LAUSR

Nursing homes (NH) provide care in a congregate setting for residents at high risk of severe outcomes from SARS-CoV-2 infection. In spring 2020, NH were implementing new guidance to minimize SARS-CoV-2 spread among residents and staff. Objective To assess whether telephone and video-based infection control assessment and response (TeleICAR) strategies could efficiently assess NH preparedness and help resolve gaps. Design We incorporated Centers for Disease Control and Prevention COVID-19 guidance for NH into an assessment tool covering six domains: visitor restrictions; healthcare personnel COVID-19 training; resident education, monitoring, screening, and cohorting; personal protective equipment supply; core infection prevention and control (IPC); and communication to public health. We performed TeleICAR consultations on behalf of health departments. Adherence to each element was documented and recommendations provided to the facility. Setting and Participants Health department-referred NH that agreed to TeleICAR consultation. Methods We assessed overall numbers and proportions of NH that had not implemented each infection control element (gap) and proportion of NH that reported making ≥1 change in practice following the assessment. Results During April 13 to June 12, 2020, we completed TeleICAR consultations in 629 NH across 19 states. Overall, 524 (83%) had ≥1 implementation gaps identified; the median number of gaps was 2 (IQR: 1, 4). The domains with the greatest number of facilities with gaps were core IPC practices (428/625 [68%]) and COVID-19 education, monitoring, screening, and cohorting of residents (291/620 [47%]). Conclusions and Implications TeleICAR was an alternative to onsite infection control assessments that enabled public health to efficiently reach NH across the U.S. early in the COVID-19 pandemic. Assessments identified widespread gaps in core IPC practices that put residents and staff at risk of infection. TeleICAR is an important strategy that leverages infection control expertise and can be useful in future efforts to improve NH IPC.