The Hidden Danger: Why Reducing Infection in Nursing Homes Should be a National Priority

By Amy Carenza

Over the past several years, the world has experienced devastating infectious disease outbreaks involving Norovirus, H1N1, MRSA (Methicillin-resistant Staphylococcus aureus), SARS-CoV-2 (COVID-19), and most recently, the drug-resistant Candida auris, or C. auris. Health care settings, particularly nursing homes, served as an important illustration of how epidemic-prone pathogens can spread rapidly under the right circumstances. Nursing homes exposed deficiencies in infection control and prevention, highlighting why reducing infection among the most vulnerable populations should be a national priority, even though it is challenging.

The Prevalence of Infectious Diseases
According to the CDC, one in 43 nursing home residents suffers from a health care–acquired infection (HAI). 

HAIs can cause significant threats to nursing home residents, staff, and visitors, and are a source of mortality and morbidity, with an estimated 1.7 million infections and 99,000 deaths annually. Infection prevention and control (IPC) practices in long term care facilities have the potential for far-reaching benefits, both financial and lifesaving. 

The COVID-19 pandemic was catastrophic for nursing home residents and taught us important lessons about caring for our most vulnerable populations. Residents in assisted living communities are often high-risk and immunocompromised, so standard infection control practices such as hand washing, the use of personal protective equipment, and environmental cleaning are not enough. 

As such, compared with the general population, nursing home residents experienced an excess death rate due to COVID-19. According to the study, Nursing Home Quality, COVID-19 Deaths, and Excess Mortality, published in 2022, “the death rate (per 100,000 people) for non-nursing home residents is roughly 87,” whereas, “the death rate for nursing home residents is about 9,200, or about 108 times the rate for the general population.” The authors “calculate that the COVID-19 death rate for people 65 and over living outside of nursing homes is 390, meaning the nursing home death rate is about 24 times this number.”

Although the public health emergency has officially ended, the crisis in nursing homes persists. Nursing home residents and staff are still contracting and dying from COVID-19. According to the CMS, from January 1 to April 23, there have been 183,992 confirmed cases and 3,885 deaths of nursing home residents due to SARS-CoV-2.

Current Challenges
The COVID-19 pandemic exposed significant IPC gaps in nursing homes on a global scale. And today, nursing homes continue to struggle with IPC practices in large part due to the following. 

1. Recruiting and retaining quality personnel. According to the Bureau of Labor Statistics, skilled nursing and assisted living centers experienced the most significant workforce contraction of any health care delivery segment (-15%), forcing greater dependency on contract nursing and the associated wage inflation. Staffing shortages and high turnover can hinder implementing and maintaining consistent, best-in-class IPC measures.

2. Emerging pathogens. Emerging pathogens can be challenging to detect and diagnose, which can delay the implementation of IPC measures. In some cases, infected individuals (residents and staff) may not show symptoms or may have mild symptoms, making it challenging to identify and isolate cases.

3. Lack of resources. Nursing homes may also struggle with limited resources necessary to invest in IPC measures, such as personal protective equipment, disinfectants, and staff training.

4. Inadequate infrastructure. Outdated or deficient infrastructure, such as inadequate ventilation systems or insufficient isolation rooms, can make it hard to prevent the spread of infections.

5. Lack of awareness. Some nursing home staff and administrators may not be aware of the latest IPC guidelines, practices, or available technologies, which can lead to inadequate or ineffective IPC measures. IPC awareness requires a concerted effort from staff, administrators, and regulatory agencies.

The Financial Impact of Nursing Home Infections
The financial impact of not implementing IPC measures in nursing homes can be significant, leading to revenue penalties, increased costs of care, and a reduction in patient census and new patient referrals. There’s also the cost of a lost bed if an infected patient needs to be isolated or relocated. Combined, these impacts can devastate the facility's financial health and viability. 

21st-Century Solutions for Infection Control and Prevention 
With new technologies and innovations, nursing homes can adopt 21st-century solutions to supplement their existing infection control methods. For example, implementing continuous surface and air disinfection technology utilizing advanced photocatalysis.

Improving indoor air quality (IAQ) has long been shown to have significant benefits in preventing the spread of infections without requiring additional skilled labor, extensive training, or environmental cleaning practices. In addition, some IAQ technologies, such as advanced photocatalysis, can help target decolonization on surfaces as well as reduce airborne contamination, which is especially important when dealing with multidrug-resistant organisms. 

IAQ Benefits
Layering in continuous surface and air disinfection technology can offer numerous benefits ranging from patients to personnel and financial cost savings. These benefits could potentially include the following:

• reducing CMS penalties based on HAI control practices;

• reducing costs associated with the treatment of HAIs (disposables, antibiotics, and staffing demands);

• decreasing staff absenteeism;

• giving employees, residents, and visitors confidence that the air they breathe and the surfaces they touch remain free of contagious pathogens and contaminants;

• realizing increased community reputation based on high-quality ratings and reviews from patients; and

• reducing patient isolation due to illness, allowing for increased occupancy.

Nursing homes are still grappling with significant infection control and prevention challenges, despite implementing various measures, such as better training, resources, protective equipment, and enhanced barrier precautions. Residents and staff of nursing homes continue to be vulnerable to infections, so if we want to see healthier environments for these communities, we must start exploring automated 21st-century technologies that can minimize potential outbreaks and prevent the spread of infections.

Reducing infections in nursing homes is a national issue that requires prioritization by everyone, and it will necessitate the adoption of new technologies to succeed.

— Amy Carenza is the chief commercial officer at ActivePure, a global leader in sustainable, active, continuous surface and air disinfection systems for health care and educational institutions, commercial and public facilities, hospitality, and residential applications. There, she has global responsibility for the development and implementation of commercial strategy for the company. Prior to joining the company, Carenza enjoyed a distinguished career in financial services spanning the last 20 years and has worked across a diverse range of industries and advised numerous mid- and large-cap companies on the evaluation of strategic alternatives and optimal execution in debt and equity capital markets, domestic and international treasury, global trade, and risk management. Carenza is a member of The American Society of Heating, Refrigerating and Air-Conditioning Engineers and is active in the Dallas/Ft. Worth chapter of the International Facility Management Association.