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Focus On...Infection Control

May 1, 2006
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The Changing Role of Infection-Control Programs in Long-Term Care Management by Linda L. Spaulding, RN, C; CIC
focuson Infection Control

The changing role of infection-control programs in long-term care management

Linda L. Spaulding, RN, C; CIC, explains how a well-run infection-control program can benefit long-term care Nosocomial infections are the major source of morbidity and mortality in long-term care facilities.1 Over the past two decades, the prevalence of infection in long-term care settings has been documented between 5.4 and 32.7 per 100 residents per month, and infection incidence rates have been documented between 1.5 and 9.4 per 1,000 resident days.2,3-8 An estimated 1.5 million infections occur annually in long-term care facilities in the United States.9 Facility-acquired infections account for 30% of all hospital admissions from nursing homes10 and are the most common immediate cause of death in nursing home residents.11

The increasing incidence of new drug-resistant microorganisms such as Clostridium difficile, Streptococcus pneumoniae (pneumococcal pneumonia), methicillin-resistant staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum beta-lactamases (ESBLs) requires well-developed infection-control programs. In addition, the hospital payment system is causing a shift of sick and terminally ill patients to be moved from the hospital setting to nursing homes, with a subsequent increase in nursing home deaths. Therefore, infection-control practitioners (ICPs) are no longer only an option, but a necessity.

Facilities must have a program for detecting, preventing, controlling, and reporting infections. An infection-control program should address areas such as food handling, laundry, waste disposal, employee health, pest control, visitation, asepsis, quality control, and safety. This would include the development of policies and procedures for such things as isolation and handwashing. The key element of an infection-control program includes a well-trained ICP who is knowledgeable in basic microbiology and familiar with resident care problems. Because of the decreased availability of physicians in nursing homes and the fact that the elderly tend to have many underlying chronic diseases that increase their risk for infection, the ICP has greater responsibility for the diagnosis and prevention of infections.

Components of an effective infection-control program include surveillance, outbreak investigation, education, policies and procedures, an employee health program, a resident health program, environmental control, antibiotic monitoring, a performance improvement program, and cost containment. Each component is explained as follows:

Surveillance. Surveillance consists of collecting and evaluating data. The ICP must be able to differentiate between infection and colonization. Knowing a facility's baseline infection rates will help the ICP identify an outbreak situation early. While the ICP is performing surveillance duties, it is a great time to provide education to other staff members to assist in keeping the infection rates low. Surveillance can also be used to monitor the progress of an individual resident who has an infection and assist in the development of education programs.

Outbreak investigation. A key component of surveillance is the ability to identify outbreak situations. Early detection is the best way to limit the number of residents who will become infected and, at the same time, decrease the cost of the outbreak.

Education. Ongoing changes in federal and state infection-control regulations and guidelines require continuous staff education by the ICP. New employees must understand their role in preventing infection, as well as how they can avoid transmitting infections to residents. Education must include handwashing, standard precautions, immunizations, review of policies and procedures, aseptic practices, the facility's isolation procedures, and the importance of maintaining good personal hygiene.

Policies and procedures. A facility's policies and procedures must be continuously updated to reflect changes in regulations and guidelines, as well as changes in facility practices. Policies and procedures should cover all areas of the facility, including employee health, isolation, disinfection/sterilization, laundry, housekeeping, dietary services, engineering, waste disposal, resident visitations and, most importantly, handwashing. These policies should be readily available to all staff.

Employee health program. An active employee health program can accomplish two things. First, it will prevent employees from spreading infections to the residents; and second, it will prevent employees from contracting an infection while at work. Elements of an effective employee health program include: screening new employees for infectious diseases, educating employees about their role in transmission of nosocomial infections, updating employee immunization, periodically screening for infectious diseases (such as tuberculosis), ensuring employee safety from bloodborne pathogens (standard precautions), and investigating employees as potential agents for the spread of infectious disease during outbreaks.

Resident health program. A resident health program is aimed at issues such as resident hygiene, skin care, Foley catheter care, aspiration prevention, TB screening, and immunization for pneumococcal pneumonia and influenza.