A vast majority of nonprofit and government-owned nursing homes across the U.S. complied with federal infection prevention training requirements, according to the results of an audit conducted by the Office of Inspector General (OIG), released Tuesday. Those that failed to comply cited staffing challenges.

The OIG’s audit, conducted between April 2024 through October 2024, examined whether nursing homes met federal regulations requiring Infection Preventionists (IPs) to complete proper training. To assess this, the OIG selected a stratified random sample of 200 nursing homes – 100 nonprofit and 100 government-owned facilities. These included homes located in all 50 states, the District of Columbia, and Puerto Rico, and a majority were located in Texas.

Of the nearly 15,000 Medicare- and Medicaid-certified nursing homes nationwide as of October 2023, there were 3,294 nonprofit and 922 government-owned nursing homes in operation during the audit period.

The audit methodology involved contacting each of the selected nursing homes and requesting detailed information about the IPs, including their job descriptions, the dates they served in the role, and their qualifications. This data was reviewed to determine whether these facilities adhered to the regulatory standards set for infection prevention training.

“We did not assess CMS’ or the nursing homes’ overall internal control structures. Rather, we limited our review of internal controls to the nursing homes’ policies and procedures related to the IP,” OIG’s report noted.

While most nursing homes complied, the OIG audit revealed gaps at certain nursing homes. The report identified that three nonprofit and two government-owned nursing homes may not have met the federal requirement for IPs to complete specialized training before assuming their roles. These findings, when extrapolated, suggest that approximately 117 nursing homes nationwide, including 99 nonprofit and 18 government-owned, may not have complied with these regulations.

Officials from these nursing homes pointed to staffing challenges as the primary reason for their potential noncompliance. They mentioned difficulties in hiring and retaining experienced and qualified IPs, a factor that may have contributed to lapses in meeting federal training requirements, the report states.

As a result of its findings, the OIG recommended that the Centers for Medicare and Medicaid Services (CMS) instruct state survey agencies to follow up with the five identified nursing homes to ensure they take corrective actions. And, CMS agreed, having reached out to the respective nursing homes that had failed compliance.

Past OIG audits have found that nursing homes did not always comply with federal regulations regarding designating an IP who met federal requirements for that position.

Federal regulations require that nursing homes designate at least one individual as the IP who is responsible for the facility’s Infection Prevention and Control Program (IPCP). The IPs must have primary professional training in nursing, medical technology, microbiology, epidemiology, or other related fields. They must also be qualified by education, training, experience, or certification and work at least part-time at the facility. And last, they are required to complete specialized training in infection prevention and control – the condition that some nursing homes found difficult to meet due to hiring challenges.

An estimated 1.3 million people live in nursing homes nationwide, many of whom are deemed at risk for a high number of health care-associated infections, the OIG said, in explaining the intent behind the audit.