Page 22 GAO-22-105133 Nursing Home Infection Control
Examples of actions CMS and CDC took prior to the COVID-19 pandemic
include the following:
• Required designated infection preventionist. CMS updated IPC
requirements to include the requirement that nursing homes designate
at least one infection preventionist to oversee the facility’s IPC
program, effective beginning November 2019.
• Developed infection preventionist training. To support the infection
preventionist requirement, CMS, in consultation with CDC, developed
a free online infection preventionist training program that was
available to nursing homes as of March 2019.
50
The specialized
training provided content covering a range of IPC topics to prepare
infection preventionists for their role.
• Conducted IPC pilot program and released Infection Control
Worksheet tool. To help assess and prevent infections in nursing
homes, CMS, in consultation with CDC, conducted a 3-year IPC pilot
project from fiscal year 2016 through 2018, which used a worksheet
tool, developed with CDC and expert input, to identify gaps in nursing
home IPC practices and guide assistance to address those gaps.
51
CMS released the worksheet as an IPC self-assessment tool to
nursing homes in November 2019.
52
Examples of key actions CMS and CDC took during the pandemic include
the following:
• Initiated focused infection control surveys. In March 2020, CMS
made key changes in how it oversees nursing homes by requiring
state survey agencies to conduct a new survey type known as the
focused infection control survey that assessed IPC-related
requirements specific to COVID-19, such as adherence to visitor
50
See Centers for Medicare & Medicaid Services, Specialized Infection Prevention and
Control Training for Nursing Home Staff in the Long-Term Care Setting is Now Available,
QSO-19-10-NH (Baltimore, Md.: March 11, 2019).
51
See Centers for Medicare & Medicaid Services, Infection Control Pilot Project, S&C-16-
05-ALL (Baltimore, Md.: Dec. 23, 2015).
52
For the pilot, the new survey tool was used for educational purposes rather than to
assess compliance with existing IPC requirements. After the surveyors assessed the
participating nursing homes’ IPC practices, the nursing homes were provided with
technical assistance based on the survey’s results. See Centers for Medicare & Medicaid
Services, S&C-16-05-ALL (Dec. 23, 2015).
The infection preventionist role
The infection preventionist is a nursing home
employee with training in infection prevention
and control who is responsible for the home’s
program for preventing, identifying, reporting,
investigating, and controlling infections and
communicable diseases. Beginning
November 2019, the Centers for Medicare &
Medicaid Services (CMS) required all nursing
homes to designate one or more infection
preventionists who has completed specialized
training in infection prevention and control and
who works at the nursing home at least part-
time. Some of the responsibilities of the
infection preventionist may include contact
tracing during an infectious disease outbreak,
reporting surveillance data, and educating
staff on proper adherence to infection
prevention and control practices.
Source: GAO summary of CMS and the Centers for Disease
Control and Prevention documents. | GAO-22-105133