Content Review of Public Health Infection Control Efforts During the COVID-19 Pandemic

BACKGROUND: The COVID-19 pandemic is devastating the healthcare community with unprecedented severe illness and mortality. Facilities are navigating evolving guidance through staffing shortages and turnover. The state health department (SHD) has deployed a network of dedicated infection preventionists to bolster public health response efforts. METHODS: From March 2020 through October 2021, the SHD performed 374 infection control assessments. Assessments were performed using the Nursing Home COVID-19 Infection Control Assessment and Response (ICAR) Tool designed by the Centers for Disease Control and Prevention, versions 1.0 (N=254) and 2.0 (N=120). Infection control domains were assessed for gaps, including personal protective equipment, environmental services, and SARS-CoV-2 testing. Visits included visual assessment including the designated COVID-19 patient care area. RESULTS: Within available data, facility-reported challenges were staff burnout and compliance (18%), staffing shortages (17%), and resident compliance (13%). Only 56% of facilities reported that staff were fit tested for the type of respirator being used, and of those, 12% reported no medical clearance. Facilities reported using disposable respirators for up to 5 shifts. Practices of extended use (56%) and reuse (38%) were noted. Approximately 16% of facilities reported not discarding disposable gowns after doffing at point of use. Additionally, gowns were worn outside of resident rooms by staff in 25% of facilities assessed. Approximately 49% of facilities report having alcohol-based hand rub inside each resident room. Disinfectant product contact time was known by 87% of staff representatives. Only 18% of individuals tasked with infection prevention and control at their facilities reported having no other job duties. Designated COVID-19 care units were present at 71% of facilities. CONCLUSIONS: Gaps noted in infection prevention and control are consistent among facilities. Consistent high rates of staff turnover and staffing shortages contribute to lapses in practice. Self-reported challenges were consistent across facilities and will continue to contribute to future outbreaks within facilities.