Infection Prevention: Keep Your Organization Out of the News

Infection prevention and control in post-acute care is an everyday job, but the potential negative outcomes are far from mundane. Paying vigilant attention to infection prevention is important if you don’t want to end up making the news for outbreaks like these:

• In a Vermont retirement community, Shigella sonnei caused an outbreak of diarrhea among residents, staff, and visitors in 2018, according to the Centers for Disease Control (CDC). Investigative information supported foodborne transmission, CDC noted, with cases identified among a staff member and visitors. Analysis predicted that the isolates were multidrug resistant. Of the 75 cases identified, two patients with serious comorbidities died, and six patients were hospitalized.
• A Nebraska long-term care facility experienced an outbreak of respiratory illness with cough and fever in 2014. Before it was over, 55 people became sick with symptoms matching the respiratory illness, 12 were hospitalized, and seven died, the CDC reported. Testing found Mycoplasma pneumoniae in 40% of specimens, and the illness affected residents, staff, and community members.
• In Colorado in 2012, an assisted-living facility had an outbreak of severe respiratory illness that led to three resident deaths. During the outbreak, CDC and health department investigations found two confirmed and five probable cases of pneumococcal disease in six patients and one staff member. Three of the resident patients died.

These are just a few snapshots of tragic outcomes that can occur when infection outbreaks hit residents of post-acute care facilities and the people who care for them and visit them.

Besides these devastating outcomes, the incentive to monitor safety practices and prevent infections comes in the form of federal rules as well. The Centers for Medicare and Medicaid Services (CMS) requires that long-term care facilities have an infection prevention and control program and an antibiotic stewardship program to comply with the Requirements of Participation (ROP). Starting in November, Phase 3 of the ROP as proposed requires facilities to have an Infection Prevention and Control Officer on staff who is designated to lead the infection prevention and control program and serve on the quality assessment and assurance committee.

Infection prevention and control is every team member’s job; yet Infection Preventionists (IPs) have specialized skills to lead the charge. As Amanda Thornton, RN, MSN, CIC, noted in a Relias webinar on the role of IPs in long-term care, they are trained to monitor the environment and people’s behavior, spot the risk factors, analyze data, and take steps to limit the spread of infection.

Eight Areas of Focus to Keep Your Patients and Staff Safe

Providing training can help increase awareness among all staff and increase your facility’s or home care setting’s defenses against healthcare-associated infections. These specific areas of training as they relate to infection prevention and control are of significant importance:

1. Infectious disease processes
2. Antibiotic stewardship
3. Healthcare-associated infections
4. Isolating precautions
5. Bloodborne pathogens
6. Multidrug-resistant pathogens
7. Hand hygiene
8. Safe food handling

As noted, the ROP requires skilled nursing facilities to have antibiotic stewardship programs, which are a key tool in the fight against infections. The CDC has identified seven core elements crucial to antibiotic stewardship:

• Leadership commitment to appropriate antibiotic use.
• Accountability among physicians, nurses, and pharmacy leads.
• Drug expertise gained by consulting with pharmacists or other experts.
• Actions to improve antibiotic policies and practices.
• Tracking antibiotic use and outcomes.
• Reporting to keep the team informed about antibiotic use and resistance.
• Education about antibiotic resistance for clinicians, nursing staff, residents, and families.

Strategies for Providing Care in the Home

Looking at post-acute settings outside skilled nursing facilities and assisted living communities, home health nurses also have infection prevention and control responsibilities. Similarly, home health agencies are subject to the Conditions of Participation (CoPs), which CMS updated in 2018 to require that an agency establish, document, and maintain an infection prevention and control program—as a component of its QAPI program—to prevent the transmission of infections and control communicable diseases.

Because home settings are less controlled environments and cultures and lab tests are not routine as in acute care, the infection risks are complicated by different factors. The CDC suggests home health infection strategies should focus on identifying patients at risk during wound care, respiratory care, infusion therapy, enteral therapy, and urinary tract care. Nurse education is key.

CMS and the CDC identify six standard precautions during patient care in the home:

• Hand hygiene.
• Environmental cleaning and disinfection.
• Injection and medication safety.
• Appropriate use of personal protective equipment.
• Minimizing potential exposures.
• Reprocessing of reusable medical equipment between each patient and when soiled.

Compliance depends on education about infectious diseases as well as on clinical skills. A study published in December in the American Journal of Infection Control found that home healthcare workers’ beliefs about infection risk were more important than knowledge about how to comply with infection prevention protocols in terms of their actions. The authors concluded that more efforts to educate nurses about infection risk would aid compliance in home health settings.

The study notes the importance of educating home health nurses about the efficacy of the influenza vaccine, hand hygiene protocols with nursing bags, and wearing personal protective equipment when anticipating contact with bodily fluids or blood products.

The charge to improve education, policies, procedural skills, tracking of compliance, and reporting on improvements is crucial to improving infection prevention and control efforts in post-acute care and keeping residents and clients infection-free and out of the hospital.

You can strengthen your team’s approach by assessing competence and providing training to keep everyone at their best. You want to ensure that your organization gets attention for infection prevention improvements, not tragic outbreaks.