Program Helps Curb Costly SNF Infections, But Improvements Still Needed

A collaborative program has shown promise in reducing a common type of costly infection in nursing homes, though researchers note that some structural barriers to success remain.

An initiative from the Agency for Healthcare Research and Quality (AHRQ) to reduce catheter-associated urinary tract infections (CAUTI) received high marks from participants across the country, according to a new paper published in the December issue of the American Journal of Infection Control.

About a quarter of all nursing home residents face hospital readmissions due to infections, University of Michigan researchers noted, leading to up to $4 billion in annual health care costs. And with readmissions forming a key cornerstone of new quality metrics from the Centers for Medicare & Medicaid Services (CMS), skilled nursing facilities have an additional incentive to curb infections among residents.


The AHRQ’s program involved collaboration between organizers and nursing home staff, with the goal of teaching infection-control practices and improving teamwork among workers. Earlier analysis of the initiative revealed that participants saw CAUTI infections drop 54%, and the Michigan study focused on employee satisfaction and development.

For instance, staffers who responded to the Michigan survey said nurses at their facilities felt more empowered to educate their clinical supervisors about the importance of catheter and urine-culture practices.

“They found their voice to be able to say, ‘You know what? What else can we do, because this is really, I don’t believe, the course for the resident,’” one participant told the researchers. “Empowerment, I think, was the biggest takeaway that’s going to allow them to take any project in the future with a bit better ease.”


Supporting and encouraging collaboration was a clear benefit of the program, lead author Sarah L. Krein told Skilled Nursing News. Krein, a research investigator at Ann Arbor VA Health Services Research and Development (HSR&D) Center of Excellence, said the educational effort brought expert guidance down to the facility level.

“Often, I think they feel a little bit isolated in their practice environment,” Krein said of SNF employees. “This provided another strategy to bring them expert information and build some networks, hopefully, with others in the field.”

Still, the AHRQ initiative ran into some structural roadblocks. Given the high turnover in the skilled nursing industry, it could often be difficult to keep all employees up to speed at any given time. In addition, the lack of conferencing infrastructure at nursing homes made webinar-based education difficult, leading some to print out materials for distribution to nurses and other staff.

“The educational tools and the process that were used, I think could benefit from a little bit more improvement to deliver this information to the staff and the nursing home,” Krein said.

AHRQ recently funded another study from Krein and her colleagues about improving the flow of information between nursing homes and hospitals to help curb readmissions, she said. It’s a topic that she’s experienced firsthand in her work with Veterans Affairs hospitals: Because those facilities tend to be located on the same campus as an affiliated VA nursing home, information sharing generally goes more smoothly than when patients are discharged from hospitals to independent nursing homes.

“Really bringing people together, I think, is part of the key,” Krein said.

Written by Alex Spanko

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