Getting the Most Out of the ICAR Visit by Using a Scoring Report to Provide Feedback
Authors: Abdelfattah Rehab , Fields Virgie , Jamerson Carol , Lineberger Sarah 
Published: November 2020

Background: The Centers for Disease Control and Prevention developed the Infection Control Assessment and Response (ICAR) tools to assist health departments in assessing infection prevention practices and to guide quality improvement activities. ICAR tools are available for the following healthcare settings: acute care (including hospitals and long-term acute-care hospitals), outpatient, long-term care, and hemodialysis. The Virginia Healthcare-Associated Infections and Antimicrobial Resistance (HAI/AR) Program developed a scoring report that provides a quantitative measure for each infection control domain and summarizes strengths and opportunities for improvement. The scoring report aims to provide feedback to facility administration in a simple, user-friendly way to increase their engagement, prioritize follow-up actions for areas in need of improvement, and to analyze statewide data systematically to identify and address major defects. Methods: Scoring reports were developed for acute care, long-term care, and hemodialysis facilities. Each report includes 2 tables: infection control domains for gap assessment and direct observation of facility practices. The first table has rows for infection control assessment domains, and the second table summarizes direct observations conducted during the ICAR visit such as hand hygiene, point-of-care testing, and wound dressing change. Each row is stratified by the score, which is determined by responses to the ICAR tool, for each domain or observation, interpretation of the score, strengths, and opportunities for improvement. Stoplight colors with assigned percentages are used for score interpretation. ICAR visit results from 5 long-term care facilities (LTCFs) and 3 hemodialysis centers were entered into a REDCap database and analyzed. Results: Data from these visits elucidated consistent gaps in Infection Prevention and Control programs and defined what practices are most lacking. The low-performance areas in LTCFs included hand hygiene, personal protective equipment (PPE), environmental cleaning and disinfection, and antimicrobial stewardship. In hemodialysis centers, respiratory hygiene and cough etiquette, injection safety, and surveillance and disease reporting had the lowest scores. Positive feedback on the scoring report was received from facilities and other state HAI programs. Conclusion: The Virginia HAI/AR Program developed a scoring report that engaged healthcare facility administration, including corporate leadership, by providing a composite score with interpretation. The report prioritized areas for improvement and guided public health follow-up visits. Common gaps in infection prevention practices were identified across facilities, and this information has been used to determine statewide training needs by facility type. The scoring report is an effective method to help allocate state resources and improve communication and engagement of healthcare facilities. Reports can be adapted for use in other jurisdictions.Funding: NoneDisclosures: None