Nebraska Benefiting from Aggressive Infection Control

The COVID-19 virus crisis continues and those most affected continue to be older people, especially those living in long-term care facilities. Facilities, armed with more knowledge, have taken steps to limit infection. While there are down sides to their efforts, like isolation from family members, the goal has been to maintain the safety of residents and staff in these facilities.

Nebraska has had success in this area. Early on the University of Nebraska Medical Center and Nebraska Medicine has been active working with facilities to promote the heath and safety of everyone. According to the CDC the state has one of the fewest death rates per 1000 long-term care residents in the United States with only 15 deaths per 1000 residents as of July 12, 2020 which is among the least in the country.

Average number of death per 1000 residents – CDC – updated live here.

Over 40% of COVID-19 Deaths Were Living in Nursing Homes

The New York Times has reported that over 40% of all COVID-19 deaths are those who were living in long-term care facilities. Comorbidity is associated with these deaths as residents tend to both be older and have several health problems, which makes them more vulnerable.

Muhammad Salman Ashraf, MBBS, associate professor of internal medicine at the UNMC and medical director of the Nebraska Infection Control Assessment and Promotion Program, says the pandemic has hit long-term care facilities particularly hard.

"If you compare Nebraska to other states you would see that less than 1% of the nursing home population in our state has succumbed to COVID-19, where more than 10% of the nursing home population have died in other states. We believe the lower numbers we see in our state are a direct result of the impressive infection control measures and practices of the nursing homes and the educational efforts of the Nebraska ICAP," Dr. Ashraf said.

They provide no cost, peer-to-peer infection control assessments, and recommendations based on on-site visits, consultations, and online training. Experienced infection preventionists, infectious disease trained medical directors, and professional educators are all involved in helping promote health and safety during this crisis.

Invention Prevention Critical

The program was actually launched back in 2015 through a grant from the Centers for Disease Control provided to the Nebraska Department of Health and Human Services. The goal is to assess the infection control activities in various healthcare facilities across Nebraska, including critical access hospitals, nursing homes, outpatient and surgical centers, and dialysis centers.

With the recent COVID-19 virus crisis, this program's importance has increased and is showing to be successful. To date, 81 nursing home infection preventionists and been trained through this program.

Dr. Ashraf said the team found several recurring gaps during their visits, including suboptimal hand hygiene practices, a lack of auditing and feedback programs focused on improving infection control practices, and a lack of competency-based infection control training for staff.

Once these gaps are discovered, the Nebraska ICAP team provides the resources the facilities need to make the necessary changes.

"These facilities are doing their best, often with limited resources. Our job is to help them efficiently use those resources in a way that allows them to continue to ensure the safety of their residents and patients," Dr. Ashraf said.

Because of the work of the Nebraska ICAP, Dr. Ashraf said that when the pandemic did hit, everyone was already engaged in conversations before the first case was identified in Nebraska.

"This program is meant to help these facilities prevent any kind of infection transmission, whether that is just one individual infection transmitted to one other person or a wide-spread outbreak like this pandemic, you are ready at all times, and you don't just change your routine," he said. "Once you have a program in place, then you can deal with a pandemic like we face today."

Comorbidity – COVID-19 and Long-Term Care

The CDC indicates that several comorbidity factors in COVID-19 deaths include serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies. Other factors include chronic kidney disease, COPD, obesity, sickle cell disease, and diabetes.

In long-term care facilities, you have a large group of people with health and age problems, plus staff and before the isolation rules were put in place, family and vendors who had contact with residents and staff.

With America getting older and needing long-term care services more and more, the safety of these people and the staff that serve them is vital. Many people have no option other than going to a nursing home due to several factors, including lack of Long-Term Care Insurance and financial resources to provide care outside a nursing home.

Those with the resources or who own LTC Insurance can limit their exposure to COVID-19 by staying in their own home. Care at home limits the number of people who have contact with the care recipient.

The home care providers can maintain a clean environment in the home and place the appropriate rules to ensure any family member who visits maintains social distancing and wears a mask.