​​When it comes to infection prevention, nursing facilities are lagging behind acute care hospitals, according to a March 1, 2018, viewpoint article in JAMA. Acute care hospitals have embraced evidence-based interventions and developed resourceful and effective infection prevention teams, and as a result, have successfully reduced the number of central-line-associated bloodstream infections, surgical site infections, and Clostridium difficile infections. But nursing facilities face different challenges in preventing and managing infections, and they serve different types of patients than a hospital does. Patients and residents of nursing homes also engage in different behaviors and have different needs from hospital patients. For example, in a nursing facility many patients or residents are allowed freedom of movement to go to common areas such as dining rooms or rehabilitation areas, which makes pathogen transmission more likely to occur. Nursing facilities also do not usually have diagnostic testing available on the premises, and they depend on off-site physicians, which leads to further delays in appropriately evaluating and managing infections. What can nursing facilities do to improve? Their best bet, the authors say, is to team up with a larger healthcare organization or hospital system that is already effectively using successful techniques to battle infections. Collaboration works in everyone's best interest, they suggest: Sharing resources means nursing facilities can better train their staff in infection prevention and increase their access to physicians who can properly diagnose and manage infections. Additionally, when the organization and facility communicate on a regular basis, regional outbreaks of infections caused by antibiotic-resistant pathogens can be more effectively handled, with the organizations helping more patients together than they would on their own.

HRC Recommends: To provide high-quality, safe, effective care and improve operational and financial efficiency, nursing facilities must take steps to prevent and control infections and outbreaks. In nursing facilities, a critical first step is creating an infection prevention and control program, assigning responsibility, and conducting periodic assessments. Other key components include facilitating timely recognition and diagnosis of infections, monitoring compliance with standard and transmission-based precautions, and implementing an antimicrobial stewardship program. Sharing resources among healthcare organizations can help prevent and manage infections in nursing home patients and residents, which may in turn help reduce readmissions and transmission of infections back and forth between facilities.