Infection Prevention and Control Assessment Tool for Nursing Homes Preparing for COVID-19

This tool is an update to the previous ICAR tool for nursing homes preparing for COVID-19. Notable changes as of January 7, 2022 include:

• Additions to reflect updated guidance such as SARS-CoV-2 testing in nursing homes, COVID-19 immunization of residents and healthcare personnel (HCP), situations in which source control is recommended for HCP, and how community levels of transmission affect personal protective equipment used when caring for residents without suspected or confirmed SARS-CoV-2 infection

This update does not include changes to Isolation and Quarantine guidance posted in December 2021. This tool will be updated as nursing home guidance is updated. Please contact [email protected] to request the most current draft of the ICAR tool in development as new guidance is released. 

Similar to previous updates, facilitators may decide whether to use the tool in its entirety or select among the pool of questions that best fit their jurisdictional needs and priorities as part of quality improvement efforts.

In-person versus remote ICAR

The decision to conduct an assessment in-person or remotely via a TeleICAR depends upon several factors, such as available public health resources, the location and remoteness of the facility, and the presence of an active outbreak. For facilities with recent cases of SARS-CoV-2 infection in healthcare personnel or residents, an in-person assessment is preferred; however, jurisdictions must individually determine how to best provide assistance in the timeliest manner.

In-person ICARs:

• are preferred whenever possible, especially for facilities experiencing an outbreak
• are not prone to the same technical limitations (e.g., video function failure) that may occur during a remote ICAR
• typically allow the facilitator performing the ICAR to visualize more of the facility’s IPC practices

Remote TeleICAR assessments:

• allow for a larger number of facilities to be reached in a shorter amount of time
• allow for limiting potential exposures to SARS-CoV-2
• are unlikely to identify as many gaps in practices as in-persons visits, even with the addition of the video component

Steps to an ICAR

Whether conducting an ICAR in person or remotely (i.e., TeleICAR), the steps to the ICAR process are similar. In most instances, it involves scheduling the ICAR, conducting the ICAR with the preconstructed tool to guide the assessment, providing both verbal and written feedback to the facility, and then following-up on how the facility is implementing the suggested improvements. More information on these steps can be found in the Frequently Asked Questions.

How to use this ICAR tool

This tool is intended to help assess IPC practices for nursing homes without an active outbreak of COVID-19. However, public health jurisdictions may choose to modify this tool to fit their needs beyond this defined scope. For example, jurisdictions may choose to modify the tool to assess facilities experiencing an outbreak. While many of the concepts covered in this tool should be reviewed regardless of outbreak status (e.g., PPE use, hand hygiene, environmental cleaning), some areas may require more in-depth review such as current outbreak epidemiology (e.g., affected units, number of exposed HCP and residents), resident cohorting strategies, facility management of symptomatic or exposed residents, testing strategies, and mitigating staffing shortages. In addition, the video or in-person tour should dedicate more time to observing IPC practices in the designated COVID-19 area.

The tool is available in both a facilitator guide and a non-facilitator guide format.

• The facilitator guide format contains both the question and answer choices as well as the recommended IPC practice(s) based upon current CDC guidance. By having ready access to the recommend practice(s), the facilitator may provide immediate verbal feedback and recommendations to the facility during the assessment.
• The non-facilitator guide format only contains the question and answer choices.
• Section 1 of the ICAR collects facility demographics and critical infrastructure information and is intended for completion by the facility prior to the ICAR (provided as separate PDF to send to facility, Section 1: Demographics and Critical Infrastructurepdf icon). These questions are often ones that require the facility to look up or consult with certain staff members and thus pre-collection often saves times during the actual assessment. The ICAR facilitator should decide if any of the responses need to be verbally reviewed or require further explanation at the beginning of the assessment. If no further clarification is needed, then the facilitator should start on the next section and refer to this section as needed. Section 1 of the facilitator guide provides the rationale behind the questions, and how the answers may be utilized during the rest of assessment.

Most ICARs, whether remote or in-person, begin with a discussion of current IPC policies and practices. Following this discussion, a facility tour can assess how the facility is implementing many of these discussed strategies. If the ICAR can only be conducted remotely, the assessment facilitator should include a video tour whenever possible.

The TeleICAR team within the Division of Healthcare Quality Promotion can provide training to public health jurisdictions on the use of the tool, including TeleICAR demonstrations with facilities. A Frequently Asked Questions document regarding TeleICAR remote assistance is also available. For more information contact, [email protected].

This update does not include changes to Isolation and Quarantine guidance posted in December 2021. This tool will be updated as nursing home guidance is updated. Please contact [email protected] to request the most current draft of the ICAR tool in development as new guidance is released.