Precautions for Prevention of Infection Transmission in Long Term Care Facilities
Last month I discussed the more common infections that occur in long term care (LTC) facilities. I will discuss how these transmissions can be prevented or reduced.
Preventing the spread of infectious organisms include using standard precautions with every resident and practicing hand hygiene before and after every resident contact. Identification of infectious organisms quickly and initiating appropriate treatment in addition to prompt isolation when indicated is imperative.
These are the precautions that must be in place to prevent the spread of infections:
- Standard Precautions
- Contact Precautions
- Droplet Precautions
- Airborne Precautions
Standard precautions apply to all residents, and all healthcare workers in any setting without a specific infectious process or diagnosis identified. The other precautions are transmission-based precautions that should be applied when a specific organism is known or suspected to be present in a resident. These precautions are applied in conjunction with standard precautions.
Standard precautions should be applied in all healthcare delivery systems.They are based on the concept that all body fluids may contain transmissible infectious agents. Standard precautions are designed to eliminate exposure to blood and other potentially infectious material (OPIM).
Standard precautions include proper hand hygiene and the use of gloves, gown, mask, face shield, eye protection and safe injection practices including the proper disposal of needles as indicated.
Contact precautions are designed to cut down on the transmission of organisms that are easily spread by contact with hands and other objects, and areas of the residents’ environment that may be contaminated.
Droplet precautions attempt to prevent the transmission of diseases that are easily spread by particle droplets produced when a person sneezes, coughs or talks. Wearing a simple surgical mask will protect the caregiver when entering the the room or cubicle. When the resident shares a room, spacial separation of three feet or more and drawn cubicle curtains are required.
Airborne precautions are designed to prevent the spread of disease by the true airborne route. The organisms leave the resident in respiratory droplets that evaporate into the atmosphere. Most organisms die when they dry out but tuberculosis, chickenpox, measles and smallpox can survive drying out and can be widely dispersed by air currents. These precautions require a negative-pressure airborne infection isolation room (AIR) with the door closed and use of an N95 respirator. Please follow the facility policy.
As we all know hand hygiene is the single most important procedure for preventing the spread of infection. All employees should be randomly requested to perform hand hygiene on a routine basis. This will encourage using the correct technique. The use of an alcohol based hand rub should not replace hand washing.
Inservice education on infection control issues is mandatory and a record of the occurrences must be maintained. The infection control procedure manual should be available for review by all employees as needed.
Follow the facility policies for the routine care, cleaning and disinfection of environmental surfaces, beds and bedside equipment. Proper decontamination and sterilization of equipment and supplies is important.
Linens must be handled, transported and processed in a manner that prevents contamination. Ensure that single use items are discarded properly Do not use single dose vials for several residents.
Food and drink should be be removed from places where blood or OPIM is present. Environmental controls help prevent the spread of infection by reducing the concentration of organisms in the environment. Housekeeping, waste management and linen (laundry) management must be performed with this concept in mind.
Before I conclude this blog, I would like to discuss the Occupational Health and Safety Administration (OSHA) requirements.
OSHA was established by an Act of Congress in 1970 “to assure the safety and health of American workers, by setting and enforcing standards, providing training and education, by outreach and establishing partnerships and encouraging continual improvements in workplace safety and health”.
OSHA came to the forefront in the healthcare environment with the emergence of the HIV virus and concern for the risk of healthcare workers acquiring the virus through patient contact.
The Bloodborne Pathogens Act became law in 1991 and Standards were put in place to provide workplace safety.
Employers should have an exposure control plan in place that makes universal precautions mandatory where all blood and body fluids (except sweat) are considered infectious.
- Personal Protective Equipment (PPE) must be available to employees at no personal cost.
- Employees who are in contact with contaminated laundry must wear gloves and other PPE as appropriate.
- All employees whose job involves tasks with potential exposure to blood and OPIM must be offered Hepatitis B vaccination. This vaccination is free, safe and highly effective.
- Provide bloodborne pathogen training to employees annually.
- Employers must provide safe needles and sharps containers their disposal.
As healthcare workers, we should remember if we do not explicitly follow these directives we are breaking the law and are subject to legal ramifications.
Refer to the OSHA website for a complete list of guidelines.
