Madelaine Cuevas

  • Designation: APIC San Francisco Chapter
  • Country: USA
  • Title: What Local Health Department’s Infection Prevention Nurses Do to Improve Infection Prevention Practices.


Madelaine Cuevas works at the San Mateo County local health department as an Infection Prevention (IP) nurse. She started her infection prevention career at O’Connor Hospital and Valley Medical Center, where she led the clostridioides and hand hygiene committee before moving to the local health department of San Mateo. In her current job, she and her colleague support 14 skilled nursing facilities (SNFs) and 12 hemodialysis facilities to bridge the gap between SNFs and acute care practice.


A concrete infection prevention foundation in skilled nursing facilities (SNF) is essential to decreasing healthcare-associated infections. In 2021, SNFs were required to have a full-time infection prevention (IP) staff. However, due to the increased demand for qualified IPs, most SNFs had to train staff since, without proper training and guidance, success in this field is challenging. This paper aims to provide an understanding of what IP nurses in local health departments (LHD) can do to improve infection prevention practices in SNFs.

The LHD assessed IP practices, utilizing a modified infection control assessment tool that identified the general facility demographics and infection prevention practices. The sizes of the SNFs vary, and all cater to adult residents. While most IPs have minimal experience and have additional roles in the facility, results showed that most are licensed vocational nurses who completed the training mandated by the state. However, there was insufficient knowledge regarding transmission-based precautions, multidrug-resistant organisms, surveillance, and other core infection control practices.

To improve the practices, LHD established a trusting relationship with the facilities by meeting with the facility's IP and leadership and emphasizing the importance of leadership support. LHD provided in-services in various IP practices and multidrug-resistant organisms (MDROs). To establish the cornerstone of infection prevention, monthly hand hygiene compliance and healthcare-associated infection rates were collected. SNF IPs were encouraged to participate in various IP meetings conducted by state agencies.

After several months, there was a noticeable improvement in IP practices. SNF IPs routinely communicate their IP processes with the local health department for the most common outbreaks, such as COVID-19, scabies, and MDROs. In the recent statewide IP training, the majority of IPs and staff developers attended the training.

The role of a knowledgeable and dedicated LHD is pivotal in improving SNF practices, bridging information gaps, and elevating practices.

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