Preventing the Spread of Infection in Long-Term Care Facilities

Anaheim­—In 2014, the Centers for Disease Control and Prevention (CDC) reported that >200 Americans die each day from a hospital-acquired infection. As such, healthcare professionals should be vigilant to reduce the risk of infection in healthcare facilities.

During an educational session at the NADONA conference, Steven J. Schweon, RB, MPH, MSN, CIC, HEM, FSHEA, outlined steps that both frontline care staff and the facility administration should take to prevent the spread of infection in long-term care (LTC) facilities.

The simplest and most effective way to prevent the spread of infection is practicing hand hygiene, Mr. Schweon said. An alcohol-based hand rub effectively kills most types of common microbes more effectively than soap and water, with the exception of certain germs, such as norovirus and Clostridium
difficile (C diff). Mr. Schweon suggested that each staff member keep a bottle of alcohol-based hand rub in the pockets of their uniforms for immediate and easy access. Another strategy for preventing the spread of infection is implementing a hand hygiene program for residents, for example, by requiring them to wash their hands before and after every meal. Additionally, administrators should remind staff and residents to cover their mouths and noses when they sneeze or cough and to wash their hands immediately afterwards.

LTC facilities are also responsible for providing a clean environment for residents, Mr. Schweon said. Although surfaces may appear to be clean, using the appropriate disinfectants is important for eliminating pathogens that can live outside the body and linger on surfaces for weeks. Mr. Schweon noted that Enterococus can live for up to 4 months, Acinetobacter and C diff can live for up to 5 months, Staphylococcus aureus can live for up to 7 months, and Klebsiella can live for up to 30 months. In particular, LTC providers should pay special attention to disinfect and to properly store bedpans and urinals to reduce the risk of cross-contamination.

Providing regular skin hygiene among older adults is crucial to prevent skin breakdown, which can lead to infection of the underlying tissue and bone. Staff should take care to reduce the risk of skin breakdown by keeping skin clean and dry; for example, they should change residents’ undergarments frequently, especially after episodes of incontinence.

“It is easier to prevent infection than it is to treat it,” said Mr. Schweon. To reduce the risk of transmission and outbreaks in LTC facilities, it is imperative that both residents and staff receive the recommended vaccinations. The CDC recommends annual influenza vaccination for all older adults and strongly advises it for all staff working in LTC facilities. In fact, many states have influenza and pneumococcal vaccination mandates for residents; however, judicious administration of vaccination is important, as most vaccines are contraindicated in older individuals with moderate or severe acute illness, with or without fever.

To reduce the risk of spreading disease during vaccination administration, Mr. Schweon reinforced the importance of following hygiene protocols, such as handwashing, wearing gloves, and properly disposing of equipment. Specifically, Mr. Schweon stressed the importance of using a separate needle and syringe for each injection, properly dating or disposing of used vials, and disinfecting glucometers after each use.  

Successful incorporation of these strategies requires good communication among staff and administrators, Mr. Schweon added. Additionally, LTC providers should routinely collect patient data, which can be used to improve performance, heighten awareness of infection control, identify trends, and ultimately prevent outbreaks of infection.—Melissa Cooper