Infection control-focused COVID-19 survey for nursing homes

State agencies will significantly increase Infection Control surveys to 100% of nursing homes in respective states. You can expect a COVID-19 Focused Infection Control Survey, and you and your facilities must be prepared.

On June 1, 2020, The Centers for Medicare & Medicaid Services (CMS) announced updated guidance to state survey agencies regarding enhanced enforcement for Infection Control deficiencies in nursing homes during COVID-19 Survey Activities. By July 1, 2020, CMS expects that state agencies will significantly increase Infection Control surveys to 100% of nursing homes in respective states. If a state agency cannot meet this threshold, it must submit a plan of correction that specifies how that agency will accomplish this within 30 days, or risk losing 10% of designated funds from the Coronavirus Aid, Relief and Economic Security Act (CARES Act).

To evaluate the effectiveness of the new Infection Control Guidance, CMS and the Centers for Disease Control and Prevention (CDC) conducted targeted Infection Control surveys at select facilities. The results showed that 36% of those facilities surveyed on March 30^th, 2020 failed to demonstrate appropriate handwashing techniques, while 25% failed to demonstrate appropriate use of Personal Protective Equipment (PPE).

Lack of an acceptable infection control program

CMS has stringent penalties for nursing homes that fail to have an acceptable infection control and prevention program that is properly communicated and administered. These penalties are anticipated to serve as a deterrent to non-compliance, and to enhance accountability within all nursing homes. According to CMS, under the increased enforcement effort, those providers struggling to comply with Infection Control requirements could be assessed fines up to $20,000.

Past infection control deficiencies

Fines will be more significant for nursing homes with a history of past Infection Control deficiencies. For example, a Provider found currently not in compliance with Infection Control and prevention requirements could be fined up to:

• $5,000 if that facility had a previous Infection Control related deficiency that was not widespread.
• $10,000 if that facility had a previous Infection Control related deficiency that was widespread.
• $15,000 to $20,000 if that facility had two or more citations in the last two years, depending on scope and severity.

What does this mean for providers?

Since CMS expects that state agencies will significantly increase Infection Control surveys to 100% of nursing homes in respective states,you can expect a COVID-19 Focused Infection Control Survey, and you and your facilities must be prepared. Key areas of preparation include knowing what surveyors will be looking for or observing during their visits and performing continuous Self-Assessment Audits.

Leading Age has created a Self-Assessment Tool and Checklist to assist you in preparing for these surveys and have also provided the relevant regulations and guidance to surveyors. The areas for self-assessment are summarized below; however, click here for the full text.

Areas of focus during COVID-19 focused infection control survey

The survey team will review various policies and procedures, conduct staff and resident interviews, and/or observe the following:

1. Standard transmission-based precautions
2. Hand hygiene
3. Personal Protective Equipment (PPE) – availability, proper donning, doffing, and disposal
4. Resident care
5. Policies and procedures on site including:
6. Infection surveillance
7. Visitor entry
8. Education monitoring and screening of staff
9. Reporting to families and CDC
10. Emergency preparedness - staffing in emergencies

Be sure to communicate the new Infection Control Survey guidance to all your staff and discuss them at resident council meetings. In addition, conduct periodic random audits of handwashing, PPE use, in-service education records, and review all related policies and procedures to ensure that they adequately meet the respective requirements.

These resources and actions discussed will help you prepare for your upcoming focused Infection Control Surveys and will also ensure you have the proper controls in place to manage risks and keep your residents and staff safe and healthy.