California skilled nursing facilities.
It is estimated that of the 2.2 million people who turned 65 years of age in 1990, approximately 1 million will be cared for in a SNF at least once before they die (Satterfield, 1993). Under pressure from federal and state governments to reduce costs associated with acute care hospitalization, SNFs are admitting patients who require more complex medical and surgical care than in the past. Until recently, FS-SNF ICPs did not have the motivation to develop and implement complex infection prevention and control programs because their patients required a level of care that assured that their activities of daily living were met. In today's continuum of health care structure, SNFs are expected to maintain patients on ventilators and hyperalimentation and to care for patients recovering from complicated postsurgical procedures, such as total hip replacements and coronary artery bypass grafts. These patients are not expected to remain in SNFs until they die. They are expected to recover to their prehospitalization health status and, at a minimum, be discharged to the next lower level of care (i.e., board and care homes) or to assisted care in the family home. With the increased level of complex medical and surgical care that SNFs are now required to provide, infection prevention and control programs take on new emphasis. This is evidenced by the educational needs assessment reported by Leinbach and English (1995) and confirmed by this study. The basic principles of infection prevention and control are the same whether the patient is in a hospital, a DP-SNF, or a FS-SNF. However, the person responsible for infection prevention and control for a DP-SNF may be the same individual who is the ICP for the acute care hospital of which it is a part. Persons designated as ICPs for FS-SNFs often function in a much more isolated setting with limited access to resources. It is now time for experienced hospital-based ICPs to reach out to personnel in FS-SNFs to work together to develop and implement effective infection and prevention and control programs that meet the needs of patients cared for across the continuum.