CDC Updates Infection Control Assessment and Response (ICAR) Tools

The Infection Control Assessment and Response (ICAR) tool provided by Centers for Disease Control and Prevention (CDC) was updated on November 20, 2020. This tool should be used to systemically assess a healthcare facility’s infection prevention and control (IPC) practices and as a guide for quality improvement activities.

The updated ICAR tool is a more comprehensive assessment of infection control practices within nursing homes. The facilitator of this tool may decide to use it in its entirety, or they may select among a pool of questions that best fit their needs and priorities in regard to their quality improvement efforts.

The ICAR tool is intended to help assess IPC practices for nursing homes without an active outbreak of COVID-19. The public health jurisdictions can choose to modify the tool to fit their needs beyond the defined scope. Many of the concepts covered in this tool should be reviewed regardless of outbreak strategies, and some areas may require a more in-depth review, such as current outbreak epidemiology, cohorting strategies, testing strategies, and others.

The updated ICAR tool for nursing homes preparing for COVID-19 includes:

• • Additions to reflect guidance for SARS-COV-2 testing in nursing homes.
  • Increased emphases on the review Personal Protective Equipment (PPE) uses and handling
  • Addition of sections to help guide a video tour as part of a remote TeleICAR assessment or in-person tour of a nursing home
  • Addition of an accompanying facilitator guide to aide with the conduction of the ICAR and to create subsequent recommendations for the facility

There are four steps to an ICAR:

1. 1. The facility will be contacted to schedule an ICAR
   2. The ICAR will be conducted
   3. Feedback will be provided to the facility
   4. There will be follow-up on ICAR feedback implementation

Jurisdictions will individually determine whether to conduct an assessment in-person or remotely via a TeleICAR. The decision will be based upon several factors, including, available public health resources, the location and remoteness of the facility, and the presence of an active outbreak. If a facility has had recent cases of SARS-COV-2 in healthcare personnel or residents, then an in-person assessment is preferred.

Most ICAR’s will begin with a discussion of current IPC policies and practices. A facility tour will be conducted to assess how the facility is implementing many of the infection control strategies. If the ICAR can only be conducted remotely, the assessment facilitator should also provide a video tour whenever possible.

The updated Nursing Home COVID-19 Infection Control Assessment and Response (ICAR) Tool Facilitator Guide can be accessed here: Nursing Home COVID-19 Infection Control Assessment and Response (ICAR) Tool Facilitator Guide (cdc.gov).

Compliance Perspective

Issue

Failure by a nursing home to implement infection prevention and control requirements for residents with suspected or confirmed COVID-19 may result in other residents being placed in immediate jeopardy of contracting the Coronavirus. Resulting citations and sanctions may occur, up to and including temporary management appointed by the Department of Health.

Discussion Points

• • Review policies and procedures regarding the facility’s Infection Control Plan and any CDC or CMS recommendations for preventing or responding to an outbreak of Coronavirus.
  • Train all staff about the facility’s Infection Control Plan and their individual responsibility. Train appropriate staff on how to complete the ICAR assessment tool.
  • Periodically audit to ensure that facility’s Infection Control Plan is in effect, and that staff have implemented fully any recommendations issued by the CDC or CMS. Review results from completion of the ICAR assessment tool at QAPI/QAA.