Infection Prevention Success Stories
CDC is learning from the experiences of long-term care facilities, nursing home partners and public health departments as they successfully respond to COVID-19.
Lessons learned from their experiences provide practical approaches and solutions that can be used to protect residents, staff, and communities. Stories are organized by key prevention strategies.
Many long-term care facilities across the country are taking actions to implement CDC guidance and keep residents and staff safe during the COVID-19 pandemic. These stories highlight a small selection of the ongoing work of those facilities.
Building trust with residents and families is essential.
Broad Reach Health
When visitor and access limitations were implemented at Liberty Commons skilled nursing facility in Massachusetts, leadership knew that the fear of the unknown could be more paralyzing than any realities. Broad Reach decided right away to communicate regularly, across the board, with families, residents, and staff alike. The response, they say, has been “nothing short of overwhelmingly positive.”
To communicate with families and residents, the team at Liberty Commons opted for automated voice messages, which had long been part of its emergency preparedness plan. The messages are also posted on the facility’s website every day and shared on social media. The website shows ongoing aggregate COVID-19 testing results for both residents and staff; information about PPE procurement and recoveries from COVID-19; and “human interest” updates, especially as they relate to visitor restrictions and isolation precautions. A key communication success has been the implementation of a dedicated “info” email address and voicemail for families to leave questions, promising response within a business day.
Broad Reach says there has been no backlash or perception of information being withheld, and frontline staff has not had to field as many calls about what’s happening. When two residents tested positive for COVID-19, the response remained positive about preparedness, operational response, and communication.
Learn more at Broad Reach Healthcare: COVID-19 Information and Resourcesexternal icon.
Supporting staff improves morale.
Minnesota Department of Health
As the COVID-19 pandemic progressed, the Minnesota Department of Health (MDH) began to realize there were substantial anxieties and concerns among healthcare personnel (HCP) in long-term care facilities (LTCF), even in those that had not experienced COVID-19 cases. These psychosocial issues were often not addressed because of the pressing concerns of sourcing personal protective equipment (PPE), coping with staff shortages, and containing the spread of the virus. To address this gap, MDH and CDC set out to develop and disseminate information to help.
Although there is a lot of information available online about self-care, dealing with distress, and psychological first aid, there was no single resource to help HCP during a crisis, or in outbreak situations affecting their residents and coworkers. MDH and CDC developed materials to provide leaders in LTCF with simple strategies and steps to support their HCP as they adapted to new and demanding working conditions. Materials were expanded to also include information about burnout, secondary traumatic stress, grieving, self-care, and coping at home.
Valuable discussions with HCP at many LTCF guided the creation of the Mental Health and Resiliency Tools, which have been shared with LTCF and other healthcare settings throughout Minnesota, it is hoped that other states can adopt similar materials to support their critical healthcare workforce.
The “Mental Health and Resiliency Tools for Health Care Workers: COVID-19external icon” feature:
- Four ready-to-use 1-pagers:
- Common Staff Fears and Concerns pdf icon[PDF – 1 page]external icon
- Seven Things You as a Leader Can Do Right Now pdf icon[PDF – 1 page]external icon
- Tips for Taking Care of Yourself pdf icon[PDF – 1 page]external icon
- Where to Turn for Mental Health Support during the COVID-19 Pandemic pdf icon[PDF – 1 page]external icon
- COVID-19 Wellness Pocket Guide pdf icon[PDF – 1 page]external icon
- Appendices with more detailed information:
- Ways to Address Common HCP Anxiety & Concerns pdf icon[PDF – 6 pages]external icon
- Addressing Anxieties: 7 Things You Can Do as Leaders Right Now pdf icon[PDF – 5 pages]external icon
- Tips for Taking Care of Yourselfexternal icon
- Tips for Communicating with Health Care Workers pdf icon[PDF – 4 pages]external icon
The Maryland Institute for Emergency Medical Services (EMS) & The Workplace Trauma Center
In early March 2020, Maryland local and state EMS responders noticed that the COVID-19 pandemic was not only affecting residents of long-term care facilities (LTCF), but also the mental health of many staff in these facilities. Staff were struggling to cope with the illnesses and deaths of coworkers and longtime residents who were like family, communicating with grieving and upset family members, working long hours with limited personal protective equipment, and managing the fear of taking the illness home to family members. Recognizing that LTCF staff had limited support in dealing with these extremely stressful circumstances, the Maryland Institute for EMS Systems (MIEMSS) worked with the Workplace Trauma Center to find a way to help.
The Workplace Trauma Center developed and implemented a comprehensive program to provide support to LTCF in Maryland. Funding for the project was made available through the Maryland Department of Health Behavioral Health Administration, and services are provided at no cost to the facility or staff. Each facility requesting support is assigned a licensed mental health professional experienced with crisis management. Facilities can choose from a variety of services including management consultation, group team support, critical incident support, emotional health webinars, grief support, and assistance developing memorial services.
Individual support is also available at no charge for any LTCF staff in Maryland. Employees can submit a confidential online request for support and a licensed clinician is provided. The Workplace Trauma Center notes that most service requests have been filled within 12-24 hours, and the program also has clinicians available immediately if needed. Overall feedback from facilities and employees has been positive and the Workplace Trauma Center is hoping to increase staff and facility participation in the program through promotional campaigns and the availability of Spanish speaking providers. The program is currently scheduled to continue until the end of 2020 and is a shining example of public-private partnerships to support frontline workers during crisis.
American Health Care Association/National Center for Assisted Living (AHCA/NCAL)
With most media coverage of COVID-19 in long-term care facilities (LTCFs) about outbreaks and deaths, AHCA/NCAL has started an initiative to highlight positive stories during the pandemic. It calls attention to the healthcare heroes in LTC who are keeping residents safe, and to the many residents who have recovered from the virus.
The organization launched “Faces of Careexternal icon,” a new page on CareNotCOVIDexternal icon, a site where people can share videos of support for seniors in LTC. The page features a photo gallery of residents who have recovered from COVID-19, as well as staff who have stepped up during the pandemic. Visitors can submit their own stories if they work in LTC or know a resident who survived COVID-19.
People have remarked that they enjoy and look forward to these uplifting stories, which have also helped boost the morale of LTCF staff and residents. Telling these stories has encouraged others to share their own accounts, and news outlets have covered the feel-good stories, broadening the scope of this narrative even more.
Identifying infections and acting early protects residents.
Massachusetts Senior Care Association and Hebrew SeniorLife
In April 2020, Massachusetts (MA) nursing homes became a hotspot for COVID-19 infections and deaths. The MA Governor responded by providing additional funding to assist all nursing homes contingent upon their compliance with specific infection prevention and control strategies, infection prevention and control practice audits, and testing, in order to reduce the spread of COVID-19 and save lives.
Massachusetts Senior Care Association and Hebrew SeniorLife were the primary partners in this state-wide effort. Performing the initial infection prevention and control (IPC) competency audits for nursing homes, providing on-site and virtual consultation and training, as well as resources for personal protective equipment (PPE) procurement, recruitment of temporary staff, and SARS-CoV-2 testing.
At the onset of this program, 123 “special focus” facilities were identified as deficient in infection prevention and control practices and were targeted for follow-up consultations. Consultations included a review of audit findings, strategies for cohorting residents appropriately, guidance for PPE use and optimization, procedures for cleaning and disinfection, identification of resource needs and accessibility, and updates on state and federal guidance. All facilities were invited to join weekly webinars that reinforced aspects of the audit checklist and offered opportunities for live Q&As following each webinar.
This innovative MA program helped to rapidly improve audit scores in these “special focus” facilities, and upon reassessment and comparison to non-special focus facilities, interventions were found to have a positive outcome.
Program partners feel strongly that providing ongoing, sustained support to long-term care providers, could serve as a model to keep nursing home residents and staff safe even after the COVID-19 pandemic has subsided.
Learn more in a recent publication “Stemming the Tide of COVID-19 Infections in Massachusetts Nursing Homesexternal icon”.
Vetter Health Services
In mid-March, the team at Vetter Health Services learned to “trust your gut and insist on testing” when dealing with the first case of COVID-19 at Papillion Manor, a long-term care facility in Nebraska. The team prevented the spread of COVID-19 in the facility by quickly identifying symptoms and implementing appropriate Transmission-Based Precautions for the resident with suspected infection.
When a resident presented with fever, the resident was placed in Precautions and a COVID-19 test was requested within an hour and a half. Additional measures included designating staff to care for the resident and logging contacts between residents and staff. As the resident’s symptoms worsened, the team continued to advocate for testing and obtained approval. The results confirmed their suspected diagnosis of COVID-19.
The eight team members who cared for the resident were placed on voluntary “sick leave” for 14 days following their last exposure to the infected resident, and all residents, families, and team members were notified of the facility’s positive case via phone or in person.
In addition to acting promptly, even before test results, the team learned that it takes a lot of personal protective equipment to care for a patient with COVID-19. They did not initially have eye protection and feel fortunate that they implemented strategies to limit the number of staff exposed while caring for the resident. They feel their greatest success was that no other residents or team members tested positive for COVID-19.
Learn more at Vetter Senior Livingexternal icon.
Cantata Adult Life Services
When COVID-19 cases began occurring in other healthcare facilities in their community, the administrative leadership at Cantata Adult Life Services recognized early that they needed a multilevel action plan to prevent COVID-19 from entering their facility in Brookfield, IL. Through quick action in early March, Cantata implemented strategies to keep COVID-19 out and identify potential cases early.
Cantata’s action plan included:
- establishing connections with key healthcare and public health partners in the community
- placing signs on campus encouraging handwashing and advising ill visitors to not enter buildings
- screening employees and essential visitors for symptoms of COVID-19
- canceling all in-person activities
- creating a 14-day quarantine unit for all admissions in health services
- keeping open lines of communication with families and between administration and clinical team
- contact tracing for employees who did not pass screening or self-reported COVID-19 exposure
- supporting staff members and listening to their concerns
One of the keys to Cantata’s success has been the understanding that change will occur quickly and frequently as we learn more about this virus. Throughout the pandemic, Cantata has constantly reviewed and revised their action plan based on new guidance from CDC and CMS. They have remained vigilant despite rapid change, working with their frontline staff to identify potential breaks in mitigation plans and correct them immediately. If not for their open communication, support to staff, and engagement of their leaders, they say, their COVID-19 experience might have been very different.
Learn more at Cantata: Daily Life on Campusexternal icon.