Talking Points to Reviewing Infection Control Home Health Care

Acknowledgments

Content leads for the preparation of this document were as follows:

Deb Patterson Burdsall, G.S.Due north., R.N.-B.C., CIC
Infection Preventionist
Lutheran Home/Lutheran Life Communities
Arlington Heights, IL

Steven J. Schweon, R.N., M.P.H., M.S.N., CIC, HEM, FSHEA
Infection Prevention Consultant
Saylorsburg, PA

Sue Collier, M.South.N., R.N., FABC
Clinical Content Development Atomic number 82
Health Research & Educational Trust
American Hospital Clan
Chicago, IL

This project was funded under contract number HHSA290201000025I, task lodge 8, from the Agency for Healthcare Enquiry and Quality (AHRQ).

Disclaimer: AHRQ and its contractor, Health Inquiry & Educational Trust, accept made a good faith effort to take all reasonable measures to ensure that this product is accurate, upwards to date, and free of mistake in accordance with clinical standards accepted at the time of publication. Whatsoever 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 past individual professionals of the content of this production to item patient circumstances encountered in their practices.

This certificate 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 Guide

This guide is divided into four sections, some of which accept multiple subsections. Each department and subsection is arranged into 4 categories:

Key Letters are high-level takeaways for each topic.

Basic Groundwork provides general information about each topic. Information technology is designed to requite simple "what" and "why" know-how.

Practise Tips are deportment to take to reduce the take a chance of infections in long-term intendance (LTC) facilities.

Communication Tips offer ways to talk with residents, families, coworkers, and others virtually infection prevention.

Contents

Introduction
I. Infections and Infection Prevention in Long-Term Care
Infections in Long-Term Intendance
Infection Prevention and Control in Long-Term Care
Multidrug-Resistant Organisms
Two. Standard Precautions: Infection Prevention Nuts
Specific Standard Precautions
Hand Hygiene
Ecology Cleaning and Disinfection
Personal Protective Equipment
Resident Placement
Respiratory Hygiene and Etiquette
Safe Injection Practices
Soiled Linen
III. Transmission-Based Precautions and Outbreak Management
Transmission-Based Precautions (General)
Specific Transmission-Based Precautions
Contact Precautions
Droplet Precautions
Airborne Precautions
Outbreak Direction
Iv. Engaging Anybody in Infection Prevention and Control
Antibiotic Use and Resistance
OSHA Compliance
References

Introduction

In the Us alone, more than fifteen,000 long-term care (LTC) facilities serve more than 1 million residents. The residents and staff in LTC facilities have an increased chance of infection due to the unique challenges in the intendance setting and the resident population. Health intendance-associated infections business relationship for every bit many every bit 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 rubber piece of work surround for staff.

In 2013, the Clan 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 volume provides data 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 cognition most 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 4 key areas:

• An overview of infections and infection prevention in LTC facilities.
• A review of standard precautions and infection prevention basics.
• Ways to implement transmission-based precautions and outbreak management.
• Ways to appoint all team members in infection prevention and control.

Each topic area includes a summary of fundamental letters, background data, practice tips, and advice tips. The guide can be fabricated available to staff past hard copy or digitally.

The practical and user-friendly approach to this content is intended to assistance frontline staff develop the skills, cognition, and conviction to be active squad 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 inside a civilisation of safe.

Together, all LTC facility team members—residents, family, and staff—can improve quality and foreclose infections!

Return to the Contents

I. Infections and Infection Prevention in Long-Term Care

Infections in Long-Term Care

Key Messages

• The aging process affects multiple organs and systems, causing a decline in overall health and the power to fight infection.
• People who live or work together, such as in an LTC facility, are more probable to share germs.
• Infections cause pain, injury, disability, and sometimes even death, and tin can be very expensive to treat.
• Residents and staff may be afraid of catching an infection when they stay or work in an LTC facility.
• Many infections can exist prevented with basic infection prevention and control steps, such as hand hygiene and vaccination.

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 accept germs inside them simply they don't get sick. When this happens, it'southward called colonization. If a resident is colonized, that resident could still spread the germs to other people.

Aging and Infections

As residents age, they tin can get more vulnerable to infections due to changes in their bodies such as—

• Breaks in the skin.
• Wounds.
• Problem chewing, swallowing, and drinking.
• Difficulty moving.
• Loss of bladder and bowel control.
• Mental status changes/impairments.
• Medical conditions such as lung illness and diabetes.
• Disability to make clean their hands or take a deep jiff when asked.

Poor nutrition and hygiene, some medications, and intravenous fluids and catheters tin brand residents more vulnerable to infection.

Basic Background

How Exercise Infections Occur?

Germs are tiny organisms that are capable of causing an infection once they enter the trunk. Germs include—

• Leaner
• Viruses
• Molds
• Fungi

Germs are present on our skin and inside our bodies. In add-on, germs can be plant in the air, on surfaces in the environment, and sometimes in nutrient and water. They tin can enter a person'south torso 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, peel infections, and wound infections. Examples of infections from viruses include the cold, influenza, some illnesses involving diarrhea, and some types of pneumonia. Fungi can cause pare and nail infections, besides as other types of infections, especially in people with weakened immune systems.

LTC Infection Types

The well-nigh common types of infection in LTC facilities involve the—

• Urinary tract.
• Lungs.
• Skin and soft tissue.
• Gastrointestinal organisation.

How Do Infections Spread?

Germs tin can be found on the hands or gloves of health intendance 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 environs. 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 tin can become infected more easily.

Germs can too motility from person to person. Residents, family members, visitors, and staff may unknowingly spread germs to others past—

• Coughing and sneezing germs into the air.
• Touching other people or surfaces with hands that may be carrying germs.
• Touching body fluids and secretions that may contain germs.

Practice Tips

• Expect for signs and symptoms of infection.
• Ask the resident how he or she is feeling.
• As y'all work with a resident, you will become more than familiar with what is and isn't normal for that resident.
• Promptly report any signs of an infection to the clinical supervisor.

Advice Tips

• If yous run into signs of an infection, talk over them with the resident.
• Tell the resident that you are seeking additional assist from your clinical supervisor.
• Carefully document vital signs and all observations per facility policy, and report to your supervisor correct away.
• Tell your charge nurse or supervisor about—
  • New signs or symptoms of infection
  • Changes in vital signs, such as—
    • Increased temperature
    • Changes in respiration or pulse rate
    • Changes in blood pressure (too high or too depression)
• Loose stools or diarrhea
• Blood in the urine
• Resident complaining of pain/burning when urinating, or increased frequency or incontinence

SIGN of Infection

A sign of infection is what y'all can detect (for example what you tin can see, hear, feel, or mensurate). Signs may include—

• Coughing
• Congestion
• Vomiting
• Diarrhea
• Pus
• Rash
• Redness
• Swelling
• Change in mental status

SYMPTOM of Infection

A symptom of infection is what the resident tells you lot he or she is experiencing.

Symptoms include—

• Nausea
• Pain
• Feeling feverish
• Burning when urinating

Infection Prevention and Command in Long-Term Care

Cardinal Messages

• Intermission the chain of infection.
• Observe, diagnose, and treat infections rapidly and finer.
• Do non blitz to utilise antibiotics.
• Carefully follow facility policies and procedures to foreclose infections.

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 intendance workers, other residents, family members, and visitors. These practices can also assist preclude health care workers from getting infections from residents. Information technology's important that health intendance workers are familiar with these policies and procedures and follow them closely to reduce the risk of infection. Residents also can play an active office in maintaining their health and preventing infection.

Practice Tips

Health care workers tin can reduce the risk of infection by—

• Cleaning hands with an alcohol-based paw rub or soap and water, as well known every bit practicing hand hygiene.
• Wearing gloves and other personal protective equipment per facility policy.
• Keeping the environment clean and properly disinfecting surfaces and medical equipment.
• Handling waste safely.
• Avoiding touching your face.
• Covering mouths and noses when sneezing or coughing.
• Non coming to work when sick.
• Staying up to engagement on all recommended vaccinations.
• Practicing standard precautions for all residents.

Help residents play a role in reducing risk of infection by encouraging them to—

• Clean hands before meals and afterward bathroom activities.
• Comprehend their mouths and noses when sneezing or coughing.
• Maintain personal hygiene, including oral intendance.
• Accept all recommended vaccines.
• Consume healthy foods.
• Drinkable an acceptable amount of water and other liquids.
• Get plenty residue.

Communication Tips

• Report to your clinical supervisor any visitor or coworker who doesn't appear salubrious.
• Encourage residents to stay good for you past promoting paw hygiene, mouth and skin care, vaccinations, and good food choices.
• Encourage residents, family members, visitors, and staff to cover their mouths and noses when sneezing or coughing.

Multidrug-Resistant Organisms

Key Messages

• Multidrug-resistant organisms (MDROs)³ occur when bacteria adapt to and are no longer killed by an antibiotic.
• MDROs make it more difficult to care for an infection, tin result in utilise of boosted antibiotics, longer treatment times, and more financial costs, and may lead to hospitalization and fifty-fifty death.
• Contact isolation precautions may be used to forbid MDRO transmission to other residents and staff.
• Practicing good manus hygiene is the unmarried most important affair to prevent MDROs from spreading.

Basic Background

Multidrug-resistant organisms are bacteria and other germs that have developed a resistance to antibiotics and sure other drugs. Examples of MDROs include—

• MRSA (methicillin-resistant Staphylococcus aureus)
• VRE (vancomycin-resistant Enterococcus)
• C. difficile (Clostridium difficile)
• ESBL (extended spectrum beta lactamase) bacteria
• CRE (carbapenem-resistant Enterobacteriaceae)

Many residents of LTC facilities are at chance of acquiring an MDRO considering they are less healthy due to aging or chronic illness. Other risk factors include the apply of intravenous catheters (IVs) or other catheters, treatment with multiple antibiotics, and long hospitalizations.

Practice Tips

• Practice paw hygiene.
• Encourage residents to practice hand hygiene at mealtimes and after bathroom use.
• Proceed residents' environments clean and sanitary.
• Cover all cuts and wounds with a dressing.
• Follow contact isolation precautions when in place.
• Encourage residents to complete the total round of antibody handling.

Advice Tips

• Thoroughly discuss with the clinical supervisor any contact isolation precautions in place to understand why contact isolation was needed and how to follow the precautions.
• Advisedly explain the need for any contact isolation precautions to the resident and family unit.
• Promote manus hygiene for the resident, family members, and other staff.

2. Standard Precautions: Infection Prevention Basics

Key Messages

• Practice standard precautions for the intendance of all residents all the time.^four
• Observe the standard precautions of not touching blood, body fluids, mucous membranes, cuts, wounds, or rashes with blank hands—and non letting these touch your skin, face, or clothes.
• Apply personal protective equipment (PPE) when contact is possible with blood, torso fluids, mucous membranes, or nonintact pare.
• Practice hand hygiene.
• Use condom needles and sharps.
• Exercise respiratory etiquette by roofing coughs in sleeves and wearing masks when recovering from coughs or colds.

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.

Do Tips

• Practice skillful hand hygiene.
• Make sure PPE (gloves, gowns, masks, and eye protection) are available at all times.
• Keep PPE supplies close to resident intendance locations.
• Use just safety engineered needles, including lancets for testing blood sugar and safety needles for insulin pens.
• Do the motto "1 needle/syringe, one resident, one time."
• Always cough into sleeves, and wear a mask when recovering from a coughing or cold.

Communication Tips

• Remind coworkers to go on their hands clean and cover their coughs.
• Explain to residents that standard precautions are for anybody.
• Remind residents not to feel offended or afraid if staff use gloves, gowns, or eye protection when providing care.
• Explain to the resident, if needed, that the constabulary requires the use of safety lancets and needles to prevent needle stick injuries.
• When practicing respiratory etiquette, explicate that the mask is worn to forestall the spread of germs.
• Help residents exercise hand hygiene. Offer residents time for manus hygiene after they use the toilet and before and after meals.

Return to the Contents

Specific Standard Precautions

Paw Hygiene

Fundamental Messages

• Exercise hand hygiene when moving amid residents and from soiled to clean spaces.
• Wash easily with soap and h2o for at to the lowest degree 20 seconds, or employ an alcohol-based paw rub or booze hand wipe, covering all surfaces of the easily.

Bones Groundwork

Mitt hygiene refers to the practice of removing or killing germs on hands so that the germs practice not spread to other people or to surfaces. Keeping your hands clean is the nearly important affair that tin can be done to preclude infections.

To practice hand hygiene, keep your hands clean by either washing with soap and water or using an alcohol-based hand sanitizer. Modify gloves oft, and perform hand hygiene each time gloves are inverse as dirty gloves can spread germs, as well. Also, do not wear the same pair of gloves for more than one resident.

Practice Tips

• Launder hands with soap and h2o for at to the lowest degree 20 seconds—
  • Earlier handling food.
  • After using the toilet.
  • If hands are visibly soiled.
  • If hands have had contact with claret or body fluids.
  • Before and after assisting residents with toileting or perineal intendance.
• Beware of rings equally they tin trap germs and get caught on wear or equipment.
• If health intendance workers must clothing a ring (a wedding ring, for example), leave the ring on the finger and launder/clean the ring forth with the hands.
• Dry easily thoroughly with newspaper towels.
• Turn off the water faucet with paper towels.
• Don't impact dirty sink handles with clean hands.
• Hand sanitizer may be used in all other mitt hygiene situations non mentioned above.
• Make sure medication and handling carts are stocked with alcohol-based mitt rub or booze hand wipes.
• Suggest setting upwardly a routine organisation to monitor how and where staff are cleaning their hands.

Communication Tips

• Encourage everyone—residents, visitors, family members, and health care workers—to clean their hands before they eat and afterwards they use the bathroom.
• Ask the supervisor to create an surround where it's OK and piece of cake for people to enquire, "Take you cleaned your hands?"
• Suggest that the facility post signs to encourage hand hygiene.

Environmental Cleaning and Disinfection

Primal Messages

• All staff have a part in keeping the facility and equipment clean and disinfected.
• The all-time cleaning products—
  • Clean and disinfect at the same fourth dimension.
  • Are safe on surfaces.
• Hospital-canonical cleaners and disinfectants are acceptable for most situations in LTC facilities.
• All staff at the LTC facility should receive training earlier using whatever cleaning products.

Bones Groundwork

Cleaning typically refers to physically removing soil and dirt. Disinfecting and sanitizing, yet, is removing or killing the germs that can cause disease. Surfaces in a room or equipment tin harbor these germs.

All surfaces and equipment must be routinely cleaned and disinfected, including betwixt utilise on each resident, to prevent the spread of germs and diseases. This includes cleaning and disinfecting high-affect areas, including—

• Doorknobs
• Counters
• Medical carts
• Tables
• Bed rails
• Phones
• Call lights
• Personal care wipe packages

When cleaning, consider the contact time for the production. Contact time is the length of time a disinfectant needs to remain wet on a surface to exist effective.

Practice Tips

• Vesture gloves if the cleaning product requires them.
• Alter gloves between rooms and when moving from a contaminated surface area to a clean one.
• Use the right production for the right surface.
• Make sure the product yous are using stays wet on the surface for the time needed to kill germs.
• Do not flush wipes down the toilet.
• Do not mix chemicals as some combinations can release toxic gas.
• Go along chemicals locked up away from residents when not in use.

Communication Tips

• Inquire the facility for training on how to use cleaning chemicals properly, and choose a surface-appropriate production.
• Advise that the facility purchase wipes that are premoistened with cleaner/disinfectant as these are easier to use.
• Ask your supervisor how to alert residents and family unit members to use alcohol-based hand wipes to aid keep their own rooms clean.

Personal Protective Equipment

Key Letters

• The PPE must prevent contact betwixt skin, mucous membranes, and dress from claret, body fluids, and other potentially infectious materials.
• All staff should wearable PPE any time there is a risk of contact with blood and torso fluids.
• All staff, family members, and visitors should wear PPE when isolation precautions are in place.

Bones Background

Personal protective equipment protects you lot from contact with blood, trunk fluids, and other potentially infectious materials that may comprise germs that tin can cause infection. PPE is used to protect both staff and residents.

Examples of PPE include—

• Gloves
• Gowns
• Masks
• Goggles and other eye protection

The Occupational Safety and Wellness Administration (OSHA) requires that all wellness care facilities provide PPE for all staff who may come into contact with blood and body fluids in the form of their jobs.

Practice Tips

• Utilize a piece of personal protective equipment i time—then throw it abroad.
• Exercise not use the same PPE for the intendance of more than ane resident.
• One time a mask touches the face, modify it.
• Modify gloves when they are soiled, and when moving from a contaminated to a make clean area.
• Perform hand hygiene prior to wearing and after removing gloves.

Advice Tips

• Remind team members to use PPE whenever they might come up in contact with another person'south blood or trunk fluids.
• Explicate to residents that PPE is a standard precaution used to protect everyone.
• Inquire for more PPE when supplies in the work area run depression.
• Encourage staff to change the PPE if they touch a contaminated expanse, or if they move from a contaminated to a clean area, or from caring for i resident to another.

Resident Placement

Key Messages

• Expert advice amongst all staff is critical so that everyone knows how to best care for residents' individual needs, including their placement.
• Individual rooms are the best mode to forbid the spread of germs and infections.
• 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-gamble residents.

Basic Groundwork

When a resident is colonized or infected with germs that may be spread to other residents, it may exist necessary to move the resident or his/her roommate to some other room in order to reduce the chance of spreading the germs to the roommate. The goal in LTC facilities should exist to place residents in rooms with the lowest hazard of infection-spreading germs. Private rooms are the best way to do this. If there are no private rooms, the next all-time choice is to cohort residents, i.e., group residents together if they have the aforementioned germ. When cohorting is not possible, identify 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

• 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 non 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 mutual shower room, and ever 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 non be moved into a room with a resident who has a urinary catheter, an IV catheter, or an open wound.

Advice Tips

• Explicate to the resident why he or she is existence 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 disease.
• Vaccinations are an important tool for preventing respiratory illnesses such equally flu and pneumococcal pneumonia.
• Staff should stay home if they are sick.
• Staff should get dwelling if they develop respiratory symptoms while working.
• A virus can cause a common cold for a staff fellow member but may develop into a serious affliction 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 encompass their mouths and noses with a tissue (or if not bachelor, 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. While a virus tin can crusade a cold for a staff member, information technology can develop into a serious disease for an older adult. Respiratory illnesses often issue in hospital stays—and sometimes fifty-fifty decease.

Practice Tips

• Pay attention to coughing and sneezing residents, family members, visitors, and staff.
• E'er cover your oral cavity and nose with your sleeve or a tissue when coughing or sneezing and then perform manus hygiene.
• Make sure infected residents wear a mask whenever they leave their rooms.

Communication Tips

• Contact the supervisor about cough and sneezing past family members, visitors, or staff.
• Ask the facility to mail signs urging the use of manus hygiene and masks, and identify masks and hand sanitizer at entrances, during community outbreaks and flu season.
• Posted signs tin also assist educate residents and visitors near covering coughs and sneezes.
• Suggest that the facility send letters to family members explaining why visiting when they are sick puts residents at risk.

Safe Injection Practices

Key Letters

• All sharps (needles/lancets/syringes) used for injections or obtaining blood must be designed to reduce the gamble of needle sticks. This tin can be done with needle guards and automatic retraction devices, or with safe engineered sharps, such every bit nonremovable needles and syringes with fixed doses.
• While residents may have their own equipment for their own personal utilize, health care workers cannot use residents' equipment.

Bones Background

Unsafe injection practices can lead to infections and even affliction outbreaks. The post-obit are unsafe practices and should never be washed:

• Reusing single-use syringes and needles
• Using contaminated multiuse vials and Iv solutions
• Improperly cleaning and disinfecting multiple-utilise equipment
• Declining to follow bones safe injection practices

OSHA requires that all sharps used by staff be rubber engineered.

Practice Tips

• Use proper technique to avoid contaminating sterile syringes and other sharps.
• Practise "1 resident, 1 needle, one time."
• Practice not share finger stick devices.
• Do not share insulin pens between residents.
• Whenever possible, practise not share blood glucose meters.
• If a blood glucose meter is used for multiple residents, brand sure to clean and disinfect the device afterwards every utilize.
• Promptly dispose of used syringes and other sharps.
• Have sharps containers available at the betoken of care.
• Talk to your supervisor if yous are unsure if a device is rubber engineered or correct for use.

Communication Tips

• Ask for training on the divergence between safety-engineered devices and nonsafety sharps.
• Ask for training on how to appoint 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 non just kills germs but as well does not spread germs from muddied to make clean linens.
• Estrus and chemical disinfection are two methods used to kill germs in laundry.
• Utilize one colour 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 claret and are being discarded in a biohazard bin.

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

• Brand sure that at that place are enough linen numberless shut to points of intendance.
• Go along clean linen separate from soiled linen.
• Transport all clean linen in covered make clean carts.
• Hold soiled linen abroad from your clothing when you are changing and carrying linens.
• Minimize handling and agitation of soiled linen (due east.g., consider wrapping soiled linen in a ball at the point of collection) and place in a proper soiled-linen pocketbook at the point of care.
• Make sure the soiled linen is properly handled from the bespeak of collection to the laundry.

Communication Tips

• Ask your supervisor for preparation on how to properly modify and handle dirty or contaminated linen.

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III. Transmission-Based Precautions and Outbreak Management

Transmission-Based Precautions (Full general)

Central Letters

There are three mechanisms of infection transmission:

• Contact
  • Indirect
  • Direct
• Droplet
  • Large respiratory particles that travel short distances (up to half dozen feet).
• Airborne
  • Small-scale respiratory particles that stay suspended in the air.
• Contact, droplet, and airborne precautions are used in improver to standard precautions.
• Adopt a person-centered arroyo to practicing transmission-based precautions: "Only when necessary for only as long as necessary."

Basic Background

Transmission-based precautions are special safeguards, such as isolating residents, that should be used when residents accept infections caused past germs that are resistant to antibiotics or may cause outbreaks at the LTC facility.

The Centers for Disease Command and Prevention has specific directions about what types of isolation are to be used for specific germs^iii,four. LTC facilities should also check their Country'south regulations to come across if the State health department has any boosted requirements.

Practise Tips

• Use transmission-based precautions if unsure what is causing an infection, until the germ is identified.
• Utilize transmission-based precautions, and discontinue when no longer needed, based on show-based best practices and facility policy.
• Do non over-isolate residents.
• Consider transmission-based precautions on a case-by-case basis as an indicator to "gown and glove upwardly" when providing direct personal intendance. For example—
  • If the resident cannot maintain make 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 blazon of germ and other factors (for instance, 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 well-nigh 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 almost questions concerning culture results.

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Specific Transmission-Based Precautions

Contact Precautions

Fundamental Messages

• Use contact precautions to prevent the spread of germs past 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 sure germs.
• Adopt a person-centered approach: "Just when necessary for simply every bit long as necessary."

Basic Background

Contact precautions, such equally 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—

• MRSA (methicillin-resistant Staphylococcus aureus)
• VRE (vancomycin-resistant Enterococcus)
• C. difficile (Clostridium difficile)
• ESBL (extended spectrum beta lactamase) bacteria
• CRE (carbapenem-resistant Enterobacteriaceae)

Do Tips

• Always clean easily earlier entering residents' rooms and after leaving the rooms.
• Wear gloves and a gown when entering residents' rooms and remove them when leaving the rooms.
• Brand certain any shared equipment is cleaned and disinfected before and subsequently apply.
• Make sure that wounds are covered.
• Contain any urine, stool, or wound drainage.
• For residents who are on contact precautions, consider their taking office in social activities every bit long equally they do not take open wounds or diarrhea, have contained drainage, and are able to proceed their hands, clothes, and equipment make clean.ⁱⁱⁱ

Communication Tips

• Teach the resident and visitors about the blazon of germ that is causing the infection and the reasons these precautions are required.
• Brand 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 wellness officials when there are increased infections with the same germ and additional guidance is needed.

Droplet Precautions

Fundamental Messages

• Droplet precautions are used against flu (also known every bit the flu).
• Wear a mask in add-on 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 article of clothing a mask.
• Consider using both droplet and contact precautions if the respiratory virus causing the affliction is unknown or if the resident has nausea, airsickness, or diarrhea.

Basic Background

Droplet precautions are special safeguards put in place when germs are spread past sneezing, coughing, or sometimes even talking. Examples of diseases that spread via large aerosol include—

• Some bacterial infections (such as Streptococcus infection)
• Some viral infections (such as influenza)

It is of import 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 employ an alcohol-based manus rub before inbound and afterward 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 nigh options for in-room therapy and other activities.
• Brand certain the reason for the droplet precautions is documented on the care programme and assignment sheets and communicated to all staff.

Airborne Precautions

Primal Messages

• Airborne precautions are used for diseases such every bit tuberculosis and craven pox.
• Airborne precautions are rarely used in LTC facilities.
• An LTC facility must have negative force per unit area 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 assist 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 individual room and asked to wear a mask while awaiting transfer.^iv

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—

• Tuberculosis
• Measles
• Craven pox
• Disseminated shingles

Practice Tips

• Enter the room just when absolutely necessary.
• Wash hands for at least 20 seconds with soap and water or apply an alcohol-based hand rub earlier inbound and after leaving the room.
• Habiliment respiratory protection (such equally 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 olfactory organ with a tissue when cough, and to place the soiled tissues into the regular trash can.
• Make sure the resident wears a surgical mask while pending transfer and during transfer.
• Create a list of all staff, residents, family members, and visitors who take had close contact with the infected resident.

Communication Tips

• Explain to the resident and family unit why the resident is in airborne isolation and needs to be transferred.
• Make sure the reason for the transfer is documented on the care programme and assignment sheets.

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Outbreak Management

Cardinal Messages

• Quick identification of clusters of infections is critical.
• Proceed the environs and equipment clean and disinfected.
• Make sure at that place are disinfectants at the bespeak of intendance.

Basic Background

An outbreak occurs when at that place are more than cases of an infectious disease in a designated population than commonly occur at a given time. LTC facilities are especially vulnerable to outbreaks because residents are generally older and many are in frail wellness.

The ii most common types of outbreaks in LTC facilities are—

• Respiratory infections
• Gastrointestinal diseases

A single example of influenza or an illness that causes nausea, vomiting, and diarrhea (such equally norovirus) tin quickly escalate into an outbreak.

Contaminated hands, gloves, and medical equipment can spread illness across surfaces. Residents, such as those with dementia who wander and may have unhygienic hands or clothes, can also spread affliction.

Practice Tips

• Consider implementing both droplet and contact precautions if the facility does non know the cause of a cluster of similar illnesses.
• Written report any new respiratory or gastrointestinal symptoms, especially if a fever develops.
• Work with the clinical supervisor to place similar symptoms amidst those who are sick.
• Staff should stay home, or go home, if they have a respiratory illness or nausea, vomiting, or diarrhea.

Advice Tips

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

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IV. Engaging Everyone in Infection Prevention and Control

Cardinal Messages

• Good infection prevention practices, including mitt hygiene, respiratory hygiene, safe injection practices, and appropriate antibody apply, contribute to a safety facility for residents and a condom workplace for staff.
• Everybody who works in the facility needs to piece of work together to do infection prevention to forestall impairment and increase resident safety.
• Residents and family members play a role in increasing resident prophylactic past practicing infection prevention themselves, and in supporting the health intendance team in prevention practices.

Basic Background

Everyone in an LTC facility has a role to play in infection prevention and control— including wellness care workers, residents, and their families. A team of staff must work together to improve resident safety outcomes and amend resident, family, and staff satisfaction.

Good teamwork and good communication are crucial to preventing infection and building a civilization of safety. Staff members should feel comfy reporting safety concerns without fear of discipline. Damage to residents from infections can increase if staff members are reluctant to written report lapses in infection prevention practices. Good teams and a culture of condom can reduce the adventure of clinical errors, reduce staff turnover, and reduce concerns past residents and their families.

Practise Tips

• Ensure all team members, including the resident and family, take a clear understanding of the resident'south goals.
• Encourage coworkers to raise questions and concerns in a nonhostile fashion and without fright of retribution.
• Provide helpful feedback to other staff.

Communication Tips

• Ask your supervisor how to help make resident intendance safer.
• Share ideas with your supervisor for making resident care safer.
• Seek feedback from the resident and family unit members nigh any potential prophylactic concerns or problems.

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Antibiotic Use and Resistance

Key Messages

• Antibiotics are medications that tin save lives when used accordingly.
• Used incorrectly, antibiotics tin lead to antibiotic-resistant infections.
• Residents should take all medications, including antibiotics, exactly as they are prescribed.

Basic Background

When they are necessary, antibiotics tin can be lifesavers.^v Only not every disease calls for antibiotics. Inappropriate utilize of antibiotics can cause health problems for the resident, including—

• Nausea
• Diarrhea
• Allergic reactions
• Antibiotic-related infection (C. difficile)

Inappropriate use and overuse of antibiotics can also lead to antibiotic-resistant organisms, which can threaten non only the resident just the unabridged community.

An antibiotic stewardship program is a coordinated plan that promotes the appropriate use of antibiotics. It tin assist to reach optimal outcomes, reduce side effects, salve money, and prevent the emergence of drug-resistant leaner.

Practice Tips

• Learn about the appropriate use of antibiotics.
• Antibiotics are non helpful when—
  • Used to treat an infection that is caused by a virus (such equally a cold or the flu).
  • Used for a medical problem that is non an infection.
  • No signs or symptoms of a urinary tract infection are nowadays but leaner are found in the urine.

Communication Tips

• Be alert for the side furnishings of antibiotics and inform the supervisor if they appear.
• Share any concerns about the antibody with the supervisor.

Survey Readiness

• Health intendance workers strive daily to provide the best intendance to residents.
• Regulatory agencies, such equally State departments of health, survey LTC facilities to ensure that the highest level of intendance is existence provided.
• Survey teams monitor compliance with Federal and State health care regulations.
• Facility policies and procedures based on Land and Federal regulations and testify-based practices will support survey readiness.
• Surveys are by and large not scheduled in accelerate, then it's of import to always be prepared.
• Every facility has a quality assurance operation improvement plan in place to proactively improve the care of all residents and to support survey readiness.

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OSHA Compliance

Key Messages

• OSHA was created to ensure a safety and healthy work environment.
• The facility is required to have safeguards in place to prevent health intendance workers from being hurt or injured on the chore, including from infections and infectious diseases.
• Information technology is important that health care workers comply with all safeguards and work practices to reduce the risk of infection on the task.

Basic Background

Most LTC facilities have a programme in identify to address the OSHA-required bloodborne pathogen standard.⁶ This plan sets out work practices that must be followed. These work practices include—

• Offering the hepatitis B vaccine to any staff member who has the potential to exist exposed at work to blood and bodily fluids.
• Making personal protective equipment available at all times.
• Using safety-engineered devices for administering injections.
• Training staff on hand hygiene.
• Stating that infectious waste must be placed in a biohazard purse.
• Stating that all sharps, including needles and razors, must be placed into precipitous containers.

Do Tips

• Go familiar with the unlike work practices to prevent infection in the LTC facility.
• Promote safe and prevent infection and tell your supervisor right away nigh whatever hazards or unsafe work practices (such as unsafe equipment, inadequate safety equipment, or a lack of information nearly a work practice or piece of equipment).
• Staff should take extra care if they are stressed or tired as they could be putting themselves at greater risk for an occupational injury leading to infection.

Communication Tips

• Explain to the resident why a task is performed in a certain manner to preclude infection.
• Tell your supervisor right away if you are stuck with a sharp or otherwise injured at piece of work; if not promptly addressed, it may pb to an infection.
• Ask your employer to provide staff with data almost potential hazards in the workplace to go on everybody condom.

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References

one. U.S. Department of Wellness and Human Services. National Action Programme To Prevent Healthcare-Associated Infections: Route Map to Elimination. Chapter viii, Long-Term Intendance Facilities. April 2013. Accessed September 23, 2015.

2. Wagner LM, Roup BJ, Castle NG. Affect of infection preventionists on Centers for Medicare and Medicaid quality measures in Maryland nursing homes. Am J Infect Control. 2014 Jan;42(one):ii-6. PMID: 24388467.

iii. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Commission. 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 Affliction Command and Prevention. Accessed May 5, 2016.

5. Get Smart: Know When Antibiotics Work. Centers for Illness Control and Prevention. Accessed November 19, 2015.

6. Bloodborne Pathogens. Occupational Condom and Health Administration. Accessed November nineteen, 2015.

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Source: https://www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/resources/guides/infection-prevent.html

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