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State Spotlight: Montana Leverages Partnerships to Manage COVID-19 Outbreaks in Long-Term Care Facilities

Posted: April 29, 2021
Author: Erika Baldry, Healthcare-Associated Infections and Antimicrobial Resistance (HAI/AR) Epidemiologist and Program Coordinator at the Montana Department of Public Health and Human Services (DPHHS)

Montana, the fourth largest state geographically in the U.S., spans more than 147,000 square miles (slightly larger than Japan) and is home to about 1 million people. Montana has a decentralized public health system so a lot of the authority and responsibility for implementing rules and regulations and every aspect of pandemic response actually land with the counties, many of which have limited staff. In order to provide public health support to city and rural areas, we partnered with our state’s local health departments, survey agency, Quality Innovation Network-Quality Improvement Organization (QIN/QIO), hospital and public health preparedness teams, and laboratory partners to identify and provide support to LTCF experiencing COVID-19 outbreaks. We worked closely with these partners prior to the pandemic, so these existing relationships led to a coordinated approach during the COVID-19 response.

Author Erika Baldry

Erika Baldry

Our team coordinates outbreak response efforts with local public health departments, healthcare facilities, and the state survey agency. At the beginning of the pandemic, I communicated with facilities at least daily to get updates on their COVID-19 outbreaks and to provide guidance and technical assistance, including offering COVID-19 focused infection control assessments (ICAR) to all healthcare facilities in Montana. I now check in with LTCFs/ALFs and local public health at least weekly to monitor active outbreaks. Our local health departments really stepped up during the pandemic. Given Montana’s decentralized governance structure, our local health department staff take on multiple roles and usually do not have a dedicated communicable disease staff person, so their collaboration with us and their engagement with the facilities was a huge benefit to the response.

The Montana HAI Program hosted weekly webinars for all Montana APIC chapter members, as well as Infection Preventionists from other states. This webinar series—which was established prior to the pandemic—provided a platform to communicate updates, share resources and provide trainings to Infection Preventionists. It also helped strengthen our relationship with Infection Preventionists, which led to timely and frequent communication about outbreaks in facilities. Additionally, in November of 2020, our HAI Program partnered with a local acute care hospital and the Agency for Healthcare Research and Quality to provide a 16-week LTCF training course primarily focused on COVID-19. We also leveraged our good relationship with QIN/QIOs and our hospital association to use their communications channels to send important messages and updates to facilities state-wide.

As a rural state, we faced unique challenges when it came to reaching every facility. Testing for example was a huge logistical challenge, since some facilities are not located near a hospital and our laboratory courier system could not reach every facility. We were fortunate to have our Governor’s support and some time to plan and respond, so we worked with our state public health laboratory and other laboratory partners to figure out ways to offer baseline testing and implement surveillance testing prior to national LTCF testing recommendations took effect.

We also worked closely with the hospital preparedness and public health preparedness programs (HPP), using data from the National Healthcare Safety Network (NHSN) to address PPE and other supply shortages in LTCFs. Each week, the HPP Coordinator submitted the State LTCF Integrated Red Report, which we used to reach out to facilities reporting PPE and staffing shortages. During this outreach, we reminded facilities of the staffing and PPE resources available through the state and communicated information on how to obtain these resources.

One of the biggest contributing factors to the success of our response was the additional funding from CDC which led to the growth of our HAI Program. We were able to expand our HAI Program team to four Infection Preventionists who now consult with facilities, perform infection control assessments, and provide direct support and assistance to facilities. The additional funding has also allowed us to expand the services we offer to facilities. As a rural state, we have more Critical Access Hospitals, so our infection prevention activities have focused on providing one-on-one support to these facilities, which typically have limited staff who are stretched across multiple roles. During the pandemic, we were able to expand these services to LTCFs and Assisted Living Facilities and have hopes to expand to other types of congregate living settings including outpatient health clinics, dialysis centers, schools, and jails.

Our experience during this pandemic has highlighted the importance of infection control. We have learned that infection control is a responsibility and duty of everyone in the facility, and this facility-wide approach to infection prevention can contribute to a successful outcome. We also recognize the importance of inter and intra-facility communication, as well as communicating information to residents and family members to prevent the spread of infections and outbreaks. We were met with challenges every day, but because of our hard working and dedicated Infection Preventionists, we were able to overcome a lot of them. It has also been inspiring to work with our amazing healthcare workers and public health staff during the response. We have a lot of work in front us, but I remain excited because this experience has been the catalyst for us to enhance our infection prevention activities, expand our reach and support, and provide guidance and education on infection prevention standards.