Background/Objective Recommendations for infection prevention and control (IPC) of COVID‐19 in long‐term care settings were developed based on limited understanding of COVID‐19 and should be evaluated to determine their efficacy in reducing transmission among high‐risk populations. Design and Setting Site visits to 24 long‐term care facilities (LTCFs) in Fulton County, Georgia, were conducted between June and July 2020 to assess adherence to current guidelines, provide real‐time feedback on potential weaknesses, and identify specific indicators whose implementation or lack thereof was associated with higher or lower prevalence of COVID‐19. Participants Twenty‐four LTCFs were visited, representing 2,580 LTCF residents, among whom 1,004 (39%) were infected with COVID‐19. Measurements Overall IPC adherence in LTCFs was analyzed for 33 key indicators across five categories: Hand Hygiene, Disinfection, Social Distancing, PPE, and Symptom Screening. Facilities were divided into Higher‐ and Lower‐prevalence groups based on cumulative COVID‐19 infection prevalence to determine differences in IPC implementation. Results IPC implementation was lowest in the Disinfection category (32%) and highest in the Symptom Screening category (74%). Significant differences in IPC implementation between the Higher‐ and Lower‐prevalence groups were observed in the Social Distancing category (Higher‐prevalence group 54% vs Lower‐prevalence group 74%, P < .01) and the PPE category (Higher‐prevalence group 41% vs Lower‐prevalence group 72%, P < .01). Conclusion LTCFs with lower COVID‐19 prevalence among residents had significantly greater implementation of IPC recommendations compared to those with higher COVID‐19 prevalence, suggesting the utility in adhering to current guidelines to reduce transmission in this vulnerable population.

This study seeks to gain a baseline understanding of the communication network structure, content of communication, and outcomes in a medical intensive care unit experiencing higher-than-expected central line blood stream infection (CLBSI) rates. The communication network structure refers to the direction and frequency of communication on evidence-based CLBSI prevention practices across various professional subgroups and hierarchical levels in the unit, including medical faculty, nurses, residents, students, unit managers, and hospital administrators. The content of communication refers to the type of knowledge (ie, tacit vs explicit knowledge) exchanged on CLBSI prevention practices. Outcomes include (1) compliance with CLBSI prevention practices and (2) hospital-acquired CLBSI rates in the unit. Data on communication network structure and content of communication are collected using communication logs completed weekly for 4 weeks, by individual participants in each professional subgroup and hierarchical level. Outcomes are collected weekly through chart (medical record) review. Study results indicate a sparse communication network structure with minimal interaction across professional subgroups and hierarchical levels. They also indicate that primarily explicit knowledge on general infection topics is being exchanged as against tacit knowledge on specific infection prevention practices. Unit outcomes are poor, with the central line bundle score at zero during all 4 weeks. The study represents an original attempt at developing methods for measuring the communication network structure related to evidence-based infection prevention practices at the unit level. It lays a foundation for testing hypotheses related to effective communication network structures for hospital infection prevention in a larger study. More significantly, the study lays a foundation for generating concrete and context-sensitive strategies for organizational learning and improvement in the context of evidence-based practices. Such insight is critical from the perspective of evidence-based health care management.

Through infection prevention and control (IPC) site visits to 23 LTCFs in Fulton County, Georgia, comparison between the Higher- and Lower-prevalence groups revealed significant differences in PPE and Social Distancing, with five specific indicators driving these differences.

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