Common Infections in Nursing Homes a Review of Current Issues and Challenges

Acknowledgments

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

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

Steven J. Schweon, R.Northward., 1000.P.H., Chiliad.S.N., CIC, HEM, FSHEA
Infection Prevention Consultant
Saylorsburg, PA

Sue Collier, Thou.S.N., R.N., FABC
Clinical Content Evolution Pb
Health Inquiry & Educational Trust
American Hospital Association
Chicago, IL

This project was funded under contract number HHSA290201000025I, task society eight, from the Agency for Healthcare Research and Quality (AHRQ).

Disclaimer: AHRQ and its contractor, Health Research & Educational Trust, accept made a good faith effort to take all reasonable measures to ensure that this product is authentic, up to date, and free of error in accord with clinical standards accepted at the time of publication. Whatsoever practice described in this product must be practical by health intendance practitioners in accord with professional judgment and standards of intendance in regard to the unique circumstances that may apply in each situation they run into. AHRQ and HRET are not responsible for any adverse consequences arising from contained application by 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. Farther reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.

None of the contributors have any affiliations or fiscal involvement that conflicts with the textile presented in this document.

How To Use This Guide

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

Key Messages are high-level takeaways for each topic.

Basic Background provides general information virtually each topic. It is designed to give elementary "what" and "why" know-how.

Practice Tips are actions to take to reduce the chance of infections in long-term care (LTC) facilities.

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

Contents

Introduction
I. Infections and Infection Prevention in Long-Term Care
Infections in Long-Term Care
Infection Prevention and Control in Long-Term Care
Multidrug-Resistant Organisms
Two. Standard Precautions: Infection Prevention Basics
Specific Standard Precautions
Hand Hygiene
Environmental Cleaning and Disinfection
Personal Protective Equipment
Resident Placement
Respiratory Hygiene and Etiquette
Safety Injection Practices
Soiled Linen
Three. Transmission-Based Precautions and Outbreak Management
Manual-Based Precautions (Full general)
Specific Manual-Based Precautions
Contact Precautions
Droplet Precautions
Airborne Precautions
Outbreak Management
IV. Engaging Everyone in Infection Prevention and Command
Antibody Use and Resistance
OSHA Compliance
References

Introduction

In the United states lonely, more than xv,000 long-term intendance (LTC) facilities serve more than one one thousand thousand residents. The residents and staff in LTC facilities have an increased risk of infection due to the unique challenges in the intendance setting and the resident population. Health care-associated infections account for as many as 380,000 deaths annually.ⁱ Additionally, infections increase health intendance costs and may result in hospitalization.^two For these reasons, all staff in LTC facilities must work together to reduce infections and provide rubber care for residents and a safe work environs for staff.

In 2013, the Association for Professionals in Infection Command and Epidemiology published a comprehensive book on infection prevention and control titled Infection Preventionist's Guide to Long-Term Care. The book provides data on specific practices and procedures in LTC facilities that ameliorate infection prevention and promote resident rubber.

A Unit of measurement Guide to Infection Prevention for Long-Term Intendance Staff is designed to provide LTC staff with basic knowledge about LTC facility infection prevention guidelines. The guide is meant to provide infection prevention data 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:

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

Each topic area includes a summary of key messages, groundwork information, practice tips, and communication tips. The guide tin be fabricated available to staff by hard re-create or digitally.

The practical and user-friendly arroyo to this content is intended to assist frontline staff develop the skills, noesis, and confidence to be active team members in LTC facility infection prevention efforts, and to appoint residents and family members in infection prevention. The guide as well can be used as a resources to promote teamwork and communication inside a culture of safety.

Together, all LTC facility team members—residents, family, and staff—tin amend quality and preclude infections!

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I. Infections and Infection Prevention in Long-Term Intendance

Infections in Long-Term Intendance

Key Letters

• The crumbling process affects multiple organs and systems, causing a decline in overall wellness and the ability to fight infection.
• People who live or work together, such as in an LTC facility, are more than probable to share germs.
• Infections cause pain, injury, inability, and sometimes even expiry, and can exist very expensive to treat.
• Residents and staff may be agape of communicable an infection when they stay or piece of work in an LTC facility.
• Many infections can be 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 tin get when in an LTC facility, a infirmary, or some other place where people become for health intendance.

What is Colonization?

Sometimes residents accept germs inside them but they don't go sick. When this happens, it'south called colonization. If a resident is colonized, that resident could notwithstanding spread the germs to other people.

Crumbling and Infections

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

• Breaks in the peel.
• Wounds.
• Problem chewing, swallowing, and drinking.
• Difficulty moving.
• Loss of bladder and bowel control.
• Mental status changes/impairments.
• Medical weather such as lung disease and diabetes.
• Inability to clean their hands or accept a deep jiff when asked.

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—

• Bacteria
• Viruses
• Molds
• Fungi

Germs are present on our skin and inside our bodies. In addition, germs tin can be establish in the air, on surfaces in the environment, and sometimes in food and water. They tin can enter a person's body through mucus membranes such as the nose, eyes, or mouth, equally well as through breaks in the pare, 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 mutual cold, influenza, some illnesses involving diarrhea, and some types of pneumonia. Fungi can crusade pare and nail infections, besides as other types of infections, especially in people with weakened immune systems.

LTC Infection Types

The almost common types of infection in LTC facilities involve the—

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

How Practise Infections Spread?

Germs tin 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 allowed 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 past—

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

Practice Tips

• Look for signs and symptoms of infection.
• Ask the resident how he or she is feeling.
• Every bit yous work with a resident, you will go more familiar with what is and isn't normal for that resident.
• Promptly report whatsoever signs of an infection to the clinical supervisor.

Communication Tips

• If you see signs of an infection, discuss them with the resident.
• Tell the resident that you lot are seeking boosted help from your clinical supervisor.
• Carefully certificate 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 charge per unit
    • Changes in claret pressure (also high or too low)
• Loose stools or diarrhea
• Blood in the urine
• Resident lament of pain/called-for when urinating, or increased frequency or incontinence

SIGN of Infection

A sign of infection is what yous can observe (for example what you tin can run into, hear, feel, or measure). 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 he or she is experiencing.

Symptoms include—

• Nausea
• Hurting
• Feeling feverish
• Called-for when urinating

Infection Prevention and Control in Long-Term Intendance

Primal Messages

• Suspension the chain of infection.
• Find, diagnose, and treat infections apace and effectively.
• Do non blitz to utilise antibiotics.
• Carefully follow facility policies and procedures to forbid infections.

Basic Background

Every LTC facility has policies and procedures to prevent infection and go on residents safe. Infection prevention and command practices help residents avoid getting infections from wellness care workers, other residents, family members, and visitors. These practices tin also aid forbid wellness care workers from getting infections from residents. It's important that wellness 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 role in maintaining their health and preventing infection.

Practice Tips

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

• Cleaning hands with an booze-based manus rub or lather and water, likewise known as 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 matter safely.
• Avoiding touching your face up.
• Covering mouths and noses when sneezing or coughing.
• Not coming to work when ill.
• Staying upward to appointment on all recommended vaccinations.
• Practicing standard precautions for all residents.

Help residents play a office in reducing take a chance of infection past encouraging them to—

• Clean easily before meals and after bathroom activities.
• Cover their mouths and noses when sneezing or coughing.
• Maintain personal hygiene, including oral care.
• Take all recommended vaccines.
• Eat healthy foods.
• Drink an adequate corporeality of h2o and other liquids.
• Get enough balance.

Communication Tips

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

Multidrug-Resistant Organisms

Key Letters

• Multidrug-resistant organisms (MDROs)³ occur when bacteria adapt to and are no longer killed by an antibiotic.
• MDROs make it more difficult to treat an infection, tin consequence in use of additional antibiotics, longer treatment times, and more fiscal costs, and may pb to hospitalization and even decease.
• Contact isolation precautions may exist used to forestall MDRO manual to other residents and staff.
• Practicing skillful mitt hygiene is the single most of import thing to forbid MDROs from spreading.

Bones Background

Multidrug-resistant organisms are bacteria and other germs that accept adult a resistance to antibiotics and certain other drugs. Examples of MDROs include—

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

Many residents of LTC facilities are at risk of acquiring an MDRO considering they are less good for you due to aging or chronic illness. Other hazard factors include the use of intravenous catheters (IVs) or other catheters, handling with multiple antibiotics, and long hospitalizations.

Exercise Tips

• Do hand hygiene.
• Encourage residents to exercise mitt hygiene at mealtimes and later on bathroom use.
• Go along residents' environments clean and sanitary.
• Comprehend all cuts and wounds with a dressing.
• Follow contact isolation precautions when in identify.
• Encourage residents to complete the full round of antibody treatment.

Communication Tips

• Thoroughly talk over with the clinical supervisor any contact isolation precautions in place to sympathize 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 hand hygiene for the resident, family members, and other staff.

Ii. Standard Precautions: Infection Prevention Basics

Key Messages

• Practice standard precautions for the care of all residents all the time.⁴
• Observe the standard precautions of not touching claret, trunk fluids, mucous membranes, cuts, wounds, or rashes with bare hands—and not letting these touch your skin, face, or clothes.
• Use personal protective equipment (PPE) when contact is possible with blood, body fluids, mucous membranes, or nonintact skin.
• Practice paw hygiene.
• Apply safety needles and sharps.
• Practise respiratory etiquette by covering coughs in sleeves and wearing masks when recovering from coughs or colds.

Basic Groundwork

Standard precautions are basic steps that every health care worker should accept to prevent the spread of germs. Standard precautions include keeping easily clean, not touching the face, covering coughs in sleeves, and using safety needles and sharps.

Practice Tips

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

Communication Tips

• Remind coworkers to keep their hands clean and cover their coughs.
• Explain to residents that standard precautions are for anybody.
• Remind residents non to feel offended or agape if staff apply gloves, gowns, or eye protection when providing care.
• Explain to the resident, if needed, that the police force requires the use of safe lancets and needles to forestall needle stick injuries.
• When practicing respiratory etiquette, explain that the mask is worn to prevent the spread of germs.
• Aid residents exercise hand hygiene. Offer residents fourth dimension for paw hygiene after they utilise the toilet and before and after meals.

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Specific Standard Precautions

Mitt Hygiene

Key Messages

• Practice hand hygiene when moving amid residents and from soiled to make clean spaces.
• Wash hands with soap and h2o for at to the lowest degree 20 seconds, or use an alcohol-based manus rub or alcohol manus wipe, covering all surfaces of the hands.

Basic Background

Hand hygiene refers to the practice of removing or killing germs on hands and then that the germs do not spread to other people or to surfaces. Keeping your hands make clean is the most important matter that tin be done to forbid infections.

To practice paw hygiene, continue your hands clean by either washing with soap and water or using an alcohol-based hand sanitizer. Change gloves oft, and perform hand hygiene each time gloves are changed equally dirty gloves tin can spread germs, too. Also, practise non wearable the same pair of gloves for more than 1 resident.

Practice Tips

• Wash hands with soap and h2o for at least 20 seconds—
  • Before handling nutrient.
  • Afterward using the toilet.
  • If easily are visibly soiled.
  • If hands accept had contact with claret or torso fluids.
  • Earlier and after assisting residents with toileting or perineal intendance.
• Beware of rings as they can trap germs and go caught on clothing or equipment.
• If health care workers must wear a ring (a nuptials ring, for case), leave the ring on the finger and launder/make clean the ring along with the easily.
• Dry easily thoroughly with paper towels.
• Plough off the water faucet with paper towels.
• Don't touch dirty sink handles with clean hands.
• Manus sanitizer may exist used in all other manus hygiene situations non mentioned in a higher place.
• Make sure medication and handling carts are stocked with alcohol-based paw rub or alcohol paw wipes.
• Suggest setting upwards 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 consume and after they employ the bath.
• Ask the supervisor to create an environment where it'due south OK and like shooting fish in a barrel for people to ask, "Take you cleaned your hands?"
• Suggest that the facility postal service signs to encourage hand hygiene.

Ecology Cleaning and Disinfection

Key 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 time.
  • Are rubber on surfaces.
• Hospital-approved cleaners and disinfectants are adequate for most situations in LTC facilities.
• All staff at the LTC facility should receive training earlier using any cleaning products.

Bones Background

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

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

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

When cleaning, consider the contact fourth dimension for the product. Contact time is the length of fourth dimension a disinfectant needs to remain moisture on a surface to be effective.

Practice Tips

• Clothing gloves if the cleaning product requires them.
• Change gloves between rooms and when moving from a contaminated surface expanse to a clean i.
• Use the correct product for the right surface.
• Make certain the product y'all are using stays moisture on the surface for the time needed to impale germs.
• Exercise 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

• Ask the facility for grooming on how to utilise cleaning chemicals properly, and cull a surface-appropriate production.
• Propose 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 utilize alcohol-based hand wipes to help proceed their ain rooms clean.

Personal Protective Equipment

Key Messages

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

Bones Background

Personal protective equipment protects you from contact with claret, 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—

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

The Occupational Safe and Health Assistants (OSHA) requires that all wellness care facilities provide PPE for all staff who may come up into contact with claret and body fluids in the class of their jobs.

Practice Tips

• Utilise a slice of personal protective equipment ane fourth dimension—then throw it away.
• Practise not use the same PPE for the care of more than one resident.
• Once a mask touches the face up, alter information technology.
• Change gloves when they are soiled, and when moving from a contaminated to a clean surface area.
• Perform hand hygiene prior to wearing and afterwards removing gloves.

Advice Tips

• Remind team members to use PPE whenever they might come in contact with some other person'southward claret or trunk fluids.
• Explain to residents that PPE is a standard precaution used to protect everyone.
• Enquire for more PPE when supplies in the work area run low.
• Encourage staff to modify the PPE if they bear on a contaminated area, or if they move from a contaminated to a clean area, or from caring for 1 resident to some other.

Resident Placement

Primal Messages

• Good communication amid all staff is critical so that everyone knows how to best care for residents' individual needs, including their placement.
• Individual rooms are the all-time way to prevent the spread of germs and infections.
• When private rooms are not bachelor—
  • Residents infected or colonized with the same germ tin exist placed together.
  • If that is not possible, place infected residents with low-take a chance residents.

Bones Background

When a resident is colonized or infected with germs that may be spread to other residents, information technology may be necessary to motility the resident or his/her roommate to another room in order to reduce the take a chance of spreading the germs to the roommate. The goal in LTC facilities should be to place residents in rooms with the lowest take a chance of infection-spreading germs. Private rooms are the all-time way to do this. If in that location are no individual rooms, the next all-time selection is to cohort residents, i.e., group residents together if they have the same germ. When cohorting is non possible, place infected residents with residents who are at low risk. Both the resident and the resident's care squad and family should be involved in resident moves.

Exercise Tips

• Consider how long residents have been roommates before deciding to move a resident with an infection or colonization. If they take 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 final when using a mutual shower room, and ever disinfect the shower room afterward use.
• A resident with an MDRO should non 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.

Advice Tips

• Explain to the resident why he or she is being moved into isolation.
• Communicate the reason for resident placement in a dissimilar 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 programme.

Respiratory Hygiene and Etiquette

Fundamental Messages

• Everyone needs to watch for and study respiratory illness.
• Vaccinations are an of import tool for preventing respiratory illnesses such as flu and pneumococcal pneumonia.
• Staff should stay home if they are sick.
• Staff should get home 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 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 cough 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 can cause a cold for a staff member, it can develop into a serious disease for an older adult. Respiratory illnesses often outcome in infirmary stays—and sometimes even death.

Practice Tips

• Pay attention to coughing and sneezing residents, family unit members, visitors, and staff.
• Always cover your mouth and nose with your sleeve or a tissue when coughing or sneezing so perform hand hygiene.
• Brand sure infected residents habiliment a mask whenever they leave their rooms.

Advice 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 likewise help educate residents and visitors virtually roofing coughs and sneezes.
• Advise that the facility send letters to family members explaining why visiting when they are sick puts residents at risk.

Safe Injection Practices

Central Messages

• All sharps (needles/lancets/syringes) used for injections or obtaining blood must be designed to reduce the gamble of needle sticks. This tin be washed with needle guards and automated retraction devices, or with safety engineered sharps, such as nonremovable needles and syringes with stock-still doses.
• While residents may take 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 fifty-fifty disease outbreaks. The post-obit are unsafe practices and should never be washed:

• Reusing unmarried-apply syringes and needles
• Using contaminated multiuse vials and Four solutions
• Improperly cleaning and disinfecting multiple-utilize equipment
• Failing to follow basic safe injection practices

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

Practice Tips

• Utilize proper technique to avoid contaminating sterile syringes and other sharps.
• Practise "one resident, one needle, once."
• Do not share finger stick devices.
• Do not share insulin pens between residents.
• Whenever possible, do not share blood glucose meters.
• If a claret 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 apply.

Communication Tips

• Inquire for preparation on the difference between safety-engineered devices and nonsafety sharps.
• Inquire for training on how to engage the safety device earlier using a precipitous.
• Explain to residents and family members that staff must employ but sharps provided by the facility.

Soiled Linen

Cardinal Messages

• Care for all soiled linen every bit potentially infectious.
• Linen must exist candy in a way that not simply kills germs but too does not spread germs from dirty to make clean linens.
• Rut and chemical disinfection are 2 methods used to kill germs in laundry.
• Employ ane color of handbag for soiled linen and a different-colored bag for trash.
• Don't put linens in cherry-red biohazard bags unless they are soaked with blood and are being discarded in a biohazard bin.

Bones Background

Soiled or improperly cleaned or disinfected linens can spread germs. As a issue, information technology's critical that they be regularly cleaned.

Practice Tips

• Brand sure that at that place are enough linen bags shut to points of care.
• Keep clean linen separate from soiled linen.
• Transport all make clean linen in covered clean carts.
• Hold soiled linen away from your clothing when you are changing and carrying linens.
• Minimize treatment and agitation of soiled linen (e.g., consider wrapping soiled linen in a brawl 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 point of collection to the laundry.

Communication Tips

• Ask your supervisor for training on how to properly alter and handle muddied or contaminated linen.

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3. Transmission-Based Precautions and Outbreak Direction

Transmission-Based Precautions (General)

Key Messages

At that place are three mechanisms of infection transmission:

• Contact
  • Indirect
  • Straight
• Droplet
  • Large respiratory particles that travel short distances (up to 6 feet).
• Airborne
  • Small-scale respiratory particles that stay suspended in the air.
• Contact, droplet, and airborne precautions are used in addition to standard precautions.
• Prefer a person-centered approach to practicing transmission-based precautions: "Only when necessary for only every bit long as necessary."

Basic Background

Transmission-based precautions are special safeguards, such as isolating residents, that should exist 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 well-nigh what types of isolation are to be used for specific germs^3,four. LTC facilities should as well check their State'southward regulations to meet if the State health department has whatsoever additional requirements.

Do Tips

• Employ transmission-based precautions if unsure what is causing an infection, until the germ is identified.
• Utilize manual-based precautions, and discontinue when no longer needed, based on evidence-based best practices and facility policy.
• Do non over-isolate residents.
• Consider transmission-based precautions on a instance-by-example footing every bit an indicator to "gown and glove upwardly" when providing direct personal care. For example—
  • If the resident cannot maintain clean hands, clean wearing apparel, 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 example, if there are no longer signs or symptoms of an infection, antibiotic therapy is completed, and wound is healed) earlier 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 unit why the resident is being put into isolation.
• Talk to the lab or clinical supervisor about questions concerning culture results.

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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 identify when dealing with residents who are infected with certain germs.
• Prefer a person-centered approach: "Only when necessary for simply equally long every bit necessary."

Basic Background

Contact precautions, such as wearing gloves and a gown, are special safeguards that staff must put in identify when dealing with residents who are infected with germs that are piece of cake 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)

Practice Tips

• E'er make clean hands before inbound residents' rooms and after leaving the rooms.
• Vesture 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.
• Comprise whatever urine, stool, or wound drainage.
• For residents who are on contact precautions, consider their taking office in social activities every bit long as they do not accept open wounds or diarrhea, accept independent drainage, and are able to keep their hands, clothes, and equipment make clean.³

Communication Tips

• Teach the resident and visitors about the type 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 intendance plan and assignment sheets and shared with all staff.
• Interact with the lab, prescribers, and public health officials when there are increased infections with the aforementioned germ and additional guidance is needed.

Droplet Precautions

Key Messages

• Droplet precautions are used against influenza (likewise known as the flu).
• Wear a mask in improver to using standard precautions.
• Residents on droplet precautions should stay in their rooms.
• If a resident on droplet precautions has to exit 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, airsickness, or diarrhea.

Basic Background

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

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

It is of import to use droplet precautions to stop the spread of these diseases to other residents and staff.

Do Tips

• Wash hands for at least xx seconds with either soap and water or use an alcohol-based hand rub before entering and after leaving residents' rooms.
• Clothing 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.
• Brand certain the reason for the droplet precautions is documented on the care plan and consignment sheets and communicated to all staff.

Airborne Precautions

Fundamental Letters

• Airborne precautions are used for diseases such equally tuberculosis and chicken pox.
• Airborne precautions are rarely used in LTC facilities.
• An LTC facility must take 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. If an airborne infection isolation room is not available at the LTC facility, the patient should exist promptly placed in a individual room and asked to article of clothing a mask while awaiting transfer.⁴

Airborne precautions are put in place when an infectious organism floats in the air and tin be spread through the air. 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 apply an alcohol-based paw 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.
• Continue the resident in the room, with the door airtight, 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 embrace his or her rima oris and nose with a tissue when cough, and to place the soiled tissues into the regular trash can.
• Brand sure the resident wears a surgical mask while pending transfer and during transfer.
• Create a list of all staff, residents, family unit members, and visitors who have 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 program and consignment sheets.

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Outbreak Management

Key Messages

• Quick identification of clusters of infections is critical.
• Keep the environment and equipment clean and disinfected.
• Make sure there are disinfectants at the signal of care.

Basic Background

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

The two most mutual types of outbreaks in LTC facilities are—

• Respiratory infections
• Gastrointestinal diseases

A unmarried example of flu or an affliction that causes nausea, airsickness, and diarrhea (such as norovirus) can quickly escalate into an outbreak.

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

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, particularly if a fever develops.
• Work with the clinical supervisor to identify similar symptoms among those who are ill.
• Staff should stay home, or go dwelling house, if they accept a respiratory affliction or nausea, vomiting, or diarrhea.

Communication Tips

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

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IV. Engaging Everyone in Infection Prevention and Control

Key Messages

• Skillful infection prevention practices, including hand hygiene, respiratory hygiene, safe injection practices, and appropriate antibody employ, contribute to a safe facility for residents and a safety workplace for staff.
• Everybody who works in the facility needs to piece of work together to practice infection prevention to prevent impairment and increment resident safety.
• Residents and family unit 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

Anybody in an LTC facility has a function 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.

Proficient teamwork and good advice are crucial to preventing infection and edifice a civilization of rubber. Staff members should feel comfortable reporting safety concerns without fear of discipline. Harm to residents from infections can increment if staff members are reluctant to report lapses in infection prevention practices. Good teams and a culture of rubber can reduce the chance of clinical errors, reduce staff turnover, and reduce concerns by residents and their families.

Practise Tips

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

Communication Tips

• Inquire your supervisor how to assistance make resident care safer.
• Share ideas with your supervisor for making resident intendance safer.
• Seek feedback from the resident and family members almost any potential safety concerns or issues.

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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 equally they are prescribed.

Bones Groundwork

When they are necessary, antibiotics tin be lifesavers.^five Merely not every affliction calls for antibiotics. Inappropriate use of antibiotics tin cause health bug for the resident, including—

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

Inappropriate use and overuse of antibiotics tin can also lead to antibiotic-resistant organisms, which can threaten not merely the resident but the entire community.

An antibiotic stewardship plan is a coordinated program that promotes the appropriate apply of antibiotics. Information technology tin help to achieve optimal outcomes, reduce side furnishings, save money, and forestall the emergence of drug-resistant leaner.

Practice Tips

• Learn about the appropriate employ of antibiotics.
• Antibiotics are not helpful when—
  • Used to treat an infection that is caused past 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 simply bacteria are found in the urine.

Communication Tips

• Be alert for the side effects of antibiotics and inform the supervisor if they appear.
• Share whatever concerns almost the antibiotic with the supervisor.

Survey Readiness

• Health care workers strive daily to provide the all-time care to residents.
• Regulatory agencies, such equally Country departments of health, survey LTC facilities to ensure that the highest level of care is being provided.
• Survey teams monitor compliance with Federal and Country wellness care regulations.
• Facility policies and procedures based on State and Federal regulations and bear witness-based practices will back up survey readiness.
• Surveys are mostly non scheduled in advance, so it's important to always be prepared.
• Every facility has a quality assurance performance improvement plan in place to proactively better the care of all residents and to back up survey readiness.

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OSHA Compliance

Key Messages

• OSHA was created to ensure a safety and salubrious work environment.
• The facility is required to have safeguards in identify to prevent health care workers from being injure or injured on the job, including from infections and infectious diseases.
• It is important that health care workers comply with all safeguards and piece of work practices to reduce the hazard of infection on the chore.

Bones Background

Almost LTC facilities accept a plan in place to accost the OSHA-required bloodborne pathogen standard.^six This programme sets out work practices that must exist followed. These work practices include—

• Offering the hepatitis B vaccine to whatsoever 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 material must be placed in a biohazard bag.
• Stating that all sharps, including needles and razors, must be placed into sharp containers.

Practice Tips

• Become familiar with the unlike work practices to prevent infection in the LTC facility.
• Promote prophylactic and forestall infection and tell your supervisor right abroad almost any hazards or unsafe work practices (such as dangerous equipment, inadequate safety equipment, or a lack of information well-nigh a work practise or piece of equipment).
• Staff should take actress intendance if they are stressed or tired as they could be putting themselves at greater risk for an occupational injury leading to infection.

Advice Tips

• Explain to the resident why a task is performed in a certain style to prevent infection.
• Tell your supervisor right abroad if you lot are stuck with a precipitous or otherwise injured at work; if not promptly addressed, it may lead to an infection.
• Ask your employer to provide staff with data about potential hazards in the workplace to go on everybody safe.

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References

1. U.S. Department of Health and Human Services. National Activity Plan To Forestall Healthcare-Associated Infections: Route Map to Elimination. Affiliate 8, Long-Term Care Facilities. April 2013. Accessed September 23, 2015.

ii. 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 Command. 2022 January;42(1):ii-6. PMID: 24388467.

3. Siegel JD, Rhinehart E, Jackson M, Chiarello Fifty, and the Healthcare Infection Command Practices Advisory Committee. Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006. Centers for Illness Control and Prevention. Accessed May five, 2016.

4. Siegel JD, Rhinehart E, Jackson M, Chiarello Fifty, and the Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Manual of Infectious Agents in Healthcare Settings. Centers for Disease Command and Prevention. Accessed May 5, 2016.

5. Go Smart: Know When Antibiotics Piece of work. Centers for Disease Control and Prevention. Accessed November 19, 2015.

half-dozen. Bloodborne Pathogens. Occupational Safety and Health Assistants. Accessed November 19, 2015.

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