Infection control feature: Taking control

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Nursing homes face a multitude of infection control challenges, and the job isn't going to get less complicated any time soon.

When federal officials decided this summer to mandate all nursing home residents receive influenza and pneumonia vaccinations, it was another aggressive salvo in an ongoing war.

In an increasingly intense battleground against infectious diseases, stakeholders – including providers – realize infection control is where lives, and fortunes, can be saved or lost. Hospitalization of residents is one of the most costly and disruptive occurrences for facilities, and it happens tens of thousands of times per year.
That's why the Centers for Medicare & Medicaid Services set a goal of raising vaccination levels to 90% by 2010. By optimistic estimates, the rate is still at least 20 points short of that for flu, perhaps more for pneumonia.
Vaccinations are a top priority of virtually every long-term care facility's infection control plan. And that includes getting workers shots, as well. A lower percentage of nursing home workers currently get vaccinated, even though they might transmit diseases to more frail, elderly people than any resident would.
Along with vaccinations, however, key elements of an infection control plan include basic hygiene, personal protective equipment (PPE), sharps-safety and education issues.
"One of the greatest challenges for infection control professionals is to assure compliance of all their staff to isolation practices. The key to this is providing educational updates to the staff as to what their specific roles should be," said Janet Franck, an author of the long-term care chapter of the new manual from the Association for Practitioners of Infection Control and Epidemiology (APIC).
"One step is a staff nurse should be making sure the appropriate sign is hung and necessary PPE is accessible, and also provide the appropriate education to family members and visitors. And they need to document in the chart that they've checked and the equipment is available and provided," added Franck, the president of Consulting Professionals Inc., Chicago.

Getting a handle
"We don't make it easy for our employees to comply," Franck said. "That's why creative educational innovations are essential. Sometimes an isolation sign might have a font that's too small or there are language barriers with visitors. Surveyors are identifying that as a deficiency because staff are not always providing enough information."
Currently the overseer of infection control programs at five nursing homes, Franck said some tools are better than ever for staving off the spread of infection. She is a big proponent of the alcohol gel dispensers approved over the last few years by federal agencies for mounting outside resident rooms and many other locations.
"Now we have a means of cleansing our hands very quickly, with easy access throughout most of the buildings," Franck said. "ICPs need to do whatever it takes to get these installed in areas where they feel they are needed."
She said she also is a fan of disposable wipes, for clean-up after residents visiting the dining areas, for example.
"We put a lot of focus on healthcare workers having clean hands but sometimes forget residents need to clean their own hands, too," she said.
"We all learn it. We just don't do it enough," added Jean Fleming, an infection control expert with New York-based PDI, which makes alcohol gel dispensers and other sanitizing products.
She called for more emphasis on infection control in long-term care facilities and was one of many to say that ICPs often have too many other responsibilities.
"A lot of people are using their assistant DONs as the be-all, for everything. The trainer, the infection control practitioner, the QA person. She's there to sign when no one else is, takes the other girls' place," observed Peggy Pass, infection control epidemiologist at Johns Hopkins Hospital in Baltimore. "You can't do it with your left foot. Infection control doesn't work real well that way."
Pass sympathized with nursing home operators, calling them "the sub-acute facilities of 10 years ago." She noted that many