long-term care infection prevention
By Buffy Lloyd-Krejci , DrPH , MS , CIC , LTC-CIP
Creating a Culture of Infection Prevention and Control Within Your Long-term Care Facility
It is no secret that a robust infection prevention and control ( IP & C ) program within a long-term care facility , aka nursing home , can literally save lives . Yet all too often , the IPC program falls on the shoulders of one individual , the infection preventionist ( IP ) and oftentimes , this one individual has little facility-wide support .
Recently , I was onsite in a nursing home conducting an IP & C supportive , boots-on-the-ground visit in a rural community . Let me set the stage . The IP had only been in his role for seven months with no prior IP & C or long-term care experience . Many of the leadership positions including the director of nursing ( DON ) and dietary manager were new . The facility employs agency nurses with a large percentage of staff traveling over two hours from a large metropolitan city . The IP took the 23-hour Centers for Disease Control and Prevention ( CDC ) training course 1 for his training . He has no mentor and no one to guide him . The previous IPs lasted only a few months , which greatly weighed on his mind . He mentioned that he does not have the time to fully dedicate to IP & C responsibilities , as he was also the wound nurse and often called to fill in where nursing gaps exist .
As we took the tour of the facility , it was evident that he was overwhelmed . He did not realize that it was his responsibility to evaluate environmental services ( breathing a sigh of relief when he learned that they were doing an excellent job ), laundry , or food services . He hadn ’ t had the time to implement the new CDC recommendations for enhanced barrier precautions , 2 had not fit-tested the staff for compliance to safely wear N-95 respirators , had not begun evaluating the appropriate prescribing of antibiotics , evaluating hand hygiene , transmission-based precautions , or safe injection practices . However , he wants to learn what to do and begin implementing these practices . He is dedicated and determined to be the best IP possible and deliver the safest care for the residents and staff .
While it makes sense to assign IP & C responsibilities to one person , every individual must implement IPC practices . From visitors , to executives , the responsibility cannot fall on the shoulders of only one individual . Yet , this is all too common the reality .
During my site visit , the IP asked me point-blank , “ Dr . Buffy , how do I get the staff to comply with IP & C practices ? This is my greatest challenge .”
I told him that it all starts with relationships and having support from his senior leadership , i . e ., the administrator and the DON . Without this support , it was going to be difficult . He told me that he goes out on the floor every day and talks with the staff , he works beside them helping with resident care . Elated , I told him he was on his way .
Next , to have a lasting I & C culture , every individual in the facility must be educated often on the best practices . Traditionally , training is conducted during new-hire orientation and then annually . Consider increasing this education and providing new and fun strategies to deliver the material . One fun way to
demonstrate the essential need to clean and disinfect the shared resident equipment after each use such as Hoyer lifts and vitals carts is to use washable paint and demonstrate how easily these “ germs ” spread .
When it comes to conducting infection prevention audits , consider encouraging the IP to delegate this task to other staff members . For example , have a certified nursing assistant ( CNA ) evaluate if their peers are conducting hand hygiene before and after leaving a room . The CNA is already working on the floor and can easily evaluate this practice . A simple tool such as the CDC ’ s ICAR hand hygiene audit tool , 3 can be utilized . In the kitchen , the dietary manager can verify daily that all temperature logs are completed ( and there are a lot ). For environmental services ( EVS ), a daily cleaning log 4 can be completed and provided to the EVS supervisor which in turn can be provided to the IP monthly .
Another strategy for creating a culture of infection prevention is communication . It is important that everyone within the facility has a voice and can communicate openly and honestly about concerns that they may have . This includes reporting any infections or outbreaks , as well as any lapses in infection control protocols , and supplies that they may need . This can be done through regular staff meetings , newsletters , email updates , and daily team huddles within each department . It is important that a representative from every department attends the daily stand-up meeting including the EVS and maintenance supervisors .
Simply put , now is the time to ensure that IP & C practices are integral to all our practices within long-term care and not simply a box that is checked when we have an IP onsite . Our vulnerable residents deserve to live out their days in an environment that prioritizes IP & C and therefore reduces the risk of cross contamination and infectious disease outbreaks . Our staff deserve support in implementing these practices . We , as an industry , want to be better , but this starts with individuals who commit . Individuals who stick with it . Individuals who can work toward a goal and not be dissuaded by setbacks . I believe this is possible .
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 . https :// www . train . org / cdctrain / training _ plan / 3814 2 . https :// www . cdc . gov / hai / containment / PPE-Nursing-Homes . html 3 . https :// www . cdc . gov / infectioncontrol / pdf / icar / IPC-mod2-handhygiene-508 . pdf
4 . https :// r . search . yahoo . com /_ ylt = AwrijnOcryFkYaME1ggPxQt .;_ ylu = Y29sbwNiZjEEcG9zAzUEdnRpZAMEc2VjA3Ny / RV = 2 / RE = 1679958045 / RO = 10 / RU = https % 3a % 2f % 2fapic . org % 2fResource _% 2fTinyMceFileManager % 2fAcademy % 2fASC _ 101 _ resources % 2fAssessment _ Checklist % 2fEnvironment _ Checklist . doc / RK = 2 / RS = EUPL1xPMmXATC3UBL8dcCd03ens-