long-term care infection prevention
long-term care infection prevention
By Buffy Lloyd-Krejci , DrPH , MS , CIC , LTC-CIP
Reduce the Threat of MDROs With This Three-Step Approach
According to the latest findings from the Centers for Disease Control and Prevention ( CDC ), more than 3 million antimicrobial-resistant infections occur each year in the United States alone , and more than 48,000 people die as a result . 1 Because they live in a congregate setting and often have multiple comorbidities , the risk of antimicrobial-resistant infections to long-term care facility residents is especially high .
There is good news , though : by taking appropriate measures , facilities can protect their residents from antimicrobial-resistant bacteria and fungi and save money . Let me explain .
Traditionally , when someone contracts an infectious or communicable disease , isolation precautions are used to stop the transmission . 2 However , long-term isolation for a resident infected or colonized with a multi-drug resistant organism is not appropriate as residents often live months or years in this healthcare setting . To top it off : nobody is happy when isolation precautions are implemented . Staff aren ’ t happy about the personal protective equipment ( PPE ) they must put on each time they interact with the residents . Residents aren ’ t happy about being isolated ( and long-term isolation has demonstrably negative effects on both health and overall happiness ). Families aren ’ t happy that their loved ones are unhappy . And facility leadership isn ’ t happy about the expense of additional PPE .
However , the very real threat of antimicrobial-resistant infections means that facilities cannot afford to ignore safety measures that will keep their residents safe . So , other than implementing long-term isolation precautions ( which are not currently recommended ), what can facilities do to keep residents safe from the growing threat of antimicrobial-resistant bacteria and fungi ?
One easy way to reduce the risk of a resident contracting an antimicrobial-resistant infection is to use hand hygiene frequently and appropriately . 3 That means using an alcohol-based hand sanitizer when entering and leaving a resident ’ s room , interacting with a resident , using the restroom , after eating , and so on . This is true for most clinical situations . Alcohol-based hand sanitizers are more effective at killing potentially deadly
germs that may be on someone ’ s hands than soap is , and they are easier to use when providing care in facilities . You can help reduce the potential spread of antimicrobial-resistant bacteria in your facility by posting signs and offering brochures reminding visitors , staff , and residents of the importance of hand hygiene and approved methods to clean their hands . 4
Alcohol-based hand sanitizer is far less expensive than the PPE required when isolation precautions are indicated . It ’ s also far less onerous for staff to use . Alcohol-based hand sanitizer may even help facilities address staff retention problems because its use can reduce the amount of time staff have to spend following isolation precautions . That may improve morale and make it more likely that personnel will stay onboard .
Along with promoting proper hand hygiene , facilities need to implement a strong antibiotic stewardship program . 5 Not only is this required for all licensed long-term care facilities , but research also suggests that the vast majority of antibiotics are prescribed inappropriately , which contributes to antibiotic resistance . 6-7 On top of that , studies consistently find that profligate antibiotic prescribing practices — up to 50 percent of all outpatient antibiotic use is inappropriate 8 — leads to local resistance patterns , 9 which contributes to the rise of multidrug-resistant organisms ( MDROs ). Infection preventionists ( IPs ) can help develop a strong stewardship program that , coupled with a facility ’ s infection prevention and control ( IP & C ) program , can help safeguard residents against the very real threat of antimicrobial-resistant infections .
Finally , facilities should implement enhanced barrier precautions . 10 I cannot say enough about how important this practice is in reducing the risk of spreading MDROs . These precautions are frequently misunderstood by healthcare personnel , residents , and families . At their core , they are intended to give facilities a way to protect residents who have been deemed “ high-risk ” from potentially contracting antimicrobial-resistant bacteria and fungi , such as C . auris , C . difficile , or drug-resistant Candida ( to name just a few ), while reducing disruption to residents and the staff who care for them . 11
Enhanced barrier precautions are indicated when a resident has a wound or indwelling medical device when high-nursing activities like peri care and bathing are being performed , or if they have an infection or colonization with an MDRO . These precautions , which are intended to reduce the need to isolate residents who may be most affected by MDROs , are only required in long-term care facilities ; because patients are generally only at hospitals for a short amount of time , isolation doesn ’ t have the negative impact that it does when residing in long-term .
Essentially , enhanced barrier precautions simply require people who care for anyone in any of the “ high-risk ” categories described above to wear a fresh gown and gloves and practice good hand hygiene . Because hand hygiene and fresh gowns and gloves reduce the risk of MDRO transmission , enhanced barrier precautions are a practical way to ensure residents can move around the facility safely , with minimum disruption to them and the staff who care for them .
Ultimately , by ensuring that your staff are engaging in proper hand hygiene , developing a robust antibiotic stewardship program , and implementing enhanced barrier precautions , your facility can help protect residents from the very real — and growing — threat of antimicrobial-resistant infections and MDROs .
Buffy Lloyd-Krejci , DrPH , CIC , LTC-CIP , is a leading authority on infection prevention in the long-term care industry . Her firm , IPCWell , delivers in-person gap analysis , training , and support to nursing homes across the country .
References :
1 . 2019 AR Threats Report 2 . Isolation Precautions 3 . Show Me the Science 4 . Clean Hands Count Promotional Materials 5 . Develop and Improve Your Stewardship Program 6 . CMS finalizes improvements in care , safety , and consumer protections for long-term care facility residents 7 . Antimicrobial Stewardship : Importance for Patient and Public Health 8 . Measuring Outpatient Antibiotic Prescribing 9 . Outpatient antibiotic prescribing and nonsusceptible Streptococcus pneumoniae in the United States , 1996 – 2003
10 . Consideration for Use of Enhanced Barrier Precautions in Skilled Nursing Facilities 11 . 2019 AR Threats Report
24 • www . healthcarehygienemagazine . com • february 2024