New training program could better protect Orange County nursing home workers and residents from coronavirus

By Ben BrazilStaff Writer

May 14, 2020 12:16 PM PT

As COVID-19 continues to tear through nursing and assisted-living homes across the state, UC Irvine, the Orange County Health Care Agency and CalOptima are teaming up to develop an infection control training program that will help protect the most vulnerable members of the community.

“We are all very aware that we have reached a critical juncture in the COVID-19 pandemic picture,” said Dr. Emily Fonda, deputy chief medical officer of CalOptima. “We continue to find ourselves with daily new cases and lists of hospitalized patients and deaths, many of which occur among nursing home patients.”

The program is a preventative measure so the fate of the county’s nursing and assisted-living homes doesn’t mirror that of the state’s.

Almost half of the deaths from COVID-19 in California occurred to residents or employees of nursing or assisted-living homes.

More than 350 residents and 170 staff have tested positive for the virus throughout the county’s nursing and assisted-living homes. There were 3,749 cases of COVID-19 in Orange County as of Wednesday, according to the OC Health Care Agency.

CalOptima’s board of directors has devoted about $629,000 to the program. The county also is providing funding.

Fonda said there have been 188 cases of CalOptima members with COVID-19 across 12 nursing home facilities in Orange County. There’s a 31% rate of hospitalization if a patient gets sick, and nine patients have died, Fonda said.

CalOptima has about 4,800 patients in nursing homes.

“Nursing homes are an incredibly vulnerable sector and there have been many that have seen COVID cases,” said Dr. Susan Huang, a UC Irvine professor who is developing the infection control training program. “The people who are in nursing homes have every risk factor that’s known for COVID for poor outcomes. They are elderly, they have comorbidities, like hypertension and asthma — all the things that makes them frail and vulnerable and unable to fight a brand new virus the body has never seen.”

Huang, professor in the Division of Infectious Diseases, said the program will include the development of a “toolkit” and training program as well as increased testing for COVID-19 and antibody testing.

CalOptima is contracted with 71 nursing home facilities, 67 of which are in Orange County. The Orange County locations will be included in this program. However, 12 of the facilities will receive more intensive infection prevention training, along with the means to track the effectiveness of the training.

She and her staff will be on site to train the staff of these 12 facilities. The facilities will also be tracking metrics and use video monitoring to ensure employees are following protocol.

“The video assist would give info to the team; for example, do they have the mask on properly before entering the room,” Fonda said. “They are not going to be filming patients. It’s mainly to see if the staff maintaining the level of technique necessary for this kind of an outbreak.”

The toolkit, which isn’t yet fully developed, will include a section on how to safely care for residents and how to properly clean and sanitize, among other topics. Huang said a number of tools, forms and skills assessments will be available to make sure the recommendations are followed.

Huang and her team of epidemiologists will provide guidance with webinars and consultation hours.

In speaking about a nursing home in Riverside where more than 80 residents had to be evacuated, Fonda said nurses were reported to be using improper care techniques.

“Some nurses were wearing their face masks around their necks,” Fonda said.” They were bringing their hands up to their eyes with contaminated gloves. The nurses probably were never trained to manage this type of infection control.”

Fonda said many of the employees working at nursing homes are certified nursing assistants, which requires less training than a registered nurse.

Well-trained staff is vital because nursing homes are perfect environments for the virus to spread.

“They are in close quarters with two to four people in a room,” Fonda described the layout of a common nursing home. “They have shared sinks, toilets, shared showers, and even they eat in a community dining room.

“The patients who are there are unable to care for themselves. They are incapacitated, usually due to chronic injuries or illnesses that don’t allow them to get up and down and care for themselves. They are dependent on the staff.”

Two of the 12 nursing homes currently participating in the program are Garden Park Care Center in Garden Grove and Victoria Health Care & Rehabilitation in Costa Mesa. Fonda said they are working on selecting the rest of the facilities.

“We want to protect them now but we also want to protect them before any fall surge,” Huang said.

Huang has spent more than a decade researching how to prevent the spread of multi-drug resistant organisms in hospitals and nursing homes.

CalOptima and Huang previously partnered on the medical care provider’s initiative to reduce the impact of multi-drug resistant organisms — like MRSA — in nursing homes. For that, CalOptima is providing financial incentives to facilities that use Chlorhexidine soap, which Huang has researched. The soap is also effective against coronaviruses. This partnership evolved out of that initiative.

“We are not racing a deliverable deadline; we are racing a virus,” Huang said. “So we really are eager to provide as useful information as quickly as we can.”

She continued: “The summer is already upon us, people are moving about, and we are going to have to protect these individuals now more than ever.”

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New training program could better protect Orange County nursing home workers and residents from coronavirus

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