Expert: Long-term Care Industry Needs Help of Pharmacists to Improve Infection Prevention, Control

The long-term care (LTC) industry has been struggling to implement infection prevention and control practices for decades prior to the COVID-19 pandemic, explained Buffy Lloyd-Krejci, DrPH, MS, CIC, during a session at the American Society of Consultant Pharmacists (ASCP) 2022 Annual Meeting. This struggle persists today and remains ongoing around issues pertaining to antibiotic stewardship as well, Lloyd-Krejci explained.

“First and foremost, I just want to say that we absolutely need [pharmacists] in long-term care,” Lloyd-Krejci said. “One of the biggest gaps that I see is our new infection preventionists are without the support they need. They're very green and they need the support of the pharmacist.”

Lloyd-Krejci explained that she has worked in hundreds of facilities across the country to support infection prevention and control prior to and during the COVID-19 pandemic. She noted that the insight she gleaned from her work in these facilities helped her understand how to move forward in a world that is more aware of the importance of infection prevention and control following the devastation of the COVID-19 pandemic.

“The statistics that we have demonstrate that nearly 3 million infections occur in long-term care every year, that leads to 380,000 deaths, which results in over 1000 deaths daily,” Lloyd-Krejci said. “So that's a lot of people dying every day from infections.”

Lloyd-Krejci noted that although this statistic is older, it is the best data available for assessing the impact of infections in LTC facilities.

“These [data] are what motivates me. Infections are the most frequent cause of transfers and hospital readmissions, leading to over 150,000 hospitalizations every year, and they cost our health care system quite a bit of money at $673 million every year,” Lloyd-Krejci said. “We know that up to 70% of infections are preventable, and that's what really wakes me up in the morning.”

Additionally, Lloyd-Krejci explained that 2 million people are infected by antibiotic resistant bacteria every year.

“This is an ongoing problem, and it has been over decades, and it continues to get worse,” Lloyd-Krejci said. “Seventy percent of nursing home residents receive 1 or more courses of systemic antibiotics in a year, and then possibly up to 75% of these antibiotics may be unnecessary and inappropriate.”

Lloyd-Krejci noted that without urgent action on the issue of antibiotic-resistant bacteria, many modern medicines will become obsolete. Additionally, a significant problem for those working to change this issue is the lack of a data collection infrastructure that would help assess the causes.

“One of the greatest problems is we are not really great at data collection,” Lloyd-Krejci said. “As a country, we're taking steps toward improving this. In 2016, I participated in a national pilot study with the CDC and CMS, and we sought to enroll 15% of the nation's nursing homes into the national health care and safety network (NHSN). This is the database where health care-associated infections are recorded within our country, such as for acute care, dialysis centers, and outpatient surgical centers.”

However, recording data in the NHSN is still not required on a federal level for all LTC facilities. Lloyd-Krejci noted that a federal mandate on this issue is something that she has been advocating for.

“But we were able to achieve great success,” Lloyd-Krejci said. “In 2013, we had only 130 facilities in the United States reporting into NHSN. By 2016, we had 2% of the nursing homes at about 300, and you can see the work that we did to increase that up to 17% and this was really exciting.”

Lloyd-Krejci explained that data collection in LTC facilities is an important component of effective infection prevention and control because without data, it becomes very difficult to understand what actually needs to change.

Regardless of the importance of data collection in solving the underlying issues, Lloyd-Krejci explained that in 2019, CMS decided it would not federally mandate LTC facilities to report infection control and prevention data.

“That was really an opportunity that we missed because we were right at the precipice of a pandemic, and this national database could have really helped a lot,” Lloyd-Krejci said. “It was at that time that I decided that I really wanted to devote myself full time to this cause as I really looked around and didn't see a whole lot of action being specifically devoted towards long-term care.”

Lloyd-Krejci explained that she decided to focus everything that she had on infection prevention and control in LTC.

“So I quit my job,” Lloyd-Krejci said. “I thought I was going to go out and enroll all of the nursing homes in NHSN, and we were going to collect data, and we were going to really understand the burden. And I didn't know what I didn't know. I was definitely naive, and I had very few nursing homes excited to sign up and report data.”

As Lloyd-Krejci began to go on site into nursing homes she quickly understood why there was a lack of enthusiasm for data reporting on infection prevention and control.

“They didn't have even basic infection prevention and control practices implemented. And I was asking them to implement data to conduct surveillance when they didn't even have hand sanitizers. We weren't even doing the basics,” Lloyd-Krejci said. “So I knew what my misstep was. I was too far ahead, and I needed to back that up.”

Then COVID-19 hit.

“Some people asked me, ‘Did you start your business when COVID-19 hit? I say, ‘No, I did a few years before.’ But thank God that I had started it then,” Lloyd-Krejci said. “I'm grateful for the opportunities that I've had to be of service across the country. I never would have imagined the challenges that have occurred.”

Lloyd-Krejci explained that she heard from many administrators at LTC facilities that health care workers in hospitals were seen as heroes during the pandemic. But health care workers in nursing homes were vilified, condemned, and blamed for the loss of patients in LTC during the pandemic.

“At the same time, there were different states like New York that required our [LTC facilities] to accept residents with COVID-19,” Lloyd-Krejci said. “They were forced to take patients whether they had [personal protective equipment] or not, or whether they had staff or not.”

Lloyd-Krejci explained that now, following the heights of the pandemic, pharmacists have the opportunity to step up and talk with infection preventionists at LTC facilities and partner with them to address some of these issues and help progress things forward.

“Don’t expect [infection preventionists at LTC facilities] or wait for them to come to you because they're not necessarily going to do that,” Lloyd-Krejci said. “Also, it's really important to have leadership support. The leadership can actually talk to the medical director, the prescribers, and those that are responsible and really come together as a team, because the infection preventionist just doesn't have that power in most facilities.”

Reference

Lloyd-Krejci B. Second General Session: How the COVID-19 Pandemic Impacted the Long-term Care Industry and How We Move Forward with Change. Presented at: American Society of Consultant Pharmacists (ASCP) 2022 Annual Meeting in San Antonio, TX; November 5, 2022.