Many efforts to implement best practices in healthcare settings concede one fundamental universal truth: Successful change doesn’t happen in a vacuum. When it comes to implementing infection control procedures that minimize adverse events and maximize survey results, a multidisciplinary approach can be powerful.
- Leave no one out. Engage top stakeholders, says Amanda Thornton, RN, clinical science liaison for PDI.
From there, “Build a core group of ‘champions’ to be on an interdisciplinary team, and have them help to recruit and retain other multidisciplinary members that can support infection control initiatives,” she says.
“Everyone must all be on the same page to efficiently and effectively assess a facility’s needs,” adds Medline’s Rosie Lyles, M.D., director of clinical affairs. As a clinical investigator at Chicago’s Cook County Health and Hospitals System, she quickly learned every long-term care facility has its own special challenges. “Engaging everyone, including those nurses practicing at the bedside and environmental staff, can help identify areas in need of improvement.”
Patrick Kehoe, marketing supervisor for 3M Commercial Solutions’ Cleaning Chemicals Portfolio, believes, “Anyone who comes in contact with a patient or staff needs to be aware of the facility cleaning protocols and standards. The entire facility needs to commit to a comprehensive cleaning/disinfection plan.”
Success also entails evaluating your facility’s infection prevention and control program (IPCP), according to Pam Campbell, product owner at PointClickCare.
“Once opportunities for improvement are identified, create and implement an action plan and add it to your infection quality assurance agenda for ongoing monitoring and review,” she says.
2. Pay close attention to gaps in practice.
Mary Madison, RN, clinical consultant, LTC/Senior Care for Briggs Healthcare, says big gaps are in employee flu vaccinations and immunizations, and employees working when ill.
Medline’s Lyles suggests performing a gap analysis (free tools for which are provided by the Centers for Disease Control and Prevention), which can help identify overlooked areas and promulgate infection prevention strategies.
Another gap is complacency in the use of personal protective equipment. As Karl Seagren, environmental product consultant for Direct Supply, notes, PPE should be standard procedure, even during brief resident interactions. Among the biggest violators are non-nursing staff in administration, housekeeping and foodservice.
Some of the other less obvious infection control practices that tend to be overlooked include cleaning shared equipment such as glucometers, gym equipment, dining equipment, bathing equipment, walkers and wheelchairs, Thornton adds. Cross-contamination from poor hand hygiene when entering and leaving a resident’s room also is common.
Steven Antokal, RN, BSN, CCCN, CWCN, DAPWCA, Director of Clinical Education for DermaRite Industries, stresses the importance of preventing cross contamination when providing wound care.
“Wound care supply carts should remain outside of resident care areas; if multi-dose wound care medications are used, they should be dedicated to one resident,” he says. “Facilities should refer to their individual infection prevention and control program policies and procedures.”
3. Be aware of the most common survey deficiencies.
The most frequently cited new survey tag across the country is F-880, which requires facilities to establish and maintain an infection control and prevention program.
Ellen Kuebrich, chief strategy officer of Providigm, offers the following most common survey deficiencies around infection control: appropriate implementation of hand hygiene, PPE use, transmission-based precautions, linen storage, handling and transport, infection surveillance and a facility’s overall infection control and prevention program.
For industry veterans that include Madison, one of the most overlooked practices linked to deficiencies are simply “bad habits,” particularly in areas such as handwashing, glove use and isolation techniques and precautions.
4. Engage staff. Anyone immersed in infection control rules and best practice agrees that a fully engaged facility staff is critical.
“Infection control is not just for environmental services, as an effective strategy involves the entire facility onboard,” Kehoe says.
That means supporting culture change as a means to allow everyone from maintenance workers to administrators “to speak freely about what’s working and what’s not,” Lyles says.
“With direct and indirect contact of patients, it takes a village to prevent an infection and to have high compliance with all infection control practices,” she adds.
Education for staff and residents, public posts about facility infection rates, and holding staff accountable through audits and performance improvement activities are additional options.
Madison offers another engagement tip: Invite all department heads and at least one member of each department to be on a facility’s quality committees.
Mistakes to avoid
—Confining the work of facility-wide infection control to a silo. Recruit participation in every facility area from maintenance to nursing to administration.
—Ignoring commonly overlooked mistakes. When a facility-wide handwashing drought is exposed during a survey, it’s too late.
—Promoting enthusiasm by memo. Successful implementation of vital infection control and prevention programs requires thoughtful engagement and buy in from all kinds of staff positions.