AcknowledgmentsContent leads for the preparation of this document were as follows: Show
Deb Patterson Burdsall, M.S.N., R.N.-B.C., CIC Steven J. Schweon, R.N., M.P.H., M.S.N., CIC, HEM, FSHEA Sue Collier,
M.S.N., R.N., FABC This project was funded under contract number HHSA290201000025I, task order 8, from the Agency for Healthcare Research and Quality (AHRQ). Disclaimer: AHRQ and its contractor, Health Research & Educational Trust, have made a good faith effort to take all reasonable measures to ensure that this product is accurate, up to date, and free of error in accord with clinical standards accepted at the time of publication. Any practice described in this product must be applied by health care practitioners in accordance with professional judgment and standards of care in regard to the unique circumstances that may apply in each situation they encounter. AHRQ and HRET are not responsible for any adverse consequences arising from independent application by individual professionals of the content of this product to particular patient circumstances encountered in their practices. This document may be used and reprinted without permission except those copyrighted materials that are clearly noted in the document. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. None of the contributors have any affiliations or financial involvement that conflicts with the material presented in this document. How To Use This GuideThis guide is divided into four sections, some of which have multiple subsections. Each section and subsection is arranged into four categories: Key Messages are high-level takeaways for each topic. Basic Background provides general information about each topic. It is designed to give simple "what" and "why" know-how. Practice Tips are actions to take to reduce the risk of infections in long-term care (LTC) facilities. Communication Tips offer ways to talk with residents, families, coworkers, and others about infection prevention. ContentsIntroduction IntroductionIn the United States alone, more than 15,000 long-term care (LTC) facilities serve more than 1 million residents. The residents and staff in LTC facilities have an increased risk of infection due to the unique challenges in the care setting and the resident population. Health care-associated infections account for as many as 380,000 deaths annually.1 Additionally, infections increase health care costs and may result in hospitalization.2 For these reasons, all staff in LTC facilities must work together to reduce infections and provide safe care for residents and a safe work environment for staff. In 2013, the Association for Professionals in Infection Control and Epidemiology published a comprehensive book on infection prevention and control titled Infection Preventionist's Guide to Long-Term Care. The book provides information on specific practices and procedures in LTC facilities that improve infection prevention and promote resident safety. A Unit Guide to Infection Prevention for Long-Term Care Staff is designed to provide LTC staff with basic knowledge about LTC facility infection prevention guidelines. The guide is meant to provide infection prevention information to frontline staff, and was developed using materials from the Infection Preventionist's Guide to Long-Term Care and other sources. The guide covers four key areas:
Each topic area includes a summary of key messages, background information, practice tips, and communication tips. The guide can be made available to staff by hard copy or digitally. The practical and user-friendly approach to this content is intended to help frontline staff develop the skills, knowledge, and confidence to be active team members in LTC facility infection prevention efforts, and to engage residents and family members in infection prevention. The guide also can be used as a resource to promote teamwork and communication within a culture of safety. Together, all LTC facility team members—residents, family, and staff—can improve quality and prevent infections! Return to the Contents I. Infections and Infection Prevention in Long-Term CareInfections in Long-Term CareKey Messages
What is an HAI? A healthcare-associated infection (HAI) is an infection that a resident can get when in an LTC facility, a hospital, or another place where people go for health care. What is Colonization? Sometimes residents have germs inside them but they don't get sick. When this happens, it's called colonization. If a resident is colonized, that resident could still spread the germs to other people. Aging and Infections As residents age, they can become more vulnerable to infections due to changes in their bodies such as—
Poor nutrition and hygiene, some medications, and intravenous fluids and catheters can make residents more vulnerable to infection. Basic Background How Do Infections Occur? Germs are tiny organisms that are capable of causing an infection once they enter the body. Germs include—
Germs are present on our skin and within our bodies. In addition, germs can be found in the air, on surfaces in the environment, and sometimes in food and water. They can enter a person's body through mucus membranes such as the nose, eyes, or mouth, as well as through breaks in the skin, or via a catheter. Some examples of infections from bacteria include urinary tract infections, skin infections, and wound infections. Examples of infections from viruses include the common cold, influenza, some illnesses involving diarrhea, and some types of pneumonia. Fungi can cause skin and nail infections, as well as other types of infections, especially in people with weakened immune systems. LTC Infection Types The most common types of infection in LTC facilities involve the—
How Do Infections Spread? Germs can be found on the hands or gloves of health care workers, on surfaces in the facility, and on medical equipment. If these are not properly cleaned and disinfected, the germs may spread to other people and the environment. In healthy individuals, the immune system fights off germs and prevents infection. Older people, due to the declining ability of their immune systems to resist germs, are more susceptible to infection and can become infected more easily. Germs can also move from person to person. Residents, family members, visitors, and staff may unknowingly spread germs to others by—
Practice Tips
Communication Tips
SIGN of Infection A sign of infection is what you can observe (for example what you can see, hear, feel, or measure). Signs may include—
SYMPTOM of Infection A symptom of infection is what the resident tells you he or she is experiencing. Symptoms include—
Infection Prevention and Control in Long-Term CareKey Messages
Basic Background Every LTC facility has policies and procedures to prevent infection and keep residents safe. Infection prevention and control practices help residents avoid getting infections from health care workers, other residents, family members, and visitors. These practices can also help prevent health care workers from getting infections from residents. It's important that health care workers are familiar with these policies and procedures and follow them closely to reduce the risk of infection. Residents also can play an active role in maintaining their health and preventing infection. Practice Tips Health care workers can reduce the risk of infection by—
Help residents play a role in reducing risk of infection by encouraging them to—
Communication Tips
Multidrug-Resistant OrganismsKey Messages
Basic Background Multidrug-resistant organisms are bacteria and other germs that have developed a resistance to antibiotics and certain other drugs. Examples of MDROs include—
Many residents of LTC facilities are at risk of acquiring an MDRO because they are less healthy due to aging or chronic illness. Other risk factors include the use of intravenous catheters (IVs) or other catheters, treatment with multiple antibiotics, and long hospitalizations. Practice Tips
Communication Tips
II. Standard Precautions: Infection Prevention BasicsKey Messages
Basic Background Standard precautions are basic steps that every health care worker should take to prevent the spread of germs. Standard precautions include keeping hands clean, not touching the face, covering coughs in sleeves, and using safety needles and sharps. Practice Tips
Communication Tips
Return to the Contents Specific Standard PrecautionsHand HygieneKey Messages
Basic Background Hand hygiene refers to the practice of removing or killing germs on hands so that the germs do not spread to other people or to surfaces. Keeping your hands clean is the most important thing that can be done to prevent infections. To practice hand hygiene, keep your hands clean by either washing with soap and water or using an alcohol-based hand sanitizer. Change gloves frequently, and perform hand hygiene each time gloves are changed as dirty gloves can spread germs, too. Also, do not wear the same pair of gloves for more than one resident. Practice Tips
Communication Tips
Environmental Cleaning and DisinfectionKey Messages
Basic Background Cleaning typically refers to physically removing soil and dirt. Disinfecting and sanitizing, however, is removing or killing the germs that can cause disease. Surfaces in a room or equipment can harbor these germs. All surfaces and equipment must be routinely cleaned and disinfected, including between use on each resident, to prevent the spread of germs and diseases. This includes cleaning and disinfecting high-touch areas, including—
When cleaning, consider the contact time for the product. Contact time is the length of time a disinfectant needs to remain wet on a surface to be effective. Practice Tips
Communication Tips
Personal Protective EquipmentKey Messages
Basic Background Personal protective equipment protects you from contact with blood, body fluids, and other potentially infectious materials that may contain germs that can cause infection. PPE is used to protect both staff and residents. Examples of PPE include—
The Occupational Safety and Health Administration (OSHA) requires that all health care facilities provide PPE for all staff who may come into contact with blood and body fluids in the course of their jobs. Practice Tips
Communication Tips
Resident PlacementKey Messages
Basic Background When a resident is colonized or infected with germs that may be spread to other residents, it may be necessary to move the resident or his/her roommate to another room in order to reduce the chance of spreading the germs to the roommate. The goal in LTC facilities should be to place residents in rooms with the lowest risk of infection-spreading germs. Private rooms are the best way to do this. If there are no private rooms, the next best option is to cohort residents, i.e., group residents together if they have the same germ. When cohorting is not possible, place infected residents with residents who are at low risk. Both the resident and the resident's care team and family should be involved in resident moves. Practice Tips
Communication Tips
Respiratory Hygiene and EtiquetteKey Messages
Basic Background Respiratory illnesses, including pneumonia, are a major cause of outbreaks in LTC facilities. While a virus can cause a cold for a staff member, it can develop into a serious illness for an older adult. Respiratory illnesses often result in hospital stays—and sometimes even death. Practice Tips
Communication Tips
Safe Injection PracticesKey Messages
Basic Background Unsafe injection practices can lead to infections and even disease outbreaks. The following are unsafe practices and should never be done:
OSHA requires that all sharps used by staff be safety engineered. Practice Tips
Communication Tips
Soiled LinenKey Messages
Basic Background Soiled or improperly cleaned or disinfected linens can spread germs. As a result, it's critical that they be regularly cleaned. Practice Tips
Communication Tips
Return to the Contents III. Transmission-Based Precautions and Outbreak ManagementTransmission-Based Precautions (General)Key Messages There are three mechanisms of infection transmission:
Basic Background Transmission-based precautions are special safeguards, such as isolating residents, that should be used when residents have infections caused by germs that are resistant to antibiotics or may cause outbreaks at the LTC facility. The Centers for Disease Control and Prevention has specific directions about what types of isolation are to be used for specific germs3,4. LTC facilities should also check their State's regulations to see if the State health department has any additional requirements. Practice Tips
Communication Tips
Return to the Contents Specific Transmission-Based PrecautionsContact PrecautionsKey Messages
Basic Background Contact precautions, such as wearing gloves and a gown, are special safeguards that staff must put in place when dealing with residents who are infected with germs that are easy to transmit through equipment or by touching other residents or staff. These germs include—
Practice Tips
Communication Tips
Droplet PrecautionsKey Messages
Basic Background Droplet precautions are special safeguards put in place when germs are spread by sneezing, coughing, or sometimes even talking. Examples of diseases that spread via large droplets include—
It is important to use droplet precautions to stop the spread of these diseases to other residents and staff. Practice Tips
Communication Tips
Airborne PrecautionsKey Messages
Basic Background Airborne precautions are safeguards, including special isolation rooms and fit-test respirators that help protect residents and staff from airborne germs. If an airborne infection isolation room is not available at the LTC facility, the patient should be promptly placed in a private room and asked to wear a mask while awaiting transfer.4 Airborne precautions are put in place when an infectious organism floats in the air and can be spread through the air. Diseases that are spread through the air include—
Practice Tips
Communication Tips
Return to the Contents Outbreak ManagementKey Messages
Basic Background An outbreak occurs when there are more cases of an infectious disease in a designated population than usually occur at a given time. LTC facilities are especially vulnerable to outbreaks because residents are generally older and many are in frail health. The two most common types of outbreaks in LTC facilities are—
A single case of influenza or an illness that causes nausea, vomiting, and diarrhea (such as norovirus) can quickly escalate into an outbreak. Contaminated hands, gloves, and medical equipment can spread disease across surfaces. Residents, such as those with dementia who wander and may have unhygienic hands or clothes, can also spread disease. Practice Tips
Communication Tips
Return to the Contents IV. Engaging Everyone in Infection Prevention and ControlKey Messages
Basic Background Everyone in an LTC facility has a role to play in infection prevention and control— including health care workers, residents, and their families. A team of staff must work together to improve resident safety outcomes and improve resident, family, and staff satisfaction. Good teamwork and good communication are crucial to preventing infection and building a culture of safety. Staff members should feel comfortable reporting safety concerns without fear of discipline. Harm to residents from infections can increase if staff members are reluctant to report lapses in infection prevention practices. Good teams and a culture of safety can reduce the chance of clinical errors, reduce staff turnover, and reduce concerns by residents and their families. Practice Tips
Communication Tips
Return to the Contents Antibiotic Use and ResistanceKey Messages
Basic Background When they are necessary, antibiotics can be lifesavers.5 But not every illness calls for antibiotics. Inappropriate use of antibiotics can cause health problems for the resident, including—
Inappropriate use and overuse of antibiotics can also lead to antibiotic-resistant organisms, which can threaten not only the resident but the entire community. An antibiotic stewardship program is a coordinated program that promotes the appropriate use of antibiotics. It can help to achieve optimal outcomes, reduce side effects, save money, and prevent the emergence of drug-resistant bacteria. Practice Tips
Communication Tips
Survey Readiness
Return to the Contents OSHA ComplianceKey Messages
Basic Background Most LTC facilities have a plan in place to address the OSHA-required bloodborne pathogen standard.6 This plan sets out work practices that must be followed. These work practices include—
Practice Tips
Communication Tips
Return to the Contents References1. U.S. Department of Health and Human Services. National Action Plan To Prevent Healthcare-Associated Infections: Road Map to Elimination. Chapter 8, Long-Term Care Facilities. April 2013. Accessed September 23, 2015. 2. Wagner LM, Roup BJ, Castle NG. Impact of infection preventionists on Centers for Medicare and Medicaid quality measures in Maryland nursing homes. Am J Infect Control. 2014 Jan;42(1):2-6. PMID: 24388467. 3. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006. Centers for Disease Control and Prevention. Accessed May 5, 2016. 4. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Centers for Disease Control and Prevention. Accessed May 5, 2016. 5. Get Smart: Know When Antibiotics Work. Centers for Disease Control and Prevention. Accessed November 19, 2015. 6. Bloodborne Pathogens. Occupational Safety and Health Administration. Accessed November 19, 2015. Which intervention would the nurse perform to prevent disease transmission?Hand Hygiene. Hand hygiene has been cited frequently as the single most important practice to reduce the transmission of infectious agents in healthcare settings 559, 712, 713 and is an essential element of Standard Precautions.
Which nursing action will be most helpful in preventing transmission of influenza in crowded communities?Use a face mask when sick and out in crowded community settings, and. Implement community measures to reduce exposure to pandemic flu (coordinating school closures, limiting face-to-face contact in workplaces, and postponing or canceling mass gatherings).
What are TransmissionUse STANDARD and DROPLET precautions for routine medical care of patients with confirmed or probable influenza, or influenza-like illness. Standard precautions include hand hygiene. When contact with body fluids is anticipated, a gown, gloves and eye protection should be worn.
Which strategy is most effective for preventing the transmission of infection?The most important way to reduce the spread of infections is hand washing - frequently wash hands with soap and water, if unavailable use alcohol-based hand sanitizer (containing at least 60% alcohol). Also important is to get a vaccine for those infections and viruses that have one, when available.
|