Designed for infection preventionists and facility educators within long-term care facilities, this course addresses the critical issue of inadequate staff training, which often leads to deficiency citations and suboptimal care standards. This course is a pivotal platform for emphasizing the importance of comprehensive infection control and prevention training. Participants will develop expertise in crafting and implementing highly effective infection control training programs. Through immersive learning experiences, they will gain insights into conducting thorough gap analyses, and learning needs assessments targeted explicitly toward enhancing the competency of long-term care staff.

The overarching objective of this course is to arm participants with the requisite knowledge and skills to cultivate a culture of safety and excellence in infection prevention and control within long-term care settings. Empowering them with practical tools and strategies in conducting gap analysis and learning needs assessment will significantly improve the quality of care delivered, ultimately safeguarding the health and well-being of the residents in long-term care settings. .

Introduction-Regulatory Framework and Guidelines

• Exploring federal and state Infection control compliance requirements in LTC
• CMS required nursing homes to:
  • Have a broad, effective infection prevention and control program (IPCP) that includes a system for preventing, identifying, reporting, investigating, and controlling infections and communicable diseases for residents and staff. 
  • Have the individuals responsible for a nursing home’s IPCP complete specialized training in infection prevention and control.

• 6,622 nursing homes (approximately 43 percent) have been cited for IPCP deficiencies related to…
• Not providing and implementing an infection prevention and control program (5,977 nursing homes)
• Not developing and implementing policies and procedures for flu and pneumonia vaccinations (232 nursing homes)
• Both (413 nursing homes)

• Nursing Homes (NHs)with trained IPs were more likely to have 5 of the 7 components of antibiotic stewardship in place  (P < .05).
• Reasons NHs get Infection Control Citations include:
  • Inadequate staff training and knowledge of infection control principles
  • Low staffing levels account for increased infection control citations in nursing homes.

6 Strategies to Effective IPC Training

1. Ask why- determine the root cause of the deficient practice.
2. Conduct gap analysis- to identify shortfalls in knowledge, practice, and policy.
3. Identify the learning needs of staff.
4. Design appropriate training.
5. Implement and evaluate training.
6. Quality Assurance and Performance Improvement (QAPI) 

Conducting Gap Analysis 

• Step-by-Step Guide to Performing a Gap Analysis
  • Define the scope. 
    • Defining the scope of a gap analysis is a critical step because it determines the focus and boundaries of the analysis.
    • Have clear objectives and specific goals.
    • What problem are you trying to solve?
    • What improvement are you seeking? 
    • The scope should align with these objectives.
      • Relevance
      • Regulatory Compliance
      • Quality Care Standards
      • Time frame
      • Resources available 
      • Data availability
      • Stakeholders – Individuals involved in or will be affected by the gap analysis.
• Identify current practice.
  • Observations
  • Self-reports- (huddles, skilled meetings, QUAPI)
  • Audit reports. 
  • Surveillance reports
  • line listings.
  • Survey results -CMS 2567
  • Quality Indicator trends
  • Ask questions on the unit. 
  • Conduct mini surveys.

• Define the ideal or desired state
• Benchmarking
  • CMS/DPH quality care standards
  •  §483.80(a)(1), (a)(2), (a)(4), (e), and (f) 
  • CDC Infection control standards
  • Facility policies and procedures

• Determine the gap or shortfalls.
  • Knowledge gaps
    • Regulatory knowledge gaps
    • Facility policy knowledge gaps
    • Quality care standard 
  • Skills gaps
    • Competency gaps (Novice to expert)
    • Frequency of performing skill
  •  Policy Gaps-Depends on defined scope.
    • Does the facility’s policy align with current practice standards and regulations?

• Analyzing to Identify Gaps
  • Determine common trends or patterns. 
  • Look for major themes in what participants/stakeholders are communicating in self-reports, conversations, and interviews.
  • Analyze to determine gaps.
  • Comparing and contrasting data in detail 
    • How many times was deficient practice observed? 
    • What shift had the highest infraction?
• Learning needs assessment – The questions to ask. 
  • What type of learners
  • Middle-aged adults
  • Young adults
  • Special needs (language barriers, accommodations)
  • Visual, tactile, audio, social learners, 
  • What content delivery approach fosters effective learning among staff
  • Gamification
  • Case studies
  • Lecture
  • Self Reading

Learning Needs Assessment Methods 

• Overview of assessment methods (audits, surveys, interviews, observations)
  • Competency evaluation (Staff perform skill)
  • Survey or poll
  • (Give survey during huddle, shift reporting etc)
  • Use digital apps such as Voice friend to poll staff
  • Ask open-ended questions.
  • Feedback from prior educations
• Choosing the right method for your facility

Data Interpretation and Analysis 

• Learning Needs Assessment
  • Determine common trends or patterns. 
  • Look for major themes in what participants/stakeholders are communicating in self-reports, conversations, and interviews.
  • Analyze to determine learning needs.
  • Comparing and contrasting data in detail 

Conclusion

• Conducting a gap analysis and learning needs assessment allows us to precisely identify the knowledge requirements of our staff and customize training to meet those learning needs, thereby enhancing compliance with best practices.
• It was quite the revelation to discover from our case study that training on time management and task prioritization was needed to help with staff compliance with Infection prevention and control.

References

• Castle, N. G., Ferguson-Rome, J. C., Men, A., Wagner, L. M., & Handler, S. M. (2011). Nursing home deficiency citations for infection control. American Journal of Infection Control, 39(4), 263-269–269. https://doi-org.ezproxymcp.flo.org/10.1016/j.ajic.2010.12.010
• Center for Medicare and Medicaid Services [CMS]. (2024). Nursing Home Compare. https://www.medicare.gov/care-compare/results?searchType=NursingHome&page=1&radius=10&sort=closest&zipcode=19056
• Herzig, C. T. A., Stone, P. W., Castle, N., Pogorzelska-Maziarz, M., Larson, E. L., & Dick, A. W. (2016). Infection Prevention and Control Programs in US Nursing Homes: Results of a National Survey. Journal of the American Medical Directors Association, 17(1), 85–88. https://doi-org.ezproxymcp.flo.org/10.1016/j.jamda.2015.10.017
• Jester, D. J., Peterson, L. J., Hyer, K., & Dosa, D. M. (2021). Infection Control Citations in Nursing Homes: Compliance and Geographic Variability. Journal of the American Medical Directors Association, 22(6), 1317–1321.e2–1321.e2. https://doi-org.ezproxymcp.flo.org/10.1016/j.jamda.2020.11.010

Stone, P.W., Herzig, C.T.A., Agarwal, M., Pogorzelska-Maziarz, M., & Dick, A.W. (2018). Nursing Home Infection Control Program Characteristics, CMS Citations, and Implementation of Antibiotic Stewardship Policies: A National Study. Inquiry: The Journal of Health Care Organization, Provision, and Financing, 55. https://doi-org.ezproxymcp.flo.org/10.1177/0046958018778636