Validation of a comprehensive infection control program in ltc

Healthcare personnel in LTC facilities may have direct or indirect contact with older adults, persons with disabilities, and persons with chronic medical conditions receiving care. Studies have attributed influenza outbreaks in LTC facilities and hospitals to low influenza vaccination coverage among healthcare workers in those facilities.

During a confirmed flu outbreak in an LTCF, up to 1 in 3 residents and one in four staff develop flu-like illness. Preventing flu among healthcare personnel can help reduce the spread of flu in vulnerable LTC resident populations. The best way to prevent the flu is by getting a flu vaccine each year. Healthcare personnel should get their flu vaccinations by October if possible or soon after the flu vaccine becomes available. Since it takes about two weeks for antibodies to develop after being vaccinated, make sure your staff are vaccinated early in the flu season so that they are protected before flu becomes prevalent in the community and in LTC facilities.

Continued efforts are needed to ensure HCP are vaccinated early in the flu season. Vaccination coverage among certain healthcare personnel, especially those in LTCFs, and among assistants and aides and administrative and non-clinical support staff in all work set-tings needs the most improvement. There are a number of studies that show proven interventions to promote flu vaccination among healthcare personnel each season.

Some strategies that employers should use to reduce barriers to healthcare personnel vaccination include offering flu vaccination onsite over multiple days and shifts, free of charge, and with frequent and strong promotion.

This comprehensive toolkit includes a number of resources intended to help long-term care facility, agency, or corporation owners and administrators provide access to flu vaccination for their workforce and to help LTC employers understand the importance of flu vaccination for their employees. As we have seen, patient transfer can facilitate pathogen transmission. New recommendations from the CDC last September advise all nursing homes to improve antibiotic prescribing practices and reduce their inappropriate use to protect residents from the consequences of antibiotic-resistant infections, such as C.

Approximately 4. Antibiotics are the most frequently prescribed medications in nursing homes. Up to 70 percent of residents receive one or more courses of antibiotics during a year. Up to 75 percent of antibiotics prescribed in nursing homes are given incorrectly, meaning either the drug is unnecessary or the prescription is for the wrong drug, dose, or duration.

The Core Elements provide practical ways for nursing homes to initiate or expand antibiotic stewardship activities. The guide provides examples of how antibiotic use can be monitored and improved by nursing home leadership and staff. The companion checklist can be used to assess policies and practices already in place and to review progress in expanding stewardship activities on a regular basis.

However, depending on resources, some facilities may need more time to implement all these important protections. Ultimately, nursing home antibiotic stewardship activities should, at a minimum, include the following: 1. Leadership commitment: Demonstrate support and commitment to safe and appropriate antibiotic use. Accountability: Identify leaders who are responsible for promoting and overseeing antibiotic stewardship activities at the nursing home.

Drug expertise: Establish access to experts with experience or training in improving antibiotic use. Action: Take at least one new action to improve the way antibiotics are used in the facility. Tracking: Measure how antibiotics are used and the complications e. Reporting: Share information with healthcare providers and staff about how antibiotics are used in the facility.

Education: Provide resources to healthcare providers, nursing staff, residents and families to learn about antibiotic resistance and opportunities for improving antibiotic use. This could lead to better recoveries from infections and ultimately improve health outcomes for all residents. As we have seen, CMS proposed a rule that would require long-term care facilities to incorporate an antibiotic stewardship program, including antibiotic use protocols and antibiotic monitoring, into their infection prevention and control program.

According to CMS, these requirements will decrease unnecessary or inappropriate antibiotic use by ensuring that residents who need antibiotics are prescribed the right drug at the right dose for the right duration.

As part of the plan, within three years CDC will provide technical assistance to federal facilities e. Resources and Tools In , the Centers for Disease Control and Prevention CDC launched a new website with infection prevention resources for long-term care settings such as nursing homes and assisted living. This site organizes existing infection prevention guidance and resources into sections for clinical staff, infection prevention coordinators, and residents.

Also in , the Joint Commission released an online educational tool designed to apply the principles of high reliability to reducing infections in long-term care settings.

It is a minute, easy-to-use and engaging e-learning tool that can be viewed all at once or in two parts, depending on the needs of the audience. It is free to anyone, not just Joint Commission customers, in online or CD formats.

The goal of the module is to introduce the principles of high reliability and show how they can have a significant impact on infection in long-term care settings. High-reliability solutions come from the study of industries such as commercial aviation and nuclear power that operate under hazardous conditions while maintaining exemplary safety records. Adapting and applying the lessons from these industries offers the promise of enabling healthcare organizations to reach levels of quality and safety that are comparable to those of the best high reliability organizations.

The learning module demonstrates these principles and directly connects them to typical situations in long-term care. It includes examples, quizzes, discussion questions and other resources so participants can ensure they are getting the maximum benefit from the module. It is best used by viewing in small groups and then discussing how the lessons learned apply to a particular care setting.

They cause pain, suffering and can even lead to death. This new education module can help long-term care organizations in their journey to achieve zero harm. The learning module is recommended for all staff levels of a long-term care facility-from the environmental services staff to the administrator -so the principles can be put into place throughout the entire organization.

Developed by a team of infection prevention experts, the book presents topic-specific information in a user-friendly format that includes numerous examples, visuals, checklists, and references to help increase the understanding of regulatory requirements, comprehensive infection prevention risk assessment and program development, surveillance and reporting, nursing assessment and interventions to prevent the most commonly occurring infections in long-term care, environmental cleaning and disinfection, unique long-term care issues such as care transitions and life enrichment activities, occupational health, immunization programs, and staff education, as well as disaster and pandemic preparedness.

Compared to an acute-care setting, long-term care can seem like a brave new world. If nursing assistants, nursing departments, and infection prevention and control programs are not supported, and if there are insufficient supplies, outbreaks of infectious diseases can be well established before nurses or primary care providers are aware they exist.

For infection preventionists crossing from acute-care into long-term care, there are some principles and practices that are universal, says Steven J. Schweon says that as someone who has transitioned from acute-care to long-term care, there are several key points to continually keep in mind: - Many of the residents have multiple co-morbidities such as diabetes, functional decline, altered sensorium, failure to thrive, incontinence, and obesity, which may be challenging to control and also increases their infection risk.

Staff turnover may be higher when compared to acute care. IPs going into long-term care must be aware of the characteristics of these residents, as Burdsall points out that, "With an average age of 80 years, older adult residents generally live in LTCFs because of a self-care deficit or a medical condition that requires constant and consistent support. Residents require assistance ranging from cues and reminders to total dependence and are more likely than those who are living independently to have conditions such as: Increased frailty, dementia, decreased immune function, decreased skin integrity and wounds, problems with nutrition, chewing, and swallowing, issues with incontinence, decreased bowel and bladder function, and decreased mobility.

Burdsall advises that IPs, as well as all healthcare personnel working in long-term care, provide a "person-centered approach to maintain health and avoid preventable infection.

The population of individuals over age 85 is expected to grow to 7. When these elements are present and practiced consistently, the risk of infection among patients and healthcare personnel is reduced. The Infection Control Assessment Tools were developed by CDC to assist health departments in assessing infection prevention practices and guide quality improvement activities e.

These tools may also be used by healthcare facilities to conduct internal quality improvement audits. While the same infection prevention elements are included in both the checklist and assessment tool, the facility demographics sections differ slightly.

The assessment tool is intended for health department use whereas the checklist is intended primarily for healthcare facility use. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Section Navigation. Facebook Twitter LinkedIn Syndicate. When private rooms are not available— Residents infected or colonized with the same germ can be placed together.

If that is not possible, place infected residents with low-risk residents. Practice Tips Consider how long residents have been roommates before deciding to move a resident with an infection or colonization. If they have been together for a long time, changing rooms may not be necessary as the roommate may already be colonized. Treat all resident secretions and excretions as potentially infectious. Have the infectious resident shower last when using a common shower room, and always disinfect the shower room after use.

A resident with an MDRO should not be moved to a room with a resident who is dependent on staff for activities of daily living.

A resident with an MDRO should not be moved into a room with a resident who has a urinary catheter, an IV catheter, or an open wound. Communication Tips Explain to the resident why he or she is being moved into isolation.

Communicate the reason for resident placement in a different room or location. Ensure that the plan of care is documented on the daily assignment sheet and that all staff are aware of the care plan. Respiratory Hygiene and Etiquette Key Messages Everyone needs to watch for and report respiratory illness. Vaccinations are an important tool for preventing respiratory illnesses such as influenza and pneumococcal pneumonia. Staff should stay home if they are sick.

Staff should go home if they develop respiratory symptoms while working. A virus can cause a cold for a staff member but may develop into a serious illness for an older adult.

Visitors, families, and staff can be a source of respiratory illness outbreaks. Cover coughs, and wear a mask if recovering from an illness. Educate residents and visitors to cover their mouths and noses with a tissue or if not available, upper sleeve when coughing or sneezing.

Residents should stay in their rooms if they develop a new cough with fever or other symptoms of a respiratory infection. Basic Background Respiratory illnesses, including pneumonia, are a major cause of outbreaks in LTC facilities. Practice Tips Pay attention to coughing and sneezing residents, family members, visitors, and staff.

Always cover your mouth and nose with your sleeve or a tissue when coughing or sneezing and then perform hand hygiene. Make sure infected residents wear a mask whenever they leave their rooms. Communication Tips Contact the supervisor about coughing and sneezing by family members, visitors, or staff. Ask the facility to post signs urging the use of hand hygiene and masks, and place masks and hand sanitizer at entrances, during community outbreaks and flu season.

Posted signs can also help educate residents and visitors about covering coughs and sneezes. Suggest that the facility send letters to family members explaining why visiting when they are sick puts residents at risk. This can be done with needle guards and automatic retraction devices, or with safety engineered sharps, such as nonremovable needles and syringes with fixed doses.

While residents may have their own equipment for their own personal use, health care workers cannot use residents' equipment. Basic Background Unsafe injection practices can lead to infections and even disease outbreaks. The following are unsafe practices and should never be done : Reusing single-use syringes and needles Using contaminated multiuse vials and IV solutions Improperly cleaning and disinfecting multiple-use equipment Failing to follow basic safe injection practices OSHA requires that all sharps used by staff be safety engineered.

Practice Tips Use proper technique to avoid contaminating sterile syringes and other sharps. Practice "one resident, one needle, one time. Do not share insulin pens between residents. Whenever possible, do not share blood glucose meters. If a blood glucose meter is used for multiple residents, make sure to clean and disinfect the device after every use. Promptly dispose of used syringes and other sharps.

Have sharps containers available at the point of care. Talk to your supervisor if you are unsure if a device is safety engineered or correct for use. Communication Tips Ask for training on the difference between safety-engineered devices and nonsafety sharps.

Ask for training on how to engage the safety device before using a sharp. Explain to residents and family members that staff must use only sharps provided by the facility. Soiled Linen Key Messages Treat all soiled linen as potentially infectious. Linen must be processed in a way that not only kills germs but also does not spread germs from dirty to clean linens. Heat and chemical disinfection are two methods used to kill germs in laundry.

Use one color of bag for soiled linen and a different-colored bag for trash. Don't put linens in red biohazard bags unless they are soaked with blood and are being discarded in a biohazard bin. Basic Background Soiled or improperly cleaned or disinfected linens can spread germs. Practice Tips Make sure that there are enough linen bags close to points of care. Keep clean linen separate from soiled linen. Transport all clean linen in covered clean carts. Hold soiled linen away from your clothing when you are changing and carrying linens.

Minimize handling and agitation of soiled linen e. Make sure the soiled linen is properly handled from the point of collection to the laundry. Communication Tips Ask your supervisor for training on how to properly change and handle dirty or contaminated linen. Return to the Contents III. Airborne Small respiratory particles that stay suspended in the air. Contact, droplet, and airborne precautions are used in addition to standard precautions.

Adopt a person-centered approach to practicing transmission-based precautions: "Only when necessary for only as long as necessary. Practice Tips Use transmission-based precautions if unsure what is causing an infection, until the germ is identified. Use transmission-based precautions, and discontinue when no longer needed, based on evidence-based best practices and facility policy.

Do not over-isolate residents. Consider transmission-based precautions on a case-by-case basis as an indicator to "gown and glove up" when providing direct personal care. For example— If the resident cannot maintain clean hands, clean clothes, and clean equipment. If the resident is colonized with a germ that is highly resistant. If the resident is new to the LTC facility.

Consider the type of germ and other factors for example, if there are no longer signs or symptoms of an infection, antibiotic therapy is completed, and wound is healed before shifting to standard precautions. Communication Tips Provide the resident and family with information about the organism causing the infection. Explain to the resident and family why the resident is being put into isolation.

Talk to the lab or clinical supervisor about questions concerning culture results. Return to the Contents Specific Transmission-Based Precautions Contact Precautions Key Messages Use contact precautions to prevent the spread of germs by direct or indirect contact with residents or their environments.

Contact precautions are special safeguards that must be put in place when dealing with residents who are infected with certain germs.

Adopt a person-centered approach: "Only when necessary for only as long as necessary. Wear gloves and a gown when entering residents' rooms and remove them when leaving the rooms. Make sure any shared equipment is cleaned and disinfected before and after use. Make sure that wounds are covered. Contain any urine, stool, or wound drainage. For residents who are on contact precautions, consider their taking part in social activities as long as they do not have open wounds or diarrhea, have contained drainage, and are able to keep their hands, clothes, and equipment clean.

Make sure the reason for the contact precautions is documented on the care plan and assignment sheets and shared with all staff.

Collaborate with the lab, prescribers, and public health officials when there are increased infections with the same germ and additional guidance is needed. Droplet Precautions Key Messages Droplet precautions are used against influenza also known as the flu. Wear a mask in addition to using standard precautions.

Residents on droplet precautions should stay in their rooms. If a resident on droplet precautions has to leave his or her room, the resident must wear a mask.

Consider using both droplet and contact precautions if the respiratory virus causing the illness is unknown or if the resident has nausea, vomiting, or diarrhea. 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— Some bacterial infections such as Streptococcus infection Some viral infections such as influenza It is important to use droplet precautions to stop the spread of these diseases to other residents and staff.

Practice Tips Wash hands for at least 20 seconds with either soap and water or use an alcohol-based hand rub before entering and after leaving residents' rooms. Wear a mask. Communication Tips Explain to the resident and the family why the resident is on droplet precautions and must stay in the room.

Talk with the resident about options for in-room therapy and other activities. Make sure the reason for the droplet precautions is documented on the care plan and assignment sheets and communicated to all staff.

Airborne Precautions Key Messages Airborne precautions are used for diseases such as tuberculosis and chicken pox. Airborne precautions are rarely used in LTC facilities.

An LTC facility must have negative pressure rooms and a respiratory fit-test program in order to safely maintain airborne precautions. Basic Background Airborne precautions are safeguards, including special isolation rooms and fit-test respirators that help protect residents and staff from airborne germs. Diseases that are spread through the air include— Tuberculosis Measles Chicken pox Disseminated shingles Practice Tips Enter the room only when absolutely necessary.

Wash hands for at least 20 seconds with soap and water or use an alcohol-based hand rub before entering and after leaving the room. Wear respiratory protection such as an N95 respirator , or if not available, a surgical mask, according to facility policy. Keep the resident in the room, with the door closed, when waiting to transfer the resident from the LTC facility to a hospital or other facility that can maintain airborne precautions.

Instruct the resident to cover his or her mouth and nose with a tissue when coughing, and to place the soiled tissues into the regular trash can. Make sure the resident wears a surgical mask while awaiting transfer and during transfer.

Create a list of all staff, residents, family members, and visitors who have had close contact with the infected resident. Communication Tips Explain to the resident and family why the resident is in airborne isolation and needs to be transferred. Make sure the reason for the transfer is documented on the care plan and assignment sheets.

Keep the environment and equipment clean and disinfected. Make sure there are disinfectants at the point of care. 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. The two most common types of outbreaks in LTC facilities are— Respiratory infections Gastrointestinal diseases A single case of influenza or an illness that causes nausea, vomiting, and diarrhea such as norovirus can quickly escalate into an outbreak.

Practice Tips Consider implementing both droplet and contact precautions if the facility does not know the cause of a cluster of similar illnesses. Report any new respiratory or gastrointestinal symptoms, especially if a fever develops. Work with the clinical supervisor to identify similar symptoms among those who are sick. Staff should stay home, or go home, if they have a respiratory illness or nausea, vomiting, or diarrhea.

Communication Tips Remind coworkers, residents, and family members to report any new respiratory symptoms. Remind coworkers, residents, and family members to immediately report any symptoms of nausea, vomiting, or diarrhea.

Return to the Contents IV. Engaging Everyone in Infection Prevention and Control Key Messages Good infection prevention practices, including hand hygiene, respiratory hygiene, safe injection practices, and appropriate antibiotic use, contribute to a safe facility for residents and a safe workplace for staff. Everybody who works in the facility needs to work together to practice infection prevention to prevent harm and increase resident safety.

Residents and family members play a role in increasing resident safety by practicing infection prevention themselves, and in supporting the health care team in prevention practices. 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.

Practice Tips Ensure all team members, including the resident and family, have a clear understanding of the resident's goals. Encourage coworkers to raise questions and concerns in a nonhostile manner and without fear of retribution. Provide helpful feedback to other staff. Communication Tips Ask your supervisor how to help make resident care safer. Share ideas with your supervisor for making resident care safer. Seek feedback from the resident and family members about any potential safety concerns or problems.

Return to the Contents Antibiotic Use and Resistance Key Messages Antibiotics are medications that can save lives when used appropriately. Used incorrectly, antibiotics can lead to antibiotic-resistant infections. Residents should take all medications, including antibiotics, exactly as they are prescribed.

Basic Background When they are necessary, antibiotics can be lifesavers. Inappropriate use of antibiotics can cause health problems for the resident, including— Nausea Diarrhea Allergic reactions Antibiotic-related infection C. Practice Tips Learn about the appropriate use of antibiotics.

Antibiotics are not helpful when— Used to treat an infection that is caused by a virus such as a cold or the flu. Used for a medical problem that is not an infection. No signs or symptoms of a urinary tract infection are present but bacteria are found in the urine. Communication Tips Be alert for the side effects of antibiotics and inform the supervisor if they appear. Share any concerns about the antibiotic with the supervisor.

Survey Readiness Health care workers strive daily to provide the best care to residents. Regulatory agencies, such as State departments of health, survey LTC facilities to ensure that the highest level of care is being provided. Survey teams monitor compliance with Federal and State health care regulations.

Facility policies and procedures based on State and Federal regulations and evidence-based practices will support survey readiness. Surveys are generally not scheduled in advance, so it's important to always be prepared. Every facility has a quality assurance performance improvement plan in place to proactively improve the care of all residents and to support survey readiness.

The facility is required to have safeguards in place to prevent health care workers from being hurt or injured on the job, including from infections and infectious diseases.