As Phase 3 Looms, Many Skilled Nursing Facilities Lack Key Required Staff

A new survey found that though antibiotic stewardship has increased at skilled nursing facilities across the country, there are still gaps with regard to the infection preventionist (IP) position -— even though that position is a key part of Phase 3 of the Requirements of Participation (RoPs) for SNFs, taking effect at the end of November.

Though the Centers for Medicare & Medicaid Services (CMS) proposed a partial delay for some aspects of the Phase 3 RoPs in July, the rule did not propose any delays related to implementing the IP requirements in terms of the person’s role and training.

In the survey, published in the American Journal of Infection Control, researchers affiliated with Columbia University surveyed 861 nursing homes in 2018 to analyze their antibiotic stewardship programs (ASPs) and provide some color on the programs’ characteristics.


They found that 33.2% had “comprehensive” ASP policies, while 41.1% had “moderately comprehensive” ones. They also found that ASPs considered comprehensive were associated with both IP training and high occupancy.

On a hopeful note for SNFs, the researchers did find a direct link between a detailed ASP and increases in prevention-control certification. Nursing homes with ASPs considered “not comprehensive” had IP certification in infection control of 2.8%; SNFs with a “comprehensive” ASP had certification rates of 10.9%.

But problems still remain with regard to the training of IPs in SNFs, the researchers noted.


“The relative lack of training of NH staff compared with hospital settings has been noted as a barrier for infection control and antibiotic stewardship, and 46% of facilities we surveyed reported that their IP had no specific infection control training,” they wrote.

In the proposed delay of parts of the Phase 3 RoPs, CMS did suggest that people who fill the IP position no longer have to work “part-time” at a facility or have frequent contact with the facility’s infection prevention and control program staff. Instead, facilities have to “ensure that the IP has sufficient time at the facility to meet the objectives of its infection prevention and control program (IPCP).”

But facilities are required to include specialized training in infection prevention and control for the individuals responsible for the facility’s IPCP, according to a March 11 memo from CMS.

The researchers did acknowledge the staffing challenges inherent in implementing an ASP, though they “did not find a significant association with higher IP turnover and ASP comprehensiveness.”

But when it comes to preparedness for the position, SNFs’ work seems to be cut out for them.

“Infection control training for IPs remains a key area for improvement, although signs of progress exist,” the researchers concluded.

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