In a recent event at IDWeek 2025, a consortium from Detroit brought forward an issue that is not uncommon in skilled nursing facilities (SNFs) – the staff is well acquainted with the fundamental infection prevention control (IPC) principles, but fails to put this knowledge into consistent practice. The inconsistencies are evident in varying rub times, inadequate dwell times, and often overlooked respirator seal checks. For the staff at SNFs dealing with a heavy infection prevention load despite having meager resources and frequent employee turnovers, this gap between know-how and implementation is a prominent challenge.
A multidisciplinary team comprising personnel from Wayne State University, Beaumont Health, Henry Ford, and the Michigan Department of Health and Human Services validated this issue by presenting comprehensive data during IDWeek held in Atlanta, Georgia, from October 19 to 22, 2025. The study was carried out using the CDC’s Project Firstline framework to measure the current status of IPC knowledge, attitudes, and practices (KAP) among healthcare personnel at Detroit-area SNFs. This crucial information now serves as a foundation for developing a custom implementation strategy.
The assessors utilized a 23-item cross-sectional survey, approved by the Wayne State IRB, spanning across eight SNFs (conducted from January 2023 to May 2024). The questionnaire covered a range of queries based on hand hygiene, personal protective equipment (PPE) usage and selection, environmental cleaning, and routine behaviors such as mask donning and conducting N95 seal checks. A total of 168 respondents anonymously answered the survey, with the majority being female (82%) and Black/African American (74%), representing a true cross-section of the Detroit long-term-care workforce.
The survey participants represented various roles within healthcare, including nursing, certified nursing assistants, housekeeping/environmental services, and administrative staff. The team found that while the fundamental IPC knowledge was solid, several practical gaps were revealed in self-reported behaviors. Surprisingly, deficiencies were observed across all job categories, suggesting that the training required to improve practice aligns with a behavioral approach rather than merely knowledge accumulation.
The findings of this study underline the need for hands-on, role-specific training; providing visual cues at the point of usage; standard work integrated into team huddles; and peer champions from different departments working together to ensure correct practice in every shift. The next steps include implementing the findings and reevaluating the KAP after training completion. Additionally, by tracking outcomes like device-associated infections and Clostridioides difficile rates, the team aims to gauge the clinical impact of this practice change.