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Nebraska DHHS LTCF Strike Team Project Survey

Nebraska DHHS HAI/AR Program is planning to offer assistance to nursing homes and assisted living facilities across the state in getting their staff fit tested with N-95 masks and train additional personnel in infection prevention and control. This program will also include training a few of the facility staff in performing their own fit testing, and each facility will be receiving its own fit testing equipment. The plan is to provide cost reimbursement to the facilities for their time spent on this project.

This survey will help the Nebraska DHHS HAI/AR Program plan for support and assist with evaluating the impact of this project among Nebraska long-term care facilities. Nebraska DHHS HAI/AR program has collaborated with Nebraska Healthcare Association and LeadingAge Nebraska throughout the planning phase of this project, and this survey has been developed based on the input received from both associations.

Nursing homes and assisted living facilities can use this survey to inform the Nebraska DHHS HAI/AR program of their intent if they are planning to join this program upon announcement. However, we request that facilities complete this survey even if they have not yet decided to participate in this project to help Nebraska DHHS HAI/AR Program with planning.

The estimated time to complete this survey is 10 minutes.

What is the name of your facility?

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Other:

Please choose the option below that best describes your facility:

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Skilled Nursing Facility

Assisted Living Facility

Both Skilled Nursing & Assisted Facility

Other

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Other:

Approximately how many staff members does your facility have who may have interactions with residents? (e.g., nurses, certified nursing assistants, physicians, physician assistants, nurse practitioners, therapists, medical providers, contractors, social workers, case managers, dietary staff, environmental cleaning staff, and others who interact with residents)

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Does your facility currently have staff trained on the procedures for providing N-95 fit testing to your employees?

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Yes No

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How many current staff at the facility have been trained on the procedures for providing N-95 fit testing?

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Out of those current staff in your facility who have regular interactions with residents (as mentioned above), how many of them have ever been fit tested for an N-95 mask?

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Out of those current staff in your facility who have regular interactions with residents (as mentioned above), how many have been fit tested for an N-95 mask in the last year?

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Do you have fit testing equipment and supplies at your facility? (Hood and chemicals)

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Yes

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Will you be able to identify a licensed provider (e.g., RN) to screen your staff using a standard medical clearance screening form for fit testing?

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Yes

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Suppose a need arises for further medical evaluation based on the medical clearance screening process. Where will your facility most likely send that staff for further medical evaluation for fit testing?

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To the facility medical director

To a contracted physician/nurse practitioner

To staff's own PCP

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Does your facility currently have a staff member designated to oversee infection prevention and control activities?

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Yes No

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How many staff are designated to oversee infection prevention and control activities?

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How many staff in your facility have received formal infection preventionist training?

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Among your trained Infection Preventionists, which of the following pieces of training have they completed? (Please check all that apply)

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APIC CDC NICN CMS Other

Other:

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Among your trained Infection Preventionists, have any obtained formal certification in infection prevention and control (also known as CIC®) [NOTE: The CIC® credential is awarded by the Certification Board of Infection Control and Epidemiology, Inc. (CBIC), and the staff has to take an exam to obtain that certification).

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Yes

Unsure

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On average, how many hours are spent by the staff member(s) who oversee infection prevention and control activities on performing infection prevention and control and antibiotic stewardship-related duties in a week?

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Change the slider above to set a response

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Does your facility have trained infection control champions? (i.e., front-line staff who assist their colleagues with proper adherence to infection control practices during their shifts)

[Note: Do not count Infection Preventonists as infection control champions]

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Yes No

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How many staff in your facility currently function as infection control champions?

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Where did they receive training to become infection control champions?

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How long ago was the staff(s) infection control champion training?

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How helpful do you think the above-mentioned fit testing program will be for your facility:

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How helpful do you think the above-mentioned infection control training support (i.e., cost reimbursement for staff time spent in training) will be for your facility:

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Does your facility intend to participate in the Nebraska DHHS LTCF Strike Team Project?

[Note: if you say yes, we will provide your facility name to your local health department for them to reach out to you for planning purposes when they are ready to provide support]

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Yes No Not sure at this point

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Name of the staff who is completing this survey:

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Title of the staff who is completing this survey:

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Email address of the staff who is completing this survey:

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.