The association of nursing home infection preventionists' training and credentialing with resident COVID 19 deaths

Abstract

AbstractBackgroundNursing home (NH) residents' vulnerability to COVID‐19 underscores the importance of infection preventionists (IPs) within NHs. Our study aimed to determine whether training and credentialing of NH IPs were associated with resident COVID‐19 deaths.MethodsThis retrospective observational study utilized data from the Centers for Disease Control and Prevention's National Healthcare Safety Network NH COVID‐19 Module and USAFacts, from May 2020 to February 2021, linked to a 2018 national NH survey. We categorized IP personnel training and credentialing into four groups: (1) LPN without training; (2) RN/advanced clinician without training; (3) LPN with training; and (4) RN/advanced clinician with training. Multivariable linear regression models of facility‐level weekly deaths per 1000 residents as a function of facility characteristics, and county‐level COVID‐19 burden (i.e., weekly cases or deaths per 10,000 population) were estimated.ResultsOur study included 857 NHs (weighted n = 14,840) across 489 counties and 50 states. Most NHs had over 100 beds, were for profit, part of chain organizations, and located in urban areas. Approximately 53% of NH IPs had infection control training and 82% were RNs/advanced clinicians. Compared with NHs employing IPs who were LPNs without training, NHs employing IPs who were RNs/advanced clinicians without training had lower weekly COVID‐19 death rates (−1.04 deaths per 1000 residents; 95% CI −1.90, −0.18), and NHs employing IPs who were LPNs with training had lower COVID‐19 death rates (−1.09 deaths per 1000 residents; 95% CI −2.07, −0.11) in adjusted models.ConclusionsNHs with LPN IPs without training in infection control had higher death rates than NHs with LPN IPs with training in infection control, or NHs with RN/advanced clinicians in the IP role, regardless of IP training. IP training of RN/advanced clinician IPs was not associated with death rates. These findings suggest that efforts to standardize and improve IP training may be warranted.