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Title: Five Steps to Effective Infection Control in Long Term Care
Author: Joseph J. Tomaino, M.S., RN

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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:

  1. 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

  2. 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

  3. 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

  4. Follow state and local health department requirements regarding reporting of infections.

  5. 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 

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