Nursing home experiences third outbreak of the season.

Mayhem at the Manor

Case Study

The Client

A for-profit, long term care provider, operating a 234 bed multi-level care complex, in a regional hub community. Built in 1993, the complex included day programming, independent and assisted retirement living units, nursing and specialty long term care beds. Infection Prevention and Control (IPAC) is provided by the Director of Care, who also is responsible for managing the entire Nursing Home. Environment Services is managed by the complex‛s Director of Facilities.

The Situation

  • The nursing home had just experienced its third Outbreak of the season. This past one was a whopper! A facility-wide respiratory outbreak that lasted for over 20 days; many staff booked-off sick, and there were a large number of symptomatic residents, including 2 deaths.
  • Family members were very worried, some quite angry; the local newspaper ran a story on poor seniors care in the community (featuring the outbreaks and deaths at the facility); public health was concerned, and licensing officials had made a number of unscheduled visits. The pressure was on!
  • The nursing department had been overwhelmed; staff shortages were a problem due to the level of sick time; the Director of Care spent most of her time in the office dealing with the extra paperwork, answering panic calls, and trying to call-in extra staff on overtime.
  • Environmental Services was also in disarray and the Director of Facilities was not available to take charge as he was focused on a number of critical infrastructure repairs and expensive capital renovation projects in other parts of the complex.
  • The Executive Director was under fire from family members, and was being pressured by head office to get the situation under control, return the retirement and assisted living units to full occupancy, and get operating costs under control – this past quarter was a financial disaster! 

HPS Solution

  • The HPS team met with the Executive Director and Director of Care to understand the problem and clarify the solutions objective (aka what “problem-solved” looked like). Our specialists met privately with nurses, personal support workers, cleaners, public health officials, residents and families to get their perspective on the problem; we spent time observing clinical and environmental practices.
  • HPS inspected the facility for cleanliness, hygiene, surface integrity (cleanability), and general maintenance. A number of deficiencies were identified, and a plan was established to address them in order of importance and safety.
  • HPS implemented an Enhanced Services Program that included IPAC education for all staff and families. Staff members were tested on their IPAC competencies, the team level results were shared at meetings and improvement plans created for each unit.
  • The outbreak management plan was completely revamped. Surveillance controls were upgraded; new "key controls" check-lists were established for every clinical and environmental position in the facility. Staff and public health played an important part in reviewing and testing the automated monitoring systems. Minimum staffing levels were determined and a contingency plan was put into effect.
  • Management duties were reorganized so that environmental hygiene was integrated closer into the resident care program. HPS infection control experts consulted with clinical and regional public health officials to map a plan that was accepted and understood by all.