Mario Rubano,Elana Kieffer,Elaine Larson,Nicole Colline,Carmen Portillo
The development of a long-term care infection prevention compendium during the COVID-19 pandemic
infection prevention,COVID-19,nursing home,long-term care
BACKGROUND Long-term care facilities (LTC) experienced significant morbidity and mortality rates among both residents and staff during the COVID-19 pandemic, for which they were ill-prepared to practice adequate infection prevention and control (IPC). METHODS Our team developed a process for creating a compendium of curated IPC resources. This process harnessed the experience and expertise of nurses actively working in LTC during the pandemic. RESULTS The publicly available online compendium of IPC resources relevant to all departments found within LTC settings. The compendium contains a wide array of IPC tools, research, reports, international resources, and customizable educational slide decks. DISCUSSION Online repositories of curated IPC resources can equip direct care workers with accurate, easily accessible resources to support the maintenance of proper IPC practice and protocol in LTC settings. CONCLUSION Future research should evaluate the effectiveness and usefulness of this model and explore its utility in additional medical contexts.
The development of a long-term care infection prevention compendium during the COVID-19 pandemic

Long-term care facilities (LTC) experienced significant morbidity and mortality rates among both residents and staff during the COVID-19 pandemic, for which they were ill-prepared to practice adequate infection prevention and control (IPC).

Our team developed a process for creating a compendium of curated IPC resources. This process harnessed the experience and expertise of nurses actively working in LTC during the pandemic.

The publicly available online compendium of IPC resources relevant to all departments found within LTC settings. The compendium contains a wide array of IPC tools, research, reports, international resources, and customizable educational slide decks.

Online repositories of curated IPC resources can equip direct care workers with accurate, easily accessible resources to support the maintenance of proper IPC practice and protocol in LTC settings.

Future research should evaluate the effectiveness and usefulness of this model and explore its utility in additional medical contexts.

The first recorded COVID-19 death in the United States (U.S.) occurred in a nursing home (NH) on February 29th, 2020 – a harbinger of the challenges the long-term care (LTC) sector would face. Since then, over 200,000 residents and staff of LTC facilities have died due to the illness. The infection prevention and control (IPC) literature in NHs and LTC settings has lagged behind that of acute care hospitals for decades. This dearth of research, coupled with an already-existing staffing crisis, contributed to the outsized burden of disease experienced in these settings. The unrelenting stress experienced by frontline NH staff during the height of the COVID-19 pandemic is well-documented.2, 3, 4 As a result of several factors, NH staff were often unable to access, reliable, up-to-date and accurate information regarding infection prevention measures for the novel coronavirus (as well as other viruses that were still present in NHs). Such factors included excessive workloads, fear of infection, secondary traumatic stress, staffing shortages, and inadequate PPE.5, 6 Nursing homes throughout the U.S. and around the world were operating in emergency-mode, triaging the direst cases while also trying to enforce physical distancing among the residents and maintaining staff safety and protection from the virus. Information about COVID-19 and effective IPC efforts was frequently changing as the scientific and medical community learned more about the virus. There was little, if any time, to process the incoming and ever-changing information and resources when the essential care and wellbeing needs of the residents had to be met every hour of every day. For these reasons, The New York Academy of Medicine (NYAM) in collaboration with the Yale University School of Nursing (YSN), coordinated an examination of IPC in NHs in the U.S. and around the globe which included an environmental scan of the infection prevention literature, a series of qualitative interviews with frontline NH staff in New York City, a virtual summit of global leaders in the field of IPC, and the development of an online Infection Prevention Compendium for Long-term Care (Compendium). The purpose of this paper is to describe the process of creating the Compendium and recommend how the process of developing such a resource as well as the tool itself are relevant and can be useful for quality improvement in other healthcare settings and for topics in addition to the prevention of infections (e.g., fall prevention, urinary catheter care, management of dementia, etc.).

The aim was to create a one-stop resource where NH professionals could easily locate reliable tools in a timely manner and maximize the amount of time spent addressing the direct needs of residents and the ongoing challenges of providing care in a NH. These challenges included contending with supply shortages, limited staff resources, and resident safety concerns. Once it was determined that a comprehensive online guide of available resources was needed for sharing IPC resources, the first step in its development was to identify the roles and expertise necessary to complete the project. The identified roles included: • Project Coordinators representing NYAM and YSN to oversee the planning and implementation and to facilitate communication between the two institutions. • Nurses to inform the selection of resources and ensure the practicality and user-friendliness of the Compendium’s design. These individuals held Advanced Practice Registered Nurse (APRN) certification and maintained clinical roles in LTC during the development of the Compendium. • Nurse Educators to inform the didactic elements included in the Compendium. • Research Assistants to aide in the collection of resources. • Web Developer to create and maintain the digital infrastructure that would host the Compendium.  Topical areas of focus were assigned to individuals with expertise and experience in specific aspects of the NH system. For example, one team member who was a Director of Nursing with pharmacy and administrative experience searched for online materials related to IPC in the Direct Care Providers and Administrator & Manager categories while a team member with experience in building didactic instruments assembled the PowerPoint tools for the Teaching Tools section. The inclusion of team members with current clinical experience helped ensure the relevance and practicality of the selected resources. The online search included reliable public health institutions such as the Centers for Disease Control and Prevention (CDC), the World Health Organization, and the Institute for Healthcare Improvement, as well as peer-reviewed journals cited in PubMed such as the American Journal of Infection Control, Infection Control and Hospital Epidemiology and relevant long-term care journals including The Journal of Long-Term Care and Annals of Long-Term Care: Clinical Care and Aging. Once the resources were identified, the team collectively reviewed them using four criteria: relevance, usefulness, timeliness, and accuracy of hyperlinks. The resources were then organized by category and title, and accompanying hyperlinks were sent to the web developer, who added the materials to the website in a series of interactive drop-down menus. The final product was reviewed by the internal communications teams of both institutions.

The Infection Prevention Compendium for Long-Term Care Facilities (https://www.nyam.org/center-healthy-aging/resources/infection-prevention-resources/) contains four distinct sections: 1) Infection Prevention Tools & Resources for Direct Care Providers, Administrators, and Support Staff; 2) International and U.S. Infection Control Resources; 3) Summary of NYAM Reports; and 4) Teaching Tools. The first section contains nested sub-categories addressing specific disciplines and roles found within LTC settings. The inclusion of every department found within a typical LTC facility reflects contemporary findings that demonstrate the importance of organizational culture and systems-level approaches in combating infections.12, 13 In addition to addressing transmission of infection by direct care staff, this section addresses non-clinical roles such as admitting department staff, dietary and kitchen staff, recreation staff, and various facilities management roles. An outline of the compendium can be seen in Fig. 1. The second section is a compilation of various resources from and links to international and US-based agencies such as the Centers for Disease Control (CDC), Infection Control Africa Network (ICAN), and the European Center for Disease Prevention and Control (ECDC). International resources are organized by continent and region while U.S.-based resources are organized according to the following categories: training and knowledge; quality of life; organizational culture; external influences and regulations; and general resources. The third section contains summaries of and links to the various reports, journal articles, and webinars that were generated during the course of the Compendium’s development. The final section, Teaching Tools, provides downloadable and customizable PowerPoint slide decks that are tailored to five different audiences within the LTC environment: administrators, families, nurses, residents, and specialized contract providers.

The Compendium was launched in August 2021 and disseminated via email and social media channels at NYAM and YSN. To date, the Compendium has been accessed approximately 3,500 times by users from several nations. [ Table 1] Based on the frequency and geographical range of utilization, it is evident that the Compendium has been accessed and used throughout the latter half of the pandemic. Due to limited data on the types of professionals accessing the data or any qualitative feedback on the utility of the resources, it has not been possible to assess the impact or outcomes of the Compendium in supporting NH staff or in preventing infection among themselves and their residents. The development of the Compendium suffered from a significant limitation. Because funding for the project ended when the Compendium was initially published and disseminated, resources are limited to continually update the contents of the Compendium. Although many of the references and tools included in the Compendium describe core IPC competencies and principles and information that remain stable over time, future users should bear in mind this limitation and the need to augment the existing tools through their own research and review of contemporary findings in the IPC literature. While this limitation works against the Compendium’s initial goal of simplifying and streamlining the acquisition of tools and resources, the existing items can still play an important role in the IPC regimen in NHs.

It was our goal to contribute to the prevention and control of infections and demonstrate a model for developing a one-stop resource in which reliable tools could be readily available to staff in a timely manner. We hope that the process outlined in this paper can serve as a model for the development of future IPC compendia that address the full spectrum of healthcare-acquired infections in LTC settings. Additionally, we hope that this paper stimulates further interest and research into the potential of online compendia in building effective IPC regimen for LTC settings. To our knowledge, this Compendium is one of the first collections of LTC resources and tools available for LTC staff which has been compiled carefully by experts who have confirmed that the information is as current and accurate as possible.

The New York Academy of Medicine and Yale University School of Nursing has received funding from Saraya Co. Ltd. for this research.