Infection control violations at 15 percent of US nursing homes

Conducted by a team of researchers at the University of Pittsburgh's Graduate School of Public Health, the study analyzed deficiency citation data collected for the purpose of Medicare/Medicaid certification between 2000 and 2007, representing approximately 16,000 nursing homes per year and a panel of roughly 100,000 observations. The records analyzed represent 96 percent of all U.S. nursing home facilities. The team discovered a strong correlation between low staffing levels and the receipt of an infection control deficiency citation.

Infections are the leading cause of morbidity and mortality in nursing homes, responsible for nearly 400,000 deaths per year. Although this has been the focus of mainstream media attention, very little empirical research has been conducted on the subject.

The Centers for Medicare and Medicaid Services (CMS) requires that nursing homes be certified before receiving reimbursement for Medicare and/or Medicaid residents. As part of this certification process, facilities that do not meet certain standards are issued deficiency citations. This study examined the deficiency citation for infection control requirements known as the F-Tag 441.

"Our analysis may provide some clues as to the reason for the persistent infection control problems in nursing homes," state the authors. "Most significantly, the issue of staffing is very prominent in our findings; that is, for all three caregivers examined (i.e., nurse aides, LPNs and RNs) low staffing levels are associated with F-Tag 441 citations. With low staffing levels, these caregivers are likely hurried and may skimp on infection control measures, such as hand hygiene."

The authors conclude, "The high number of deficiency citations for infection control problems identified in this study suggests the need for increased emphasis on these programs in nursing homes to protect vulnerable elders."

A number of states have enacted legislation that applies to infection prevention practices in long-term care facilities. Illinois is poised to pass legislation requiring an infection preventionist in each skilled nursing facility.