Lack of Qualified Infection Preventionist for Infection Control Program
Penalty
Summary
The facility failed to ensure that the acting infection preventionist (IP), who also served as the interim director of nursing (DON), had completed specialized training or certification in infection prevention and control. During interviews, the interim DON confirmed that she was responsible for overseeing the infection control program but had not completed the required IP training and certification. Additional interviews with facility staff and the regional administrator revealed that there was no certified IP working at least part-time or onsite at the facility. Document review showed that the facility was actively recruiting for a permanent DON and an assistant director of nursing (ADON) to oversee the infection control program, with job postings specifying the need for education, training, experience, or certification in infection control. The facility's Infection Surveillance-Overview policy outlined the responsibilities of the IP, including leading surveillance, documenting and monitoring findings, providing staff training, and tracking communicable diseases among residents and staff. However, the lack of a qualified and certified IP had the potential to affect all 18 residents residing in the facility.