Why We Need a Regional Approach to Infection Prevention

By Rosie Lyles, MD, MHA, MSc | October 11, 2018

The last few months have been busy for me. I’ve traveled as far away as Japan, but also shared my insights on infection prevention closer to home. In August I visited with a customer that owns more than 30 skilled nursing facilities in California. For so long, infection prevention has been associated with hospitals, but with our population getting older CMS is putting greater focus on the post-acute setting. The agency announced specialized training on infection control for long-term care facilities in March.

Rosie Lyles, MD, presenting on infection prevention
Rosie Lyles, MD, Medline, presents to group of skilled nursing facilities on the West Coast about latest infection trends and best practices.

The approach must be different, more regional.


Part 1: Community-Acquired Infections

The infection prevention community has been watching an increase of community-acquired C. difficile and asymptomatic C. difficile carriers.¹ Unlike the hospital, most long-term care facilities (LTCF) don’t have infection preventionists. Yet, healthcare workers in these settings are responsible for hand hygiene, bathing and even rehab. Those are germs and bacteria spreading in even more ways and among an already vulnerable population.


Part 2: Frequent Flyers and Standardization

This term is why a regional approach is important. Elderly patients are bouncing from hospitals to assisted living, sometimes to the home and then back to the hospital. We see the CDC monitoring for illnesses by region and state, yet we’re not doing anything to standardize our plan of attack on these bacteria in the same approach. It’s facility by facility or system by system.

To give you an example of why this is so important, a recent study published in Infection Control and Hospital Epidemiology (ICHE) showed that long-term care facility residents with Clostridium difficile infection (CDI), or asymptomatic carriage of toxigenic strains, are an important source of transmission in the LTCF and in the hospital during acute care admissions. Of the 37 CDI cases:

  • 7 (18.9%) were linked to LTCF residents with LTCF-associated CDI or asymptomatic carriage

This includes:

  • 3 of 26 hospital-associated CDI cases (11.5%)
  • 4 of 11 LTCF-associated cases (36.4%)²

Of the seven transmissions linked to LTCF residents, five (71.4%) were linked to asymptomatic carriers versus two (28·6%) to CDI cases, and all involved transmission of epidemic BI/NAP1/027 strains.²

If nursing homes and LTCFs had similar practices as the hospital these residents are visiting, and the local home health agencies implemented those same guidelines, we would be in a much better place at reducing infections and containing them.


I would like to see:

  • Facilities implement standardized infection control strategies (i.e. hand hygiene,  environmental cleaning and disinfecting, decolonization, antimicrobial stewardship, patient cohort and vaccinations)
  • Home health agencies provide standardized training to employees
  • Long-term care facilities to create a committee on infection prevention
  • Health systems and nearby long long-term care facilities to communication and collaborate more frequently

This is more than a compliance issue. It’s a regional issue, spanning across the continuum and we can all work together on best practices so our patients and residents have the best outcomes.

You can learn about techniques and solutions to help reinforce your facility’s infection prevention protocols and behaviors.


1. Lyles, Rosie D.. (2016). Asymptomatic Clostridium difficile Carriers: Transmission of an Infectious Pathogen. Association for the Healthcare Environmental.

2. Donskey, CJ et al. Transmission of Clostridium difficile from asymptomatically colonized or infected long-term care facility residents. ICHE 2018;39:909-916.


Rosie Lyles, MD

Director of Clinical Affairs

Rosie Lyles, MD, MHA, MSc is the director of clinical affairs at Medline. She was previously the head of clinical affairs at Clorox Healthcare where she served as the medical/clinical expert and primary medical science liaison for three healthcare businesses, supporting all scientific research, as well as clinical and product intervention design and development. Lyles has more than a decade of experience investigating hospital-associated infections (HAIs) with a particular focus on the epidemiology and prevention of multidrug-resistant organisms such as C. difficile, MRSA and CRE infections in acute care hospitals and long-term acute care hospitals as a physician-researcher at Cook County Health and Hospitals System. Lyles has also directed numerous clinical studies and interventions for the CDC and the Chicago Antimicrobial Resistance and Infection Prevention Epicenter with numerous authored peer-reviewed journal articles related to infectious disease epidemiology. She is an active member of the Infectious Disease Society of America, Association for Healthcare Environment and the Society for Healthcare Epidemiology of America. Currently she serves as a grant reviewer for the National Institutes of Health/National Institute of Allergy and Infectious Diseases (NIH / NIAID), manuscript reviewer for New England Journal of Medicine, American Journal of Infection Control, medical reviewer for U.S. Department of Veterans Affairs for HSR&D Scientific Merit Board, and Medical Advisory Board for C. Diff Foundation. Rosie received her medical degree from St. Matthew's University School of Medicine and completed a master's in Health Service Administration at St. Joseph College and a master's of Science in Clinical Research and Translational Sciences at the University of Illinois at Chicago.

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