Time to Strategically Position Nursing Homes to Effectively Manage Emerging Infections

Abstract

In response to the coronavirus disease 2019 (COVID-19) pandemic, United States nursing homes (NHs) implemented protocols to protect NH residents from contracting the virus. However, protocol implementation and effectiveness varied across regions. The restrictions included in these protocols, such as halting visitation and communal activities, resulted in NH resident isolation and disruption of many programs designed to promote healthy aging. Prior to the COVID-19 pandemic, NHs had already been struggling with high acuity, limited resources, and a uniquely high risk for emerging infections. 1 The response to the COVID-19 pandemic in NHs was further complicated by lack of access to surveillance, strategic data-informed decision-making, limited testing and access to protective personal equipment, asymptomatic transmission by residents and staff, lack of consistent infection prevention and control (IP/IC) and antimicrobial stewardship (AMS) practices, and varying local, state, and federal guidance. In an effort to support early risk mitigation and emergency preparedness in response to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and other emerging infections, we urge the Federal Government response to consider the following:

A Crucial Role for Antimicrobial Stewardship in the Midst of COVID-19

“…To meet the rigors of diagnostic stewardship, EHRs can be designed to provide a more meaningful process for ordering diagnostic tests ( 15 ). When implemented thoughtfully, EHRs can facilitate a culture of AMS, disease surveillance (identifying potential disease spread based on monitoring symptoms among a population at risk), and seamless transfers in care that successfully transition management of patients between facilities ( 29 ). When health care facilities incorporate AMS program flags, regardless of facility compliance with the AMS program flags, periodic reviews of the flags by the infectious diseases team will provide the health care community an indication of the nature of COVID-19 AMS program ( 24 ).…”