Address Knowledge Gaps to Prevent Infection Outbreaks

After its last COVID-19 outbreak, Querencia at Barton Creek, a 42-bed skilled nursing facility located in Austin, Texas, found a need for refreshed educational efforts toward hand hygiene and disinfectant measures within its community. Upon investigation, staff members demonstrated inconsistent knowledge of hand hygiene, the sequence for donning and doffing personal protective equipment (PPE), and disinfectant contact time on high-touch surfaces. To correct this, the facility developed and implemented an effective infection prevention plan that provides educational resources and additional training to staff.

Providing and maintaining a clean environment affects 100% of Querencia at Barton Creek’s direct resident care areas, so after the outbreak, all staff members in various departments were subjected to continuous monitoring. During an infection control on-site visit in which a TMF Quality Innovation Network-Quality Improvement Organization (QIN-QIO) specialist offers support, staff members provided inaccurate disinfectant dwell/contact times. The importance of appropriate contact time is its ability to effectively kill viruses, bacteria and germs. On every disinfectant bottle or container is the correct dwell time; but it is in very small print, making the information difficult to see. Staff began labeling the containers with handwritten dwell times to make them more visible, which greatly contributed to the adherence of appropriate contact times.

Starting in September 2023, routine audits were conducted to measure improvement on hand hygiene and trainings on donning and doffing PPE were offered to staff. After implementing their infection prevention program, Querencia at Barton Creek has been able to track progress through data collected from the audits. “The audits have shown improvement towards knowledge of hand hygiene, sequencing of donning and doffing PPE, and understanding of disinfectant contact time required for products used,” said Director of Nursing Jenny Evans. In order to maintain their plan, Querencia at Barton Creek continues providing infection prevention education to staff on a quarterly basis and as needed, with random observations to ensure correct measures are being taken.

The facility’s quality improvement team included Evans and Assistant Director of Nursing and Infection Preventionist Ruzanna Minasyan working alongside the TMF QIN-QIO to research and utilize available resources. “The TMF QIN-QIO provided options for educating staff, visitors and residents,” Evans said. “These efforts produced materials for educational purposes and visual aids that are accessible to staff and within the community.”

The quality improvement team’s research provided staff with tools for hand hygiene and PPE instructions, and some resources were even used to bridge a language gap. Due to the facility having a few Spanish-speaking staff members, Evans and Minasyan requested dual-language signage covering the proper PPE sequence, which is displayed in all areas where required.

Since implementing its infection prevention plan, Querencia at Barton Creek has not had another outbreak and will continue with their current efforts in place while providing quality improvement resources when training new employees. In addition to these resources, the facility will involve more leadership in new employee training to ensure a successful approach is being taken. Routine monitoring and random observations will also continue in order to measure improvements and success in infection prevention.

The TMF QIN-QIO is contracted by the Centers for Medicare & Medicaid Services (CMS) to assist nursing homes free of charge. To find out how the TMF QIN-QIO can help your facility with challenges related to COVID-19 and vaccinations, email