program. There are ample resources in the websites of APIC, CMS, NCAL and Argentum, to name a few.

Develop and implement a facility or community-wide infectious outbreak response plan. The New Jersey Legislature recently passed a law requiring assisted living, memory care, residential and skilled nursing facilities to submit response plans following an adenovirus outbreak that reportedly killed 11 children at a rehab facility. Some health officials blamed the deaths on poor hygiene; federal officials said the facility failed to respond to the situation quickly enough.

Creating the best environment for patient care, including clean staff and rooms, should be a top priority for senior living communities. These practices improve the chances of all residents, staff, and caregivers staying healthier throughout the year. For more thought leadership content, please feel free to reference our wide variety of Learn Articles provided by ValueMed and PharMerica.