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Title: Five Steps to Effective
Infection Control in Long Term Care
Author:
Joseph J. Tomaino, M.S., RN
Five Steps to Effective Infection
Control in Long Term Care
Joseph J. Tomaino, M.S., R.N.
Probably no other category of
illness has such major implications or unpredictability
of outcome for a health care provider than infection and
septic shock. A "simple" urinary tract infection can
evolve into urosepsis and a resource intensive course of
therapy in critical care. Urosepsis alone is the major
cause of death of adults over 65.
It is for this reason that
prevention of this complication must be one of the
health care provider's highest priorities. Being
vigilant to preventive measures is imperative.
Something as simple as handwashing is critical to the
spread of infection. But so often, this simple approach
is neglected.
As the health care provider tracks
and trends lengths of stay and tries to identify
variances which result in a longer stay than
anticipated, infection should always be considered.
When looking at infections, it is important to
differentiate between community acquired and nosocomial
infections. For example, when looking at pneumonia in a
subacute setting, it is important to differentiate
between an increase in pneumonia in the general
population during the flu season, and infections which
may be acquired in the facility due to care related
issues.
The way to differentiate the two is
line listing of infections. For each patient with an
infection, list the site of infection, the organism,
sensitivity report, date of admission and date of
symptoms onset. Then categorize together all of the
patients with the same site and organisms, then drop off
the infections which occurred within 48 hours of
admission (not enough time for incubation of a
nosocomial infection). Then take the patients with the
same site and organism and look at the sensitivity
reports. If the sensitivity to antibiotics is variable,
it is unlikely that the infections came from a single
source. If on the other hand, the sensitivities are
identical, it is unlikely that they were randomly
acquired community infections.
Once sepsis occurs, aggressive
monitoring, antibiotic therapy, and fluid management are
critical for successful outcome. In some cases, the
timely diagnosis of infection initiation of antibiotic
therapy can make the difference between life and death.
Ineffective management can result in extended periods of
illness. Cost issues regarding antibiotic therapy can
be complicated. A tradition step approach to
antibiotics, starting with standard and less expensive
ones and then advancing to newer, more expensive ones if
they don’t work may seem cost effective. But if going
to the newer "big guns" earlier may result in shorter
period of illness and need for critical care. On the
other hand, if you jump to the "Big Guns" and they don't
work, where do you go next?
These steps should be followed in
the continuing care setting to ensure that infections
are controlled:
-
Monitor new admissions as well as existing patients
for evidence of infections; if an infection is
identified, determine if it is community acquired
(prior to admission to your program) or nosocomial
-
Begin a line listing of each infection so it can be
tracked from start to finish, including the organism
causing the infection, the sensitivity report, the
treatment used, and the date of resolution
-
Identify patterns of infections that may indicate
they may be spread by the facility or staff; such
patterns may include several patients on a unit
having the same source organism with the same
antibiotic sensitivity report indicating they shared
the same source, or a geographical distribution
pattern of an infection that may indicate the spread
by poor hand-washing
-
Follow state and local health department
requirements regarding reporting of infections.
-
Educate staff with information gained through above
steps as to how they can prevent the spread of
infections in your particular setting
Following these steps will help
ensure that your patients and staff are protected from
unnecessary infections, and that you will enjoy higher
success with your clinical outcomes.
© Copyright, All rights reserved,
Joseph J. Tomaino, The Tomaino Group, 834 Heritage
Court, Yorktown Heights, NY 10598
www.continuingcareinsite.info
Email:
jtomaino@continuingcareinsite.info
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