 montana the fourth largest state geographically in the u s spans more than 147 000 square miles slightly larger than japan and is home to about 1 million people montana has a decentralized public health system so a lot of the authority and responsibility for implementing rules and regulations and every aspect of pandemic response actually land with the counties many of which have limited staff in order to provide public health support to city and rural areas we partnered with our states local health departments survey agency quality innovation network quality improvement organization qin qio hospital and public health preparedness teams and laboratory partners to identify and provide support to ltcf experiencing covid 19 outbreaks we worked closely with these partners prior to the pandemic so these existing relationships led to a coordinated approach during the covid 19 response our team coordinates outbreak response efforts with local public health departments healthcare facilities and the state survey agency at the beginning of the pandemic i communicated with facilities at least daily to get updates on their covid 19 outbreaks and to provide guidance and technical assistance including offering covid 19 focused infection control assessments icar to all healthcare facilities in montana i now check in with ltcfs alfs and local public health at least weekly to monitor active outbreaks our local health departments really stepped up during the pandemic given montanas decentralized governance structure our local health department staff take on multiple roles and usually do not have a dedicated communicable disease staff person so their collaboration with us and their engagement with the facilities was a huge benefit to the response the montana hai program hosted weekly webinars for all montana apic chapter members as well as infection preventionists from other states this webinar series which was established prior to the pandemic provided a platform to communicate updates share resources and provide trainings to infection preventionists it also helped strengthen our relationship with infection preventionists which led to timely and frequent communication about outbreaks in facilities additionally in november of 2020 our hai program partnered with a local acute care hospital and the agency for healthcare research and quality to provide a 16 week ltcf training course primarily focused on covid 19 we also leveraged our good relationship with qin qios and our hospital association to use their communications channels to send important messages and updates to facilities state wide as a rural state we faced unique challenges when it came to reaching every facility testing for example was a huge logistical challenge since some facilities are not located near a hospital and our laboratory courier system could not reach every facility we were fortunate to have our governors support and some time to plan and respond so we worked with our state public health laboratory and other laboratory partners to figure out ways to offer baseline testing and implement surveillance testing prior to national ltcf testing recommendations took effect we also worked closely with the hospital preparedness and public health preparedness programs hpp using data from the national healthcare safety network nhsn to address ppe and other supply shortages in ltcfs each week the hpp coordinator submitted the state ltcf integrated red report which we used to reach out to facilities reporting ppe and staffing shortages during this outreach we reminded facilities of the staffing and ppe resources available through the state and communicated information on how to obtain these resources one of the biggest contributing factors to the success of our response was the additional funding from cdc which led to the growth of our hai program we were able to expand our hai program team to four infection preventionists who now consult with facilities perform infection control assessments and provide direct support and assistance to facilities the additional funding has also allowed us to expand the services we offer to facilities as a rural state we have more critical access hospitals so our infection prevention activities have focused on providing one on one support to these facilities which typically have limited staff who are stretched across multiple roles during the pandemic we were able to expand these services to ltcfs and assisted living facilities and have hopes to expand to other types of congregate living settings including outpatient health clinics dialysis centers schools and jails our experience during this pandemic has highlighted the importance of infection control we have learned that infection control is a responsibility and duty of everyone in the facility and this facility wide approach to infection prevention can contribute to a successful outcome we also recognize the importance of inter and intra facility communication as well as communicating information to residents and family members to prevent the spread of infections and outbreaks we were met with challenges every day but because of our hard working and dedicated infection preventionists we were able to overcome a lot of them it has also been inspiring to work with our amazing healthcare workers and public health staff during the response we have a lot of work in front us but i remain excited because this experience has been the catalyst for us to enhance our infection prevention activities expand our reach and support and provide guidance and education on infection prevention standards erika baldry healthcare associated infections and antimicrobial resistance hai ar epidemiologist and program coordinator at the montana department of public health and human services dphhs 