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The Growing Importance of Advanced Hospital‑Level Infection Control: 5 Differing Standards in Post-Acute Care Protocols

By Sean R. Muldoon, MD, MPH, FCCP, Chief Medical Officer, Kindred Hospitals

This guide highlights five standards maintained by long-term acute care hospitals to combat infection and protect the most vulnerable of patients, as well as the benefits of these hospital-based standards compared to other levels of care.

The pandemic has pushed infection control standards to the forefront as patients and providers are counting on advanced protocols to reduce viral spread and prevent further outbreaks. Now more than ever, it’s important for patients to be treated in a care setting that is not only best suited to their medical needs but also upholds the highest federally and clinically-recognized health and safety requirements.

Though all post-acute settings provide value to their most appropriate patient type(s), they are not all created equal.1 This guide highlights five standards maintained by long-term acute care hospitals to combat infection and protect the most vulnerable of patients, as well as the benefits of these hospital-based standards compared to other levels of care.

Levels of Care: Comparing Infection Protocols

As healthcare leaders continue to make bold changes to protect the health and safety of patients during this time, long-term acute care hospitals have quickly adapted to meet the advanced needs of the critically ill and medically complex – including those recovering from COVID-19. When patients are stabilized in the acute care setting, it is important for providers to be aware of the infection prevention protocols of various post-acute care settings that optimize long-term patient recovery.

LTACHS Require Daily Physician Oversight, 24/7 RN Presence, Dedicated Infection Control Personnel

#1. Certifications

Many of the certifications set forth by federal programs and agencies are the foundational pieces that ensure standards of patient care are consistently met, including in the areas of quality and safety. Long-term acute care hospitals are required to adhere to a set of stringent operational guidelines, which ultimately benefit all patients who receive care in these settings:

  • LTAC hospitals are licensed as general acute care hospitals, and must comply with the same health and safety requirements. Through their conditions of participation (CoPs) guidelines, the Centers for Medicare and Medicaid Services (CMS) sets the infection control standards expected of LTAC facilities in order to participate in the Medicare program.2
  • LTAC hospitals must also meet state licensure requirements to ensure they are able to effectively manage the extensive care needs of critically ill, medically complex patients who require a longer recovery period.

All Kindred LTAC hospitals have achieved or are in process of achieving accreditation by The Joint Commission for disease-specific certification in Respiratory Failure and Sepsis. A gold standard in the acute care industry, the Joint Commission disease-specific certification “demonstrates commitment to a higher standard of service” and “strengthens community confidence in quality and safety of care.” 3

#2. Staffing

Appropriate staffing, including physician involvement and nursing expertise, is key to overseeing a medically complex patient population. LTAC hospitals are provided the staffing resources necessary to provide 24/7 care under the guidelines set forth by CMS, as well as additional guidelines established at the facility level to ensure there are personnel fully dedicated to infection control. Here are some of the key benefits of these advanced staffing guidelines:

  • Through the CMS Medicare program, LTAC hospitals require daily physician oversight and a 24/7 RN presence. Other post-acute settings, like skilled nursing facilities (SNFs), set minimum requirements to eight hours of RN coverage daily, LPN/LVN 24-hour presence, and a physician visit during the first 30 days, with one visit every subsequent 60 days.
  • LTAC hospitals feature hospital-level infection prevention and control overseen by an Infection Control Nurse. Other post-acute settings typically employ a part-time infection preventionist to manage infection control.
  • In addition to the physician-led interdisciplinary care, patients at LTAC hospitals also have immediate access to credentialed, infectious disease physicians and other medical sub-specialists.

#3. Employee Protection

As the recommendations for personal protective equipment (PPE) continue to ramp up based on the care setting, LTAC hospitals can rely on their long-standing practices of infectious disease control and treatment, infection prevention and promotion of safety at the highest level.

Additionally, LTAC hospitals participate in ongoing education regarding preventing and minimizing the spread of viruses and infections. For example:

  • Competencies and special employee training are built in at LTAC hospitals to address myriad multi-drug resistant organisms, viruses and infections in order to prevent or minimize their spread.
  • Many LTAC hospitals systems, like Kindred, have a wellestablished and robust PPE supply chain with standard best practices to react to a full range of infections and communicable diseases.

#4. Patient Safety

In addition to well-established PPE best practices and infection control training resources available for employees, LTAC hospitals also have additional guidelines in place to protect the patient. From ensuring air quality to full service testing areas, LTAC hospitals are engineered with patient safety top of mind. Some of these standards often unseen in other care settings include:

  • Protocols to isolate infected patients, negative pressure rooms (which are specially engineered to isolate patients with airborne contagious diseases), dedicated teams that monitor for outbreaks and multiple levels of protective gear.
  • On-site laboratories, dialysis, radiology, intensive care units, surgical suites and negative pressure isolation rooms that enable LTAC hospitals to meet a full range of patient needs without relying on outpatient services. Patients who access these services within an LTACH can minimize their risk of additional exposure and spread.
  • LTAC hospital licensing requires hospital-quality air filtration systems. Care settings such as skilled nursing facilities (SNFs) have the same air handling/ HVAC quality as the average residential home.

#5. Advanced Clinical Expertise

LTAC hospital professionals are leading industry experts in ventilator care, with best-in-class capabilities in weaning the most challenging ventilator-dependent patients, all while remaining committed to the safety of patients, employees and caregivers. Kindred LTAC hospitals specifically partner with agencies and organizations that help further its clinical expertise in infection control through several initiatives:

  • Kindred has been recognized for its leading antimicrobial stewardship and infection prevention efforts, part of a larger CDC-recognized initiative to improve how antibiotics are prescribed to prevent infection and combat antibiotic resistance.4
  • Kindred regularly cooperates with state, local and federal agencies, including public health departments, to study and better understand how all healthcare providers can help combat multi-drug resistant organisms and prevent disease spread.

How Kindred Hospitals Can Help

We are recognized for our infection prevention efforts and our robust PPE supply chain program. Coupled with our dedication to getting every Kindred LTACH certified by The Joint Commission in Respiratory Failure and Sepsis, these infection protocols enhance our care for the complex medical needs of many post-intensive care patients, and specifically post-COVID patients.

Kindred Hospitals provide expert care in the treatment and rehabilitation of medically complex and post-ICU patients that require continued services in an acute hospital setting, which may include continued intensive care and specialized rehabilitation.

Our interdisciplinary team of clinicians in our long-term acute care hospitals can meet the needs of your patients who have been in an ICU, critical care unit or who are chronically ill and readmit to the hospital frequently. We have proven success in treating patients suffering from pulmonary disease and respiratory failure, with a long track record of liberating patients from mechanical ventilation and artificial airways.

If you have a post-COVID patient, or other patients in need of care after a hospital stay, call a Kindred Clinical Liaison for a patient assessment. Our experts will help you determine whether an LTAC stay is appropriate for your patient. If you are unsure of who your Kindred representative is, please feel free to contact us via recoveratkindred.com and speak with a Registered Nurse who can assist. 


References

  1. www.aha.org/lettercomment/2020-06-24-ahaletter-resetting-impact-act-next-covid-19-relief-package
  2. https://www.cms.gov/Regulations-andGuidance/Legislation/CFCsAndCoPs/Hospitals
  3. https://www.jointcommission.org/en/accreditation-and-certification/become-accredited/why-achieve-accreditation
  4. https://www.cdc.gov/antibiotic-use/core-elements/index.html
By Sean R. Muldoon, MD, MPH, FCCP, Chief Medical Officer, Kindred Hospitals