Nursing home’s short-term survival as a business has perpetually been their principal priority. That choice has left behind a healthcare army of overworked and underpaid caregivers, costing lives in nursing homes. It is not their fault but rather that of the ownership for accepting the infection rates resulting in the pre-COVID-19 annual loss of life at 380,000. These are deaths caused by infections acquired during their care. This loss of life has become the industry standard without the level of concern one would expect from our many voices of science like the CDC, FDA, NIH, NAID, and the Joint Commission.
Nursing homes have been perpetually bombarded with regulations, so much so that their very implementation depletes budgets, starving “secondary” priorities like investments in hand sanitizer stations, kitchen hand hygiene and electronic handwash-monitoring technology. Understaffing makes electronic handwash-verification all the more important.
The CDC’s view that “Handwashing is the single-most-important means of preventing the spread of infection” gets little attention by facility owners where business survival is the top priority. There are no caregiver standards for handwashing from the resident’s room to rehab to the kitchen. All caregivers along these routes don’t see handwashing as a process but more like a random measure dictated by available time. They have no idea their safe-standard of handwashing/hand-sanitizing frequency may well be more than 50 times per shift.
Caregiver behavior change requires more than political edicts. Staff must be rewarded for policy compliance and disciplined for shortcomings. This requires numbers, numeric data, to establish a minimum performance expectation and motivate a path of continuous improvement. A risk-based handwashing system takes these numbers and considers the convenience factor in the location of hand-sanitizer stations and handsinks. Management must set the conditions for success and make it easier for caregivers to do the right thing.
Training is an important factor especially with high staff-turnover rates. An unchanged glove for instance is a major mode of transport for all pathogens. Gloves must be changed. A washed bare hand trumps an unchanged glove.
Enforcement systems have been lax, perpetuating the systemic nature of poor hand hygiene in long-term care. Common sense is often overwhelmed by a checklist mentality where the most minor risk factor has the same weight as a lack of handwashing.
The COVID-19 crisis exposed today’s nursing home reality which will take years to correct but new technologies stand ready to help make it happen, now. This is an opportunity for operators to define operational survival as the secondary priority, second to the lives of their trusting residents.