Managing airborne bugs
With so much attention paid to cleaning and disinfecting surfaces and items like linens, infection control-minded facilities often over- look the source of more than one-third of nosocomial infections — the air. Long-established airborne precautions are rarely used in long-term care facilities, according to the Agency for Healthcare Research and Quality. Experts advise how to reverse that.
1.Understand the risks. Influenza is by far the most prevalent airborne pathogen, and tuberculosis is the second most serious, according to Gina Pugliese, RN, MS, FSHEA, vice president emeritus of the Premier Safety Institute®. That's because the elderly are at high risk of reactivation of a old, latent infection, and early symptoms are not the usual cough and high fever.
Other common airborne infections include Norovirus, C. diff, MRSA, pneumonia, respiratory syncytial virus (RSV), parainfluenza, coronavirus, rhinoviruses, adenoviruses, disseminated shingles and human metapneumovirus.
Another surprise: Many of these also can spread in other ways.
“Illnesses transmitted through the air occur when infectious agents spread via the airborne or droplet routes. But contact with these germs can also spread these illnesses,” notes Deva Rea, clinical science liaison for PDI.
2. Know your facility's vulnerabilities. Airborne germs are opportunistic and seek weakness in places like heating, venting, air-conditioning and water systems.
“Legionella pneumophila does a great job of surviving in water and in ‘biofilms,' which can develop in water pipes and other man-made devices,” notes Deb Patterson Burdsall, Ph.D., RN-BC, CIC, FAPIC, an infection preventionist who also serves as faculty and author on various projects related to long-term care for the Association for Professionals in Infection Control and Epidemiology.
Ironically, the air itself is “a central yet often overlooked transmission vector for dangerous pathogens,” says Olivia Easly, marketing manager for Novaerus. And while airborne illnesses typically find a path through coughing and sneezing, germs easily can be aerosolized through such activities as bed making and vacuuming, she says.
Another vulnerability: group activities. “These activities may increase communicable infectious disease exposure and transmission,” Rea says. “The same is also true for occupational and physical therapy activities.”
3. Housekeeping and maintenance are vital to prevention. “Environmental service personnel are essential to infection prevention. Regardless of the pathogen, good environmental cleaning and disinfection are main prevention strategies,” Rea notes.
Facility maintenance workers are critical when dealing with certain airborne illnesses such as TB by providing monitoring of airborne isolation rooms under negative pressure, she adds.
Housekeepers should under- stand that shaking soiled linens can aerosolize germs, advises Bill Brooks, North American sales manager for UniMac®.
4. Preparing a rapid response to an emerging infection is critical. Pugliese notes that staff vigilance can prevent widespread infection. That's why it's important to understand the sometimes puzzling early symptoms of an illness such as TB. Once detected, “the usual principles of airborne isolation apply, which require negative pressure ventilation and t-tested respirators, per OSHA,” she adds.
“If an outbreak of any airborne- related illness occurs, it may be necessary to restrict admissions, visitors, and cohort residents with the same illness,” Rea says.
5. Know how to protect your most vulnerable residents. Immunocompromised residents can skew normal isolation precautions.
"With some viral illnesses such as influenza, RSV, norovirus and adenovirus, an immunocompromised patient may shed the virus for longer periods of time,” observes Rea. “So it's recommended to keep patients on isolation precautions for an extended duration.”
6. It bears repeating: Caregivers are often unwitting carriers and transmitters of airborne illnesses. That's why training and adequate and plentiful personal protectve equipment are essential.
Basic, sound personal hygiene practices such as regular hand washing and staying home when sick should be enforced. It's also not too late to receive a u shot.
As noted, coughed or sneezed aerosolized droplets aren't the only way pathogens reach the lungs. Germs on contaminated surfaces and hands have an insidious way of reaching the mouths and noses of patients. As Easly reminds, “the CDC and WHO have declared hand disinfection as the most important standard measurement of hand hygiene in healthcare facilities as it can lead — if correctly performed — to a drastic reduction of nosocomial infections.”
Mistakes to avoid
1. Relying on consumer-grade air filtration. The germ- laden air of nursing homes calls for industrial strength solutions. Consider air sterilization systems that eradicate, not filter, germs.
2. Overlooking vulnerable areas and practices. Biofilm in standing water is a breeding ground for illnesses. Shaking soiled linens can actually aerosolize numerous pathogens.
3. Neglecting to have air isolation precautions, including negative pressure rooms, available when a nasty airborne infection is first spotted.