The call inevitably comes in at 4pm on a Friday before a holiday weekend. A skilled nursing facility in your county has a high number of residents with a respiratory illness, a gastrointestinal illness, or an unusual rash. What steps should you take? What information is essential, and what recommendations can you provide to halt the spread of this yet-to-be-identified infection?
1. Confirm the Details
Before taking action, verify that a true cluster exists. Gather key information:
- How many residents are affected?
- When did symptoms begin?
- Did symptoms appear all at once, or are onset dates staggered?
- Are affected residents located in a single unit or throughout the facility?
- Are any staff members symptomatic?
These details help determine whether immediate intervention is needed or if continued monitoring is more appropriate.
2. Assess the Facility’s Current Actions
Save time by reviewing what the facility has already implemented. Ask:
- Have any infection control measures been put in place?
- Has any laboratory testing been initiated?
Understanding the facility’s current response provides insight into their infection control knowledge and helps guide your next steps.
3. Provide Initial Recommendations
Familiarize yourself with the common modes of transmission:
- Respiratory illnesses are generally spread via droplet or airborne transmission.
- Gastrointestinal illnesses often spread through direct contact or contaminated surfaces (fomites).
Based on this, offer general guidance on:
- Isolation protocols
- Environmental cleaning and disinfection
- Staff exclusion policies
Tailor your advice to the most likely transmission routes.
4. Prepare for Site Visit
When working with external partners, nothing compares to in-person interactions. Visiting the facility and discussing containment strategies is more effective than an email or phone discussion. A site visit allows for:
- More effective, focused discussions
- Real-time feedback and observations
- Monitoring of non-verbal cues that can indicate understanding or hesitation.
Utilize available resources to gain confidence while onsite. Download and review the Infection Control Assessment and Response (ICAR) Tool from the Centers for Disease Control and Prevention (CDC) prior to your visit. In response to an active illness cluster, the modules on hand hygiene, transmission-based precautions, and environmental services will be the most useful. Also review the CDC’s Project Firstline materials, which provide accessible infection control educational materials for all frontline healthcare workers.
5. Conduct Ongoing Monitoring and Support
Following your initial visit, maintain regular contact with the facility. Ongoing communication allows you to:
- Track the effectiveness of implemented measures
- Review lab results and adjust recommendations accordingly
- Offer continued support and reinforce partnership.
This sustained engagement helps build trust and encourages future collaboration.
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