Kristi Felix,MSN, RN, CIC, LTC-CIP, FAPIC
Infection Prevention Manager
Post-Acute Care Hospital System (two campuses)
How did you become an infection preventionist and what does your role look like today?
I started working in infection control (as it was called at the time) in 1989. I was working in a skilled nursing facility as a RN and like most nursing homes, I had more than one job. I was doing nursing education and helping with quality improvement projects.Infection control was part of the job.I didn’t know anything about infection control when I started and there wasn’t anyone to train me in the role at that time. I started out logging infections and looking at culture reports but I wasn’t sure what I was doing. So, I relied on the infection control staff in the three referring hospitals in the area to help when I had questions. They became my mentors and introduced me to our state APIC chapter.When I joined APIC, I found a wealth of knowledge and a group of people who understood my job and who were willing to be a resource for me. Our state chapter of APIC was very active and being a member helped me become more interested in infection control.Over the last 38 years, I have always been willing to take on the role of Infection Preventionist (IP) in the facilities where I have worked and have grown to love infection prevention.
I have been an IP at the facility where I currently work for 31 years. When I first started, I was asked to take on infection control since I had some experience.I was the only IP for our 250 bed, non-profit hospital that provided all levels of post-acute care. This included an inpatient rehabilitation hospital, a long-term acute care hospital, and a separate 130 bed skilled nursing home that housed a ventilator-skilled nursing unit.I had 3 other jobs in addition to infection control. This facility values education and training and supports our membership in professional organizations like APIC. So I was able to continue to work with my IP mentors and build a program here.I became certified in infection control in 2002.
Over the years, as our patient population and CMS regulations changed, the IP role changed, increasing from 8 hours a month to full time position.Due to opening of a second facility in a near-by city, I was able to hire a full time IP to help with infection prevention on that campus. During the summer of 2020, at the beginning of COVID-19 pandemic, a third RN joined our team, and set up the COVID monitoring/testing requirements for our skilled nursing home area.
Currently, I am the Infection Prevention Manager for our hospitals and oversee the infection prevention programs on both campuses as well as 4 outpatient therapy clinic sites. I completed my MSN with emphasis in Infection Prevention and Control in 2019.I have been certified in CIC since 2002 and LTC-CIP since 2023.I became a Fellow with the Association of Professionals in Infection Control and Epidemiology in 2016.
Can you share one specific example where your work made a measurable difference?
As part of our skilled nursing home services, we have an area that serves residents who are ventilator dependent due to multi-system failure, stroke, brain injury, spinal cord injury, or may have other chronic, complex medical conditions.They require multiple invasive devices that are medically necessary but allow a route for pathogens to enter the body.
We identified a group of 10 residents on this area who had reoccurring infections requiring multiple rounds of antibiotics, and some had to be transferred out to acute care facilities for treatment of infection. A quality improvement project plan was developed to help improve the outcomes for these residents.We knew there were acute care facilities in our area using 4% chlorhexidine gluconate (CHG) solution for bathing to decrease infections in the ICU settings.We decided to trial the use of the 4% CHG foam skin cleanser for showers and daily morning cares with this group of residents to see if we could lower the microbial counts on the skin and decrease the occurrence of symptoms of infection and antibiotic use.The outcome was successful, decreasing symptoms of infection, antibiotic days, and antibiotic costs by about 50%. It also decreased the return to acute care rate for these residents.This horizontal intervention of using CHG bathing was adopted and became standard care for all residents who live on this area.
What is the most challenging part of infection prevention in long-term care?
Resources. Infection preventionists in long-term care need to have the proper resources available to be able to monitor the care that is being provided, the services offered, and the environment where the residents live. In the skilled nursing home setting, we want to create a comfortable, home-like environment but it can be challenging for the infection preventionist to get staff, residents, and even their families to follow infection prevention practices that they don’t understand and may not think are necessary. As long-term care infection preventionists, we need resources to monitor care, conduct rounds of the environment, and be able to provide regular education and just-in-time training for direct care and support staff in the facility. We need to have the resources to be able to monitor care and educate the staff on all shifts, so they understand the “why” behind those practices. Having the proper resources to provide monitoring and education on all shifts can be challenging. Basic, evidence-based, infection prevention practices need to be reinforced with direct care and support staff so they can become part of the daily routine when providing care in the nursing home setting.
If you could speak directly to policymakers, what would you want them to understand?
Requirements and funding for proper infection prevention resources should be a priority. Infection Prevention is a department that does not generate income for the facility. It is difficult to put a number on an infection that doesn't happen because you prevented it. If you prevent infections, you can decrease the costs of antibiotics, care needs, diagnostic testing, supplies, staff time, etc. The potential monetary cost to the long-term care facility when a resident goes to the acute care facility due to an infection can be high, depending on the payer mix, diagnosis, etc. I asked our administrator for some information about readmissions and he shared that, from a national benchmark standpoint, CMS has cited an average Medicare payment of $10,352 per SNF rehospitalization, while Agency for Healthcare Research and Quality (AHRQ) reported an average all-cause 30-day hospital readmission cost of $16,300 in 2020. More severe conditions can be substantially higher; for example, AHRQ reported average sepsis inpatient costs in 2021 in the roughly $26,900-$30,500 range depending on patient characteristics. Readmissions to acute care can also affect Medicare reimbursement for the nursing home over time.
However, there is a more important cost that cannot be measured. Being placed in precautions is socially isolating and difficult for a resident who likes to be out in a common area and attend activities or sit with friends at dinner. The effect on the residents when they must be transferred to acute care for treatment can be devastating as it is a disruption to their daily routine, their regular care givers, and their quality of life. In acute care they may be at risk of exposure to resistant pathogens, the potential risk of developing wounds, and exposure to invasive devices and procedures. We need to do what we can to promote a safe, home-like environment and prevent infections so we can provide the best quality of life possible for the residents in our care.