 covid 19 has impacted healthcare associated infections and antimicrobial resistant hai ar threats across all healthcare settings los angeles county saw an increase in hais such as central line bloodstream infections clabsi as a result of many facilities changing their clabsi prevention efforts to accommodate the challenges of caring for covid 19 patients additionally los angeles county saw an increase of multidrug resistant organisms mdros such as candida auris due to personal protective equipment ppe practices being altered early in the pandemic due to severe shortages despite the difficulties brought on by covid 19 awareness of infection prevention efforts has improved over the last two years especially in nursing homes the covid 19 pandemic has had both negative and positive impacts on infection prevention in healthcare the negative impacts such as ppe shortages staffing shortages facility crowding frequent moving of patients throughout the facilities due to covid related cohorting and lack of focus on identifying and containing mdros contributed to increased mdro spread the positive impacts include new legislative actions increased funding and building stronger relationships and partnerships to support infection prevention efforts across the healthcare community california introduced a new state law requiring all nursing homes to employ a full time infection preventionist ip funding opportunities from the centers for disease control and prevention cdc at the local and state level have helped to improve infection control and has provided some much needed resources for nursing homes and other long term care facilities increased funding stakeholder engagement and requirements for infection preventionists have helped shaped the backbone for an unprecedented future educational program centered on infection prevention within nursing homes there are many insights that we have gained while leading the healthcare outreach unit at the los angeles county department of public health that can help improve hai ar response we believe that stakeholder engagement is a key to success for health departments programs rolled out by public health departments should be developed in conjunction with stakeholders and should address the concerns that these stakeholders bring to the table as an example to support nursing homes we have hired two geriatricians and nurses with experience working in this setting who understand many of the concerns and constraints present in these facilities and already have relationships in the field we have learned that you should not underestimate the importance of giving each nursing home a specific public health nurse to work with and build rapport we have also strengthened our ties with the leadership in individual nursing homes and with the nursing homes operators which helps to improve stakeholder buy in and input we plan to use the engagement and trust that we have developed over the last two years to elevate infection prevention across all nursing homes through standardized template policies and training instead of allowing each facility to develop their ip program unilaterally which is what many facilities have done in the past with mixed success overall we believe the future of hai ar response success is dependent on the ability to adapt and remain flexible while refocusing activities beyond covid 19 the council for outbreak response healthcare associated infections and antimicrobial resistant pathogen corha plays a vital role in improving practices and policies at the local state and national levels regarding hai ar outbreaks across the healthcare continuum we hope that through sharing our experience we can help promote corhas mission to improve practices and policies for the detection investigation control and prevention of hai ar outbreaks with other local health departments and healthcare facilities dawn terashita zachary rubin 