Each nursing facility should have an infection control program in accordance with state or national regulations and guidelines. Infection control programs in the long-term care setting are required by the Omnibus Budget Reconciliation Act of 1987 (OBRA) for skilled-care facilities, the Health Care Financing Administration (HCFA) for Medicare or Medicaid patients, the Occupational Safety and Health Administration (OSHA) for blood-borne pathogens and tuberculosis exposures, and the Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) Long-term Care Standards (4). National organizations such as the Society for Healthcare Epidemiology of America (SHEA), The Association for Professionals in Infection Control and Epidemiology (APIC), and The Centers for Disease Control and Prevention (CDC) also provide infection control guideline information specific for the long-term care setting.
An organizational structure that defines responsibilities for implementation and coordination of a written infection control policy should be established. An actual infection control committee that meets formally on a regular basis may not be required or necessary depending on the size of the nursing facility. However, a small group composed of a representative from administration, the physician staff (medical director), nursing staff, and a infection control practitioner should meet as necessary to oversee infection control activities. This committee or oversight group is responsible for establishing and updating policies, reviewing the infection prevalence reports, and monitoring adherence to policies and procedures. Specific policies should be developed in advance to meet regulatory guidelines as well as the needs of the individual facility (see Table 1). Meetings should occur as often as are necessary to identify problems, recommend solutions, and assess the efficacy of those actions. Regardless of the organizational structure chosen, written minutes should be maintained (1,2,4).
The infection control practitioner is responsible for infection surveillance, analysis of surveillance to date, and preparation of reports back to the organizational body. The infection control practitioner is also responsible for implementation of infection control policy, education, and notification of public health authorities when appropriate. Depending on the size of the facility, many nursing facility infection control practitioners are hired on a part-time basis to perform infection surveillance in addition to other duties. It has been suggested that facilities with 250-300 beds may require a full-time infection control practitioner. The level of formal training in infection control among practitioners in the long-term care setting appears to be increasing. It is important that the institution define the amount of time to be spent on infection surveillance in the infection control practitioner's job description and assure protection of time to carry out those duties (1,2,4).
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