A Whole New World: Changes in the Nursing Home Infection Preventionist Role in Response to the COVID-19 Pandemic

BACKGROUND: Nursing home (NH) infection prevention and control (IPC) programs struggled before the COVID-19 pandemic. As the pandemic began, NHs were challenged with frequently changing directives including isolation, testing, visitation, and reporting. Within a larger research project, we compared changes in the infection preventionist (IP) role pre-COVID (before March 2020) and during the pandemic. METHODS: 78 Michigan NHs participated in a 12-month program to reduce healthcare-associated infections from 2018-2021. A 36-question survey on IPC characteristics was sent before starting each of four cohorts. Surveys were completed by IPs, nursing directors, or NH administrators. We compared IPC characteristics pre- and intra-COVID using Fisher's exact test and Wilcoxon Rank Sum to assess significance in categorical and continuous descriptors, respectively. RESULTS: 74 (94.8%) NHs completed the survey, 56 pre-COVID (before March 2020) and 18 during COVID (> one year after COVID was identified in Michigan). Full-time equivalent (FTE) for the IP role was similar between the two groups, but hours worked per week increased significantly from an average 20 to 38 hours per week (p< 0.001). Half of respondents in 2021 reported working 40 hours or more on IPC activities. Despite the additional workload, the IP did not have a significant decrease in their non-IP responsibilities (e.g., staff educator, employee health). Pre-COVID, 21.8% of NHs were enrolled in CDC's National Health Safety Network (NHSN). As mandatory COVID reporting into NHSN began mid-2021, its use contributed to an average of five additional hours per week. Inter-facility notification of resident infections was done by a variety of methods, with facility-to-facility telephone calls increasing during COVID. CONCLUSIONS: COVID-19 has dramatically added to the IP workload in NH settings with no reduction in their other non-IP responsibilities. With reporting requirements unlikely to decrease soon, investment into staffing is needed to reduce staff burnout, maintain quality of care, and resident safety.