Real-time virtual infection prevention and control assessments in skilled nursing homes, New York, March 2020—A pilot project

Abstract

Objective: to describe a pilot infection prevention and control (IPC) assessment conducted in skilled nursing facilities (SNFs) in New York State (NYS) during a pivotal two-week period when the region became the nation’s epicenter for COVID-19. Design: a telephone and video assessment of IPC measures in SNFs at high risk or experiencing COVID-19 activity. Participants: SNFs in 14 NYS counties including New York City. Intervention: a three-component remote IPC assessment: 1) screening tool; 2) telephone IPC checklist; and 3) COVID-19 video IPC assessment (“COVIDeo”). Results: 92 SNFs completed the IPC screening tool and checklist; 52/92 (57%) were conducted as part COVID-19 investigations, and 40/92 (43%) were proactive prevention-based assessments. Among the 40 proactive assessments, 14/40 (35%) identified suspected or confirmed COVID-19 cases. COVIDeo was performed in 26/92 (28%) of assessments and provided observations that other tools would have missed including: PPE (personal protective equipment) that was not easily accessible, redundant, or improperly donned, doffed, or stored and specific challenges implementing IPC in specialty populations. The IPC assessments took approximately one hour each, reached an estimated four times as many SNFs as onsite visits in a similar timeframe. Conclusions: Remote IPC assessments by telephone and video provided a timely and feasible method to assess the extent to which IPC interventions had been implemented in a vulnerable setting and to disseminate real-time recommendations. Remote assessments are now being implemented across NYS and in various healthcare facility types. Similar methods have been adapted nationally through CDC.

Remote infection control assessments in long-term care facilities during COVID-19 pandemic in Texas, 2020

“…Similar to the estimate provided by Ostrowsky et al in New York, Texas DSHS was able to reach approximately 4 times as many LTCFs with remote assessments compared to on-site visits in the same time frame. 8 …”

“…The tele-ICAR tool also proved to be easily adaptable in response to evolving COVID-19 IPC guidance (Ostrowsky et al, 2021). 8 …”

“…Similar to the estimate provided by Ostrowsky et al in New York, Texas DSHS was able to reach approximately 4 times as many LTCFs with remote assessments compared to on-site visits in the same time frame. 8 Conducting on-site rather than remote assessments is recognized as more beneficial in some instances because in-person assessments are not prone to the same technical limitations that may limit remote ICARs and in-person ICARs typically permit the HAI epidemiologists and IPs to visualize more of the facility's IPC practices. 11 However, Texas DSHS HAI epidemiologists and IPs were still able to identify significant gaps in the facilities' IPC practices via tele-ICARs.…”

“…Remote ICARs by telephone and video proved to be efficient methods of assessing IPC interventions in New York SNFs, reaching an estimated 4 times as many facilities as on-site visits in a similar time frame. 8 …”

Journal Club: Remote infection control assessments in long-term care facilities during COVID-19 pandemic in Texas, 2020

“…2 The ICAR tool was developed in response to the Ebola outbreak as a systematic method to assess infection prevention preparedness in skilled nursing homes. 3 During the COVID-19 pandemic, a modified remote ICAR (tele-ICAR) was developed. These assessments can be conducted before cases are identified in the LTCFs (proactive) or in response to a facility outbreak (responsive).…”