How Virginia's Nursing Homes Control Infection

VIRGINIA —At a time when authorities are struggling to slow the spread of coronavirus among vulnerable populations, including seniors, 74 percent of nursing homes in Virginia, slightly above the national average, have been cited in recent years for problems with infection control.

According to a data analysis by Kaiser Health News and distributed by The Associated Press, 9,700 of the nation’s more than 15,000 nursing homes — about 63 percent — were cited by the federal government at least once during the last two inspection cycles, which ran from February 2016 to February 2020.

Nearly 3,500 nursing homes, or 23 percent, were cited more than once.

Even among those homes with the federal government’s top rating — five out of five stars — 40 percent have been cited at least once for infection problems. Such citations were issued to 80 percent of the worst-rated homes, with just a single star.

Check federal ratings for nursing homes in your area.

Infections are a persistent challenge for skilled nursing facilities. Kaiser noted that as many as 3.8 million occur in homes each year, killing nearly 388,000 residents.

The Kaiser analysis found that many infection citations concern basic sanitary practices now being stressed in the fight against coronavirus, including workers’ failure to wash hands as they move from patient to patient or to wear masks, gloves and gowns when dealing with contagious patients.

Some citations, however, involve matters less likely to factor into disease transmission —allowing patients to develop bedsores, for example, or to catch infections through urinary catheters.

“It’s all these little things that are part of infection-control practices that when they are added up can create an environment for an infection outbreak,” Patricia Hunter of the Washington State Long-Term Care Ombudsman Program told Kaiser.

Washington State faced a serious outbreak of the coronavirus in nursing homes starting a month ago at the beginning of the crisis in the U.S. but has seen conditions improve slightly, although the coronavirus is still spreading in the state.

In Virginia, where the spread of the coronavirus is only just beginning, nursing homes are bracing for the worst. When a nursing home or long-term care facility reports a positive case of the coronavirus, the facility will contact the local health department to initiate a contact investigation.

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"Our goal is to help prevent further transmission from occurring," Fairfax County Health Department spokeswoman Tina Dale said in an email to Patch. "To achieve this, the Health Department works with facilities to ensure full implementation of infection control practices."

Infection control practices include isolating residents who have symptoms of illness; restricting congregating and eliminating gatherings; screening of staff for symptoms at the beginning of each shift; discouraging cross-facility employment; guiding appropriate use of personal protection equipment; providing guidance on enhanced cleaning practices; and implementing visitor restrictions.

"We continue to work with facilities throughout an outbreak investigation to ensure these practices are followed to limit continued infection," Dale said.

Nursing homes across Virginia began restricting visitors in mid-March in an effort to prevent the coronavirus from entering the facilities.

The restrictions began after the American Health Care Association, the largest national trade organization representing long-term care centers, and the Centers for Disease Control and Prevention issued guidance recommending measures to prevent a scenario where the virus spread quickly and ended lives.

The Virginia Health Care Association-Virginia Center for Assisted Living and its member facilities have made protecting the health and safety of nursing facility and assisted living residents their top priority

"The trained health care professionals at Virginia’s long term care centers are taking the threat of coronavirus very seriously," Amy Hewett, vice president of strategy and communications for Virginia Health Care Association-Virginia Center for Assisted Living, said Monday in an email to Patch.

The member facilities of Hewett's organization are focused on minimizing the potential risks by boosting preventive actions and using fundamental infection control protocols, she said. In addition, facilities are following the CDC guidelines for screening for symptoms of the coronavirus, restricting visitors, implementing protective protocols like providing in-room meal service versus communal dining, and modifying their activity programs to employ social distancing.

The Centers for Medicare and Medicaid Services has infection control regulations in place for nursing facilities. These regulations are designed to help decrease the risk of infectious outbreaks in nursing facilities and require each nursing center to have an infection control plan and a designated infection preventionist. The infection preventionist at each facility is a clinician who has received additional training and certification in infection control.

At nursing homes across the country, federal inspectors classify violations in one of four levels of severity. Most of these fall into the category of “potential harm.” Less severe violations might create “potential for minimal harm,” but more severe might threaten “actual harm” and the most severe put patients in “immediate jeopardy” and require prompt correction.

Of 274 nursing homes in Virginia, 210 of the citations fell into the “potential for harm” category. One facility fell into the category of "immediate jeopardy" and another facility fell into the category of "actual harm."

Use this interactive map to see how often nursing homes in your area were cited for infection control problems.

Source: A Kaiser Health News analysis of the Nursing Home Compare database from the Centers for Medicare and Medicaid Services as of February 2020, which details the “deficiencies” or citations that each nursing home received during inspections over the last two inspection cycles, which stretch back to February 2016. They include planned inspections, which occur once every 9 to 15 months, and inspections prompted by complaints or facility-self reporting of problems. The Kaiser data was distributed by the Associated Press.

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