Considerations for Conducting an Infection Prevention and Control Audit in a Nursing Home

Introduction

Infection control is a critical aspect of maintaining a safe and healthy environment in residential care centres. Given the vulnerability of elderly residents to infections, conducting regular infection prevention and control audits is essential to prevent the spread of diseases and protect their well-being.

In HCI’s recently published report on a Summary of HIQA Inspection Findings in Designated Centres for Older People, we identified that of the 25 nursing home reports we reviewed, 33% had Not Compliant Orange findings against Regulation 27: Infection Control. In many of these cases, the Registered Provider had not ensured effective governance arrangements were in place to ensure the sustainable delivery of safe and effective infection prevention and control and antimicrobial stewardship.

For example, some of the findings included, there were no guidelines available on the care of residents colonised with Multi Drug Resistant Organisms (MDRO) including CPE and VRE. Additional education was required to ensure staff are knowledgeable and competent in the management of residents colonised with MDROs. Staff and management were unaware of which residents were colonised with MDROs. This meant that appropriate precautions may not have been in place when caring for these residents. It was also noted in one report that the Registered Provider had not nominated an Infection Prevention and Control Link Practitioner to increase awareness of infection prevention and control issues locally whilst also motivating their colleagues to improve infection prevention and control practices.

Given the importance of infection control, in this blog we will explore the key steps involved in conducting an infection prevention and control audit in a nursing home.

Step 1: Establish an Auditor or Audit Team

An Infection Prevention and Control Audit may involve external auditors or may be performed by staff from the residential home where they are competent to do so. If performed by a person internally, then the person must be professional, observant, decisive, a good communicator and be familiar with the regulations and best practice guidance.

Step 2: Familiarise Yourself with the Regulations and Related Internal Documents

Before beginning the IPC audit, it is crucial to familiarise yourself with the relevant regulations, standards and best practice guidance established by professional and regulatory bodies such as the HIQA, the HSE, the HPSC, the Department of Health and the World Health Organisation (WHO).

Review key documents such as the National Clinical Guidelines No. 30 Infection Prevention and Control, The HPSC and HSE Public Health & Infection Prevention & Control Guidelines on Prevention and Management of Cases and Outbreaks of COVID-19, Influenza & other Respiratory Infections in Residential Care Facilities, The HIQA Assessment Judgement Framework for Regulation 27 – Infection Control (2021), National Standards for IPC in Community Services and SI415 of 2013 Regulation 27, amongst others. IPC best practice guidance is continuously being updated so it is important to stay up to date with the latest recommendations.

It is also important to be familiar with your own internal policy and procedure on Infection Prevention and Control as well as related documents such as job descriptions, organisational charts, minutes of meetings, Key Performance Indicators (KPIs), risk registers and strategy plans.

Review previous audit reports, inspections reports, Quality Improvement Plans (QIPs) or actions from previous audits, recent incidents and complaints, recent outbreak reports and identify what IPC education has been provided.

Step 3: Develop an Infection Prevention and Control Audit Schedule

Create a detailed audit schedule and checklist that aligns with the national standards and best practice guidance. IPC audits should utilise standardised infection control audit tools, e.g. SARI Guidelines for Hand Hygiene in the Irish Setting etc, as part of the audit process.

The schedule should cover various areas, including waste management, cleaning, sharps management, management of HCAIs, Facilities, Vaccine update, Education and Training, hand hygiene, personal protective equipment (PPE) usage, outbreak management, and antimicrobial prescribing.

Step 4: On-site Infection Prevention and Control Audit

During the on-site audit, utilise a triangulation approach to conduct a comprehensive audit. This includes observing and assess the nursing home’s infection control practices, reviewing the relevant documentation and engaging in discussions or interviews with staff members to gain insights into their understanding and adherence to infection control protocols.

Some key areas to focus on during an infection control audit include:

• IPC Governance: Review key documents such as the policy and procedure, the IPC Programme, the Terms of Reference for the IPC team, job descriptions, risk registers and IPC KPIs. Determine if the appropriate governance structures are in place to assure the provider as to the effectiveness and quality of the IPC practices. Identify if there is a system in place to monitor and report on IPC activities and to identify opportunities for improvement.
• Staff Education: Assess the IPC training plans and the IPC induction programme provided to staff members. Have all staff received training on IPC or are there outstanding training requirements to be completed.
• Hand Hygiene: Evaluate hand hygiene compliance among staff, including handwashing techniques and availability of hand sanitizers.
• Personal Protective Equipment (PPE): Assess the proper use and availability of PPE, such as gloves, masks, and gowns, in various care settings. Are they being utilised appropriately and in accordance with best practice guidance.
• Cleaning and Disinfection: Review the nursing home’s cleaning and disinfection protocols, paying attention to high-touch surfaces, shared equipment, and common areas.
• Waste Management: Verify the appropriate segregation, storage, and disposal of waste to minimise the risk of cross-contamination.
• Outbreak Management: Evaluate the nursing home’s preparedness to respond to outbreaks, including isolation protocols, communication strategies, and infection surveillance.
• Resident Vaccination Programs: Review the nursing home’s policies and practices related to resident vaccination.

Step 5: Documentation and Reporting 

Thoroughly document your findings during the audit, including both strengths and areas requiring improvement. Ensure that your documentation is clear, concise, and supported by evidence. Provide practical recommendations for enhancing infection control practices, prioritising the areas that pose the greatest risks.

The results of each IPC audit should be reviewed and reported on to assess its performance, appropriate to the service by the Person in Charge (PIC), and were deemed necessary, circulated to the Management Team / IPC Team. Any identified non-conformances, or healthcare associated incident is to be reported and managed.

Step 6: Follow-Up and Continuous Improvement

Following the audit, effective Quality Improvement Plans (QIPs) should be implemented by the residential home where there are areas identified as requiring improvement. Each QIP should have an owner who is responsible for following up the QIP. The QIP should include corrective and preventive actions and may require a root cause analysis.

Results of the IPC audits should be considered as part of the residential home’s Annual Review Report of the Quality and Safety of Care Provided within the Residential Home. Staff should know the most recent IPC audit results and work with the Person in Charge and the IPC Team to further improve processes. The residential home should display IPC audit results on the resident’s board.

Conclusion

Conducting an infection control audit in a nursing home is an essential step in safeguarding the health and well-being of vulnerable residents. By adhering to regulations, standards and best practice guidance, nursing homes can implement effective Infection Prevention and Control Programmes which help create a safer environment for residents, reduce the risk of infections, and promote optimal care in nursing homes.

At HCI we help providers of health and social care make intelligence driven decisions to attain, manage and improve quality, safety and regulatory compliance. We have been implementing Quality and Safety Management Systems in health and social care organisations for almost two decades. Our Quality and Safety Specialists have extensive experience in conducting Infection Prevention and Control audits in nursing homes and can support you in conducting a comprehensive, independent and objective IPC audit. Our team can also help you to identify and implement the appropriate QIPs to drive quality improvement and promote resident safety.

If you would like further information on Infection Prevention and Control Audit Service, contact HCI at +353 (0)1 629 2559 or email info@hci.care.