A Kaiser Health News (KHN) report highlights the struggles of many nursing homes around the country — including some that have received the highest government rating for overall quality — with following "basic infection prevention protocols."

A KHN federal records analysis revealed that more than 9,000 nursing homes — or about 61% of all such facilities — were cited for one or more infection-control deficiencies.

Furthermore, the analysis showed that since the beginning of 2017, government health inspectors cited more nursing homes for failing to ensure workers follow infection prevention and control rules than any other type of violation. KHN notes that inspection reports indicate many of the infection prevention and control errors cited are attributable to lapses in following fundamental best practices, such as workers not washing their hands as they move between patients and failing to don masks, gloves and gowns when in rooms with isolated, contagious patients. Violations were also more common at homes employing fewer nurses and aides than those with higher staffing levels.

Patricia Hunter of the Washington State Long-Term Care Ombudsman Program, which advocates for residents of nursing homes, adult family homes and assisted-living facilities, told KHN, "It's all these little things that are part of infection-control practices that when they are added up can create an environment for an infection outbreak."

Of those nursing homes with the maximum government overall quality rating (five stars), KHN noted that 4 in 10 have been cited for an infection-control lapse. This includes the Life Care Center in Kirkland, Wash., where several residents have succumbed to the coronavirus. One publication has described the nursing home as the "national epicenter of coronavirus."

Unfortunately, nursing homes are likely to continue struggling with infection prevention and control. As KHN notes, these facilities are challenged by frequent staff turnover, new workers less likely to know facility protocols, keeping potentially infected workers at home (in part due to low pay and limited time-off benefits) and finding replacement staff.

On Wednesday, March 4, the Centers for Medicare & Medicaid Services (CMS) announced several actions it hopes will limit the spread of COVID-19. These include the following:

• Issuing a call to action to healthcare providers nationwide to ensure they are implementing and maintaining infection control procedures.

• Directing state survey agencies and accrediting organizations to focus facility inspections exclusively on issues related to infection control and other serious health and safety threats, beginning with nursing homes and hospitals.

• Outlining a survey regime that focuses on infection control and other emergent issues, including COVID-19.

CMS Administrator Seema Verma stated,. “All healthcare providers must immediately review their procedures to ensure compliance with CMS’ infection control requirements, as well as the guidelines from the Centers for Disease Control and Prevention (CDC).”