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 LTC Quality Leader Outlines Solutions to Prevent Infectious Disease Outbreaks

In testimony before a New Jersey state legislative panel, David Gifford, MD, senior vice president of quality and regulatory affairs at the American Health Care Association (AHCA), outlined a series of solutions and steps facilities of all types can take to help prevent infectious disease outbreaks and offered AHCA assistance to train staff on such issues.

Gifford, who appeared on Dec. 3 before the New Jersey Senate Health, Human Services and Senior Citizens Committee on skilled nursing facility-based infectious disease outbreaks, control, and prevention, spoke after an outbreak of adenovirus at a long term care facility in Wanaque, N.J., which caused 11 deaths and infected a number of children.

After expressing his condolences, Gifford offered solutions aimed at how to lower the risk of viral infections from entering a nursing facility and how to decrease the risk of viruses spreading between residents.

Of the several precautions he recommended to prevent a future outbreak was that New Jersey move up the implementation date for the new Centers for Medicare & Medicaid Services Infection Preventionist specialized training requirement from November 2019 to April of next year.

“While this tragic outbreak was due to adenovirus, we must take common sense steps to prevent other community viruses that typically cause flu-like symptoms from entering nursing homes,” Gifford said.

“They can have severe consequences in residents of all ages who have many underlying health problems. People should stay home when sick, cover their mouth when coughing, and frequently use alcohol-based hand gels. Nursing homes should also have alcohol-based hand gels readily available for visitors and staff to use to prevent the spread of viruses to the residents.”

Another solution, Gifford said, is offering free infection preventionist training. In light of the AHCA’s continued commitment to quality care, the association is offering to provide its Infection Preventionist Specialized Training at no cost for nursing facilities caring for high-risk populations in New Jersey, such as those on ventilators or children.

The online training helps facilities with the recently expanded infection prevention and control requirements and the new requirement to have a designated Infection Preventionist with specialized training. Upon completion, participants receive a certificate of specialized training and 23 American Nurses Credentialing Center contact hours.

Gifford also said there many measures facilities can take to prevent viral outbreaks from happening.

First, he said it is important to recognize that while the two recent outbreaks in New Jersey were due to adenovirus, other common viruses such as influenza, respiratory syncytial virus, para-influenza, and human-meta-pneumo virus could also have caused the problems.

“These viruses typically cause flu-like symptoms (i.e., fever, cough, and runny nose) in most of us, but as we have seen, they can have dire consequences for children in nursing homes, particularly those requiring mechanical ventilation as well as other individuals with chronic respiratory problems, chronic diseases and who are immune-compromised,” Gifford testified.

In general, he said the steps to prevent viral outbreaks are similar, regardless of the virus.

“Thus, focusing on adenovirus alone would, in my opinion, be a mistake. An analysis of data we conducted in preparation for this hearing found that 44 New Jersey nursing centers care for a large number of individuals at very high risk for complications from common respiratory viruses,” Gifford said.

Other measures to help prevent the introduction of a virus into nursing centers or any health care facility include:

  • Keeping all ill individuals from visiting the facility, including family, volunteers and employees, or restricting their interaction with residents.
  • Requiring individuals visiting a facility to wear a mask when viral infections are at increased levels in the community (e.g., influenza).
  • Immunization of health care workers (e.g., influenza, measles, diphtheria, pertussis, chicken pox) or limiting workers’ physical interaction with residents when not immunized or using masks when such viral infections are found at increased levels in the community.

Steps to help decrease the risk of viral spread within a facility include: ongoing hand hygiene at high levels, early identification of viral infections that cause upper respiratory illness (e.g., “colds,” “flu,” or “winter crud”) that lead to steps that prevent viral spread, and keeping ill individuals away from healthy individuals ideally by cohorting ill residents together, though cohorting may not be possible given the physical space and structure of facilities.

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