long-term care infection prevention
long-term care infection prevention
By Buffy Lloyd-Krejci , DrPH , MS , CIC , LTC-CIP
Aligning Infection Prevention and Control With Safety Codes in Long-Term Care Facilities
For the past eight years , my team and I have worked with hundreds of long-term care facilities throughout the United States to implement infection prevention and control ( IP & C ) measures that simultaneously comply with Centers for Disease Control ( CDC ) and Centers for Medicare and Medicaid Services ( CMS ) requirements and lower the risk of infectious disease outbreaks among residents and staff . One of the biggest barriers to achieving these goals : many times , facility staff believe IP & C best practices directly conflict with life , fire , and health safety codes .
Given the frequency with which we encounter this perspective , my team and I have spent a lot of time educating ourselves about how to align IP & C with survey requirements around safety codes . What we have come to realize in the course of our research is that , when implemented according to regulatory guidelines , IP & C measures generally don ’ t contradict safety codes .
Take alcohol-based hand rub ( ABHR ), for example . CMS guidance states that facilities should put ABHR with 60 percent to 95 percent alcohol in every resident room ( and ideally , outside of each room , as well ). ABHR should also be placed in resident care and common areas . 1 However , despite this guidance , the majority of facilities we work with believe they ’ ll get cited for violating fire safety codes if they have that amount of ABHR in their buildings .
To avoid being cited , facilities often choose to use soap and water for hand hygiene instead . However , this isn ’ t always a good solution : CDC and CMS guidance clearly states that , unless hands are visibly soiled , an alcohol-based hand sanitizer is preferred over soap and water in most clinical situations . 2
When we dug deeper into the guidance and regulations , we discovered that fire safety codes around ABHR can be adhered to while still following CMS guidance . For example , fire safety codes require that hand rub solutions do not exceed 95 percent alcohol content by volume . The capacity of the ABHR dispensers used must not exceed 1.2 liters ( 41 ounces ) for dispensers located in rooms , corridors , and areas open to corridors . Dispensers located in suites of rooms separated from corridors can have a 2-liter capacity ( 67 ounces ). Furthermore , facilities can have up to 10 gallons aggregate of ABHR within a single smoke compartment ( this amount is not inclusive of one dispenser per room ). 3
Reading through these safety codes , you can readily see that long-term care facilities should be able to easily follow CMS ’ s ABHR guidance while staying within fire safety code parameters .
Sometimes , facilities — particularly those with dementia units — also express concerns about residents consuming ABHR . To help mitigate this possibility , facilities can conduct an assessment to determine whether the risk of a resident getting into ABHR is greater than the risk of infections spreading because ABHR was unavailable .
If a facility determines that a resident ( or residents ) is likely to consume ABHR , there are solutions available other than
eliminating the sanitizer altogether . For example , perhaps the dispensers can be placed higher on the wall where they ’ re harder for residents to easily access . If that isn ’ t a viable solution , staff may be able to clip small bottles of ABHR onto their uniforms or wear a small bottle of ABHR on a lanyard . Ultimately , there ’ s no one right answer : facilities may need to find creative ways to keep residents safe while maintaining compliance with safety codes and IP & C guidelines .
Another fear facilities commonly express is regarding cleaning microfiber mops and towels . Healthcare-grade versions of these products are highly effective at picking up dangerous microorganisms . However , these products must be dried in a dryer ; if they are allowed to simply air dry , they can transfer those microorganisms to other surfaces and cause cross-contamination . Therein lies the sticking point : there are fire-associated risks with drying microfiber in a commercial clothes dryer , so many facilities opt to line dry .
To keep residents safe , the best course — and the course required by CMS — is to review and follow the manufacturer instructions for use ( IFU ) for laundering the textile . 4 If the IFU states that the microfiber mop or towel should be dried in the dryer , facilities should begin doing so , and at the appropriate heat setting . To reduce the risk of fire , staff should inspect and clean all lint in the dryer case , exhaust pipes , and / or traps daily ( this is also a life safety code ).
As you can see , when it comes to ABHR and microfiber cleaning products , IP & C measures can absolutely be implemented while still maintaining compliance with life safety codes . And this pattern holds true in every aspect of IP & C — by reviewing the updated guidance that surveyors are using , 5 each facility ’ s on-site infection preventionist ( IP ) can ensure compliance is maintained with IP & C , fire , health , and life safety codes .
There ’ s no question that it ’ s a lot to keep track of . However , at the end of the day , this truly is the best way to reduce the possibility of infection outbreaks , keep residents and staff safe , and ensure that IP & C protocols — from laundry to environmental services , hand hygiene , food prep , and more — comply with safety code regulations .
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 . CMS Announces New Measures to Protect Nursing Home Residents from
COVID-19 2 . Ibid . 3 . Fire Safety and Alcohol-Based Hand Sanitizer ( ABHS ) 4 . Guidelines for Environmental Infection Control in Health-Care Facilities 5 . Nursing Homes
28 august 2023 • www . healthcarehygienemagazine . com