Infection Control Amplification in Nursing Centers (I CAN) is a program to strengthen nursing centers’ adherence to infection control practices by fostering a “see something, say something” culture, modeled by (1) a network of peer coaches and (2) supported by a data feedback loop. The data feedback loop consists of information from the coaches and infection control best practice adherence data from "secret shopper" auditors. Both coaching and the data feedback loop are essential to implementing the program.

After more than a year battling SARS-CoV-2, your staff know the infection control measures necessary to protect themselves and the residents under your care. But implementing these practices 100% of the time is difficult, for many reasons. And even briefest lapse can lead to disruptive quarantines and to transmission. I CAN helps your team to model a "see something, say something" culture of mutual accountability that can strengthen infection control practices and defenses.

The infection preventionist leads the program, meeting regularly with the project team, providing guidance to coaches, and learning from the coaches and the audit data collected by the secret shopper. This is challenging with so many competing priorities; but the intent is to use the program to elevate the precautions and practices that can keep your residents safe and eliminate disruptions, like going into outbreak mode.

Each unit and shift has a peer coach who extends your infection preventionist's reach throughout your center. Coaches provide "in the moment" feedback to their peers, including both corrections and praise. They also share their experiences with the infection preventionist. This sharing is an important part of the feedback loop and helps your I CAN team to identify patterns and to target and tailor the program to your center's needs.

The secret shoppers are responsible for auditing adherence to infection control best practices using observation tools for hand hygiene, masking, and transmission-based precautions. They share these data with the I CAN team and others involved in quality improvement. The data are an important part of the feedback loop and help the team to monitor progress and to target and tailor the program's focus.

The I CAN team is led by the infection preventionist and includes your center's leadership — Administrator, Director of Nursing, Director of Quality — as well as coaches and the secret shopper. The team actively supports implementation, including monitoring and acting on data, troubleshooting any barriers that arise, and ensuring that coaching becomes embedded in routine care delivery.

I CAN focuses on hand hygiene, masking, and transmission-based precautions, but your team can add other practices, as needed, based on the data feedback loop (from coaches and audit data) or any other information you have about your center's priorities (case investigations, state survey, etc.).

At a high level, centers will:

• Form a team to launch, monitor, and support the program
• Designate peer coaches and a secret shopper
• Communicate regularly with coaches, to share direction and obtain feedback
• Monitor feedback from the coaches and the audit data
• Ensure that the entire center is aware of the I CAN program