Addressing Inadequate Infection Control in Long-Term Care Facilities: Bridging Knowledge and Practice Gaps

Reply from Ekaete Eyara

Inadequate infection control in long-term care facilities (LTCFs) remains a critical nursing problem, contributing to preventable illnesses and deaths among vulnerable residents. Research studies, quality improvement (QI) initiatives, and Doctor of Nursing Practice (DNP) projects each address different dimensions of this challenge, revealing gaps in both knowledge and practice that must be bridged to improve patient outcomes. 

Implicit Nursing Problems and Gaps

The research study by Wong et al. (2022) identifies a knowledge gap by examining the most common transmission routes of multidrug-resistant organisms (MDROs) in LTCFs. The implicit nursing problem is the lack of evidence-based, facility-specific infection prevention protocols tailored to the unique needs of elderly residents with comorbidities. While the study confirms that contaminated surfaces and poor hand hygiene contribute to outbreaks, it does not provide actionable strategies for frontline staff, leaving a gap between what is known and what is implemented (Wong et al., 2022).

In contrast, the QI study by Prins et al. (2025) uncovers a practice gap: even when infection control guidelines exist, adherence is inconsistent due to staffing shortages, inadequate training, and competing care priorities. The nursing problem here is not a lack of knowledge but a systemic failure to translate evidence into daily practice. For example, the study found that hand hygiene compliance rates were below 40% during high-activity periods, highlighting a critical need for workflow-adapted solutions (Prins et al., 2025).

The DNP project by Zimmerman et al. (2022) bridges these gaps by implementing a nurse-led hand hygiene reinforcement program in a dementia care unit. The implicit nursing problem is the disconnect between generic infection control policies and the reality of caring for cognitively impaired residents who may resist hygiene measures. By testing a tailored approach using visual cues and staff champions. The project addresses both the knowledge gap (which strategies work for dementia patients) and the practice gap (how to sustain compliance in understaffed environments) (Zimmerman et al., 2022)

Comparison of Problems and Influence on Practice Change

Research (Wong et al., 2022): Focuses on identifying risk factors (e.g., surface contamination) but does not test interventions. QI (Prins et al., 2025): Exposes barriers to adherence (e.g., time constraints) and tests real-world solutions like streamlined hygiene stations. DNP (Zimmerman et al., 2022): Translates evidence into a context-specific intervention, measuring both compliance and clinical outcomes. Together, these studies demonstrate how complementary approaches can drive change: research informs what to do, QI addresses how to do it, and DNP projects ensure who will do it and under which conditions.

Key Measurements/Variables

Wong et al. (2022): MDRO colonization rates (surveillance swabs). Prins et al. (2025): Hand hygiene compliance (direct observation audits). Zimmerman et al. (2022): Reduction in unit-acquired infections (pre/post intervention chart review).

Critique of Question Development (Hicks, 2024)

The DNP project by Hicks (2024) evaluates a CLABSI reduction program in a Surgical Intensive Care Unit (SICU). The problem, EBP question, and measurement are well-aligned. The problem is clearly defined, which is the high CLABSI rates due to inconsistent adherence to evidence-based protocols, exacerbated by staff turnover and inadequate training. The EBP question is specific and measurable: “Will a retrospective evaluation of a quality improvement initiative involving an evidence-based CLABSI reduction program demonstrate reductions in CLABSI rates in the SICU?”. The project uses multiple validated metrics: CLABSI rates (primary outcome). Bundle compliance (e.g., CHG baths, dressing changes, "scrub the hub"). Statistical significance (p-values) to validate improvements.

 Overall, Hicks 2024’s question development tool effectively links the problem, EBP question, and measurement but could be strengthened by addressing systemic challenges and real-time barriers to compliance.

Conclusion

Inadequate infection control in LTCFs requires solutions that address both knowledge deficits (research) and implementation challenges (QI/DNP). By combining these approaches, nurses can develop scalable, evidence-based protocols that reduce infections and improve resident safety.

Reference:

Hicks, T. (2024). Quality evaluation of a central line-associated bloodstream infection. Walden University CAO Repos