In last month’s blog I discussed the precautionary measures in place to prevent the transmission of infections that can occur in residents of Long Term Care (LTC) facilities. Now, I will discuss the most important aspects of a good Infection Control (IC) program and the nurse who is in charge of it.
The Centers for Medicare and Medicaid (CMS) regulations address the need for a comprehensive program that include surveillance of infections, implementation of methods for preventing the spread of infections; including the use of isolation measures when necessary, hand hygiene practices and the appropriate handling, processing and storage of linens. Health protocols for preventing infections by employees and residents should also be included. Policies and procedures relevant to Infections must be in place and readily available.
LTC facilities are required to establish and maintain
an IC program designed to provide a safe, sanitary and comfortable environment and to help prevent the development and transmission of disease and infection.
During a survey, surveyors will request to see this program and a list of residents/employees who had acquired infections during the previous year.
CMS has also established a final rule requiring LTC facilities offer annually, to each resident, immunization against influenza and offer a lifelong immunization against pneumococcal disease. Furthermore, each resident or their legal representative must receive education on the benefits and potential side effects of the immunizations prior to administration of the immunizations. A written consent and acknowledgement of the information must be signed by the resident/legal representation and maintained as part of their medical record. Review of residents admitted to facility with infections or on antibiotics should be included and should indicate “admitted with”.
The IC nurse is an essential component of a good infection control program who is designated by the facility to be responsible for it. They should be a registered nurse, who has received formal infection control training and has the ability to interact tactfully with personnel, physicians, residents and their families. It would be beneficial for the IC nurse to belong to a professional organization, in order to keep abreast of any current prevention and control information. Peer networking is also very valuable. Based on the size and staffing of the facility, this should be a full-time position if possible.
All direct care nurses should be observing their residents for any signs of infections as well as observing the medication administration record (MAR). I have always advised my nursing staff that there are two reasons for a resident receiving an antibiotic, (1) they have an infection or (2) it is prescribed prophylactically.
One of the better Infection Control Programs I have seen
included the following components:
- The direct care nurse identified the resident with an infection, notified the physician and received appropriate orders.
- The nurse then filled out the IC report sheet.
- By the end of the shift, this form was given to the IC nurse.
The information in the report should include:
(1) Residents name and room number.
(2) date and time of onset of symptoms
(3) date and time of physician and family notification.
(4) cultures or x-rays if ordered.
(5) Antibiotics ordered, including name, dose, and duration.
(6) Type of isolation if indicated.
Upon receiving this report the IC nurse begins surveillance of the infection. This should be done timely and includes record review, laboratory and radiology reports, treatment reviews, antibiotic usage data and clinical observations as sources of data. It should also be determined if this was a healthcare associated infection (HAI). This surveillance should be performed for each infection identified. The causative organism should be added to the report when identified.
Analysis of the surveillance reports should be done weekly or monthly. Computerized graphs and charts can assist in compiling data and it is important to identify causative organisms and trends in areas of the facility where similar infections occur. Other elements necessary for a good IC program include: outbreak control requires a system for detection, investigation and control of epidemics. Preparation for this event should be in readiness at all times.
Isolation: An isolation and precaution system to reduce the risk of transmission. Keep in mind that elderly residents can become easily depressed when isolated, therefore isolation should be for the shortest possible duration and modified if appropriate.
Education: continuing education in IC prevention and control is mandatory. Education on the principles of IC for employees should begin in orientation. We are all aware of the high rate of employee turnover in LTC facilities. Frequent review of the many aspects of the Infection Control Program should be presented and random monitoring of correct handwashing technique is very necessary.
Resident and employee health programs. Follow federal and state requirements and the facility policies. Disease reporting to public health authorities may vary from state to state. Infection control protocols for facility management, including environmental control, laundry services, waste management, sterilization and disinfection must be in place and followed.
Antibiotic stewardship is of vital importance. Antibiotic utilization and appropriateness should be monitored for each resident. Antibiotic resistant bacteria pose a significant hazard in LTC facilities and this resistance has been strongly associated with antibiotic use. Antimicrobials are the most frequently prescribed medications in LTC facilities.
The IC nurse should oversee all aspects of the program and should have well defined support from administration and have additional support staff depending on the size of the facility. Some LTC facilities have an infection control oversight committee in place to review IC data, review policies and monitor program goals and activities. The committee should meet monthly and should consist of IC nurse, administrator, medical director and nursing supervisor or their designee. Written records of the meetings should be kept.
Over the last three months, I presented blogs on infections, precautions and control programs. I hope they have been beneficial.
No comments:
Post a Comment