About one in four for-profit nursing homes may not have complied with federal requirements regarding infection preventionists, according to an audit from the Office of the Inspector General (OIG).

The federal watchdog agency found that, out of a 100 for-profit facility sample size, 17 potentially didn’t comply with the requirement that the infection preventionist complete specialized training prior to assuming the role. About 7 facilities didn’t designate an infection preventionist at all, OIG found.

OIG recommended the Centers for Medicare & Medicaid Services (CMS) should have state survey agencies follow up with the 24 nursing homes that may not have complied with federal infection prevention requirements to ensure they’ve taken corrective actions.

CMS should also share the results of the audit with state survey agencies, encouraging them to focus oversight on verifying that nursing homes designate an infection preventionist and that they complete specialized training prior to taking on the role.

CMS agreed to these recommendations, according to the OIG audit.

Tania Bubb, president for the Association for Professionals in Infection Control and Epidemiology (APIC), said that while the association appreciates the recommendations, they don’t go far enough.

“With current laws that don’t require dedicated infection preventionists in nursing homes and don’t require routine surveillance of healthcare-associated infections, we are in the dark on what the overall rates of infection are in these facilities,” said Bubb.

Nursing homes need a dedicated infection preventionist rather than someone designated to the role, she said.

“Without someone dedicated to the job of infection prevention, the job remains ‘other duties as assigned’ for existing overburdened nursing home staff who are designated to do this job in addition to their other work,” Bubb added.

Officials with OIG said these nursing homes encountered difficulties in hiring and retaining experienced and qualified infection preventionists, while facilities also encountered significant turnover in administrators and ownership, on top of infection preventionist turnover.

Pandemic work demands got in the way of completing specialized training in a timely manner, officials added. Access issues related to training for the infection preventionist role, both statewide in-person and online, were also a factor.

Infection control comes with a high price tag too, with concerns still prevalent over drug-resistant superbugs such as Candida auris, as a change in Covid-era protocols has meant less money for infection prevention efforts.

Applying sample size findings to the wider industry, OIG estimated that 2,568 for-profit nursing homes on a national level likely didn’t comply with federal infection prevention requirements.

It should be noted, however, that such requirements were in place long before the pandemic. CMS in 2016 implemented new regulations requiring nursing homes to establish and maintain an infection prevention and control program (IPCP), including a system for preventing, identifying, reporting, investigating and controlling infections and communicable diseases.

Other aspects of the IPCP adds an antibiotic stewardship program that includes a system to monitor antibiotic use, and a system for recording incidents identified under IPCP and corrective actions taken by the nursing home.

“Management and staff at a nursing home are ultimately responsible for ensuring the safety and well-being of residents and staff and for complying with federal, state, and local regulations,” OIG said in the audit. “They are responsible for ensuring that the nursing home develops, maintains, and implements an IPCP.”