JMIR Publications

ABSTRACT

Background:

Nationally, nursing homes have been devastated by COVID-19 with 710,000 cases and 138,000 deaths. Although facilities are required to have infection control staff, only 3% of designated infection preventionists have taken a basic infection control course prior to the COVID-19 pandemic. Most research has focused on infection control in the acute care setting. However, little is known about the implementation of infection control practices and effective interventions in nursing homes. This study utilizes Project ECHO (Extension for Community Health Outcomes), an evidence-based telementoring model, to connect Penn State University subject matter experts with nursing home staff and administrators to proactively support evidence-based infection control guideline implementation.

Objective:

Our study seeks to answer the research question of how evidence-based infection control guidelines can be implemented effectively in nursing homes, including comparing the effectiveness of two ECHO-delivered training interventions on key patient-centered outcomes, including reducing the number of residents with a COVID-19 diagnosis.

Methods:

A stratified cluster randomized design was utilized. Using a 1:1 ratio, we randomly assigned 136 nursing homes to ECHO or ECHO Plus. Randomization was stratified by geographic location, baseline COVID-19 infection rate, and facility capacity. The study arms included two phases. In phase one, nursing homes in both study arms received a 16-week infectious disease and quality improvement training intervention via real-time, interactive videoconferencing and the ECHO learning model. Phase one sessions were up to 90 minutes in duration. In phase two, the ECHO group was offered optional 60-minute office hours for nine weeks and the ECHO Plus group received nine weeks of 60-minute sessions on emerging topics and an additional eight-session refresher series on infection control.

Results:

Two hundred ninety nursing home facilities were assessed for eligibility, with 136 nursing homes recruited and randomly assigned to ECHO or ECHO Plus. Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, we will simultaneously evaluate the study’s effectiveness and implementation outcomes at baseline (intervention start date), 4, 6, 12, and 18 months. The primary outcome is COVID-19 infection rate reduction in nursing homes. Secondary outcomes include reduction of flu-like illness and COVID-19 hospitalizations and deaths, and improvements in quality of life (QOL). Surveys and interviews with participants will also provide data as to the adoption, implementation, and maintenance of best practices taught throughout ECHO sessions.

Conclusions:

A multi-pronged approach to improving infection control and emergency preparedness in nursing homes is important, given the toll that the COVID-19 pandemic has taken on residents and staff. The ECHO model has significant strengths when compared to traditional training, as it allows for remote learning delivered by a multi-disciplinary team of experts and utilizes case discussions that match the context and capacity of nursing homes. Clinical Trial: NCT04499391