Infection management strategies can reduce hospital readmissions, experts say
Long-term care facilities with an outbreak of influenza-like illnesses may want to consider running viral panels, as well as increase measures to prevent and promptly treat pneumonia, two infection control experts said Friday.
Residents may appear to have a cold, an influenza-like illness, pneumonia or a lower respiratory infection, said Deb Burdsall, MSN, RN-BC, CIC, a doctoral candidate and an infection preventionist at Lutheran Home/Lutheran Life Communities during a session at the LeadingAge Illinois conference.
“Viral identification is really important,” she said. “Running a viral panel can be a fascinating way to see what's floating around your facility.”
Residents may have a traditional seasonal flu, but could also have RSV or adenovirus, which would have similar symptoms, she noted. While viral panels are not cheap, running between $300 and $700, they may be needed during an outbreak in order for a long-term care facility to treat residents appropriately.
Residents must be assessed frequently for pneumonia, Burdsall said. Prevention efforts include vaccinating residents for flu and pneumonia and having a top-down directive that people with “just a cold” should not be in the facility. This includes employees and visitors.
When pneumonia appears, long-term care facilities have the ability to treat residents rather than send them to the hospital, she said. But nurses need to be trained on doing IVs and should be able to use laboratory services, and have someone available with respiratory therapy experience.
Nurses also need to be trained on how to talk to the physician on-call or medical director and give the appropriate information in a time-efficient manner. Theodore M. Homa, MD, CMS, medical director at Lutheran Life, stressed the importance of communication, especially with regard to a resident with a change in condition. That may mean a nurse needs to call repeatedly or move up the food chain to calling the medical director, and to present the information with correct facts, such as vitals. That is more likely to guarantee the resident receives the appropriate intervention for a condition such as pneumonia without being sent to the hospital.
“My confidence level in the person on the other end of the phone makes a big difference,” he said.
While a physician would likely recommend a broad-spectrum antibiotic initially to treat what appears to be pneumonia, that can be adjusted to the “least expensive and most efficient” medication after cultures return results, Homa said.
Homa and Burdsall also spoke of strategies to reduce sepsis in long-term care residents, who are especially at risk if they have weak immune systems, are undergoing chemotherapy, have inflammatory bowel disease, have rheumatoid arthritis or have received an organ transplant. Taking tubes out, increased hydration and increased oral hygiene initiatives all reduce the risk of a resident developing sepsis, Homa said.
The LeadingAge Illinois conference took place in Rosemont,IL and concluded Friday.