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Prepare to prevent infectious outbreaks

September 14, 2011
by Sherrie Dornberger, RN, CDONA, FACDONA, Jane Kirk, RN, MSN, CIC, and Trina Zabarsky, RN, MSN, CIC
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Watchfulness, awareness and an action plan can reduce the risk of outbreaks
Jane kirk, rn, msn, cic
Jane Kirk, RN, MSN, CIC


Sherrie dornberger, rn, cdona, facdona
Sherrie Dornberger, RN, CDONA, FACDONA


Have you ever been at a meeting or conference and overheard someone say, “We have 2.3 hours per week for an infection prevention/control nurse”? Is this what is happening at your facility?

Infection prevention programs can make or break a facility along with the staff that oversees it. If the program makes the mistake of trying to do too much, reinventing the wheel, or culturing every “perceived” dirty surface in the facility, it is not only overwhelming, but it may discover information that you, your medical staff and your facility were not anticipating. Instead of doing random cultures or searching for organisms “to do something about,” use the information that you have readily available at your fingertips, sometimes on the computer screen in front of you!

F-tag 441 requires that the facility has an Infection Control (IC) program. The IC program enhances the long-term care facility and its residents in many ways.

MANAGING RISK

The risk assessment is the building block of an IC program because it identifies the factors that place residents and employees at risk for facility-acquired infections. The risk assessment also helps to determine what areas to focus on for surveillance and process improvement projects. It also highlights the need for prevention programs, such as an employee influenza vaccine program. Some accrediting bodies ask to see the IC Risk Assessment during survey, and presenting one provides strong evidence of an active IC program.

To get started on the risk assessment, remember no man (or woman) is an island. Teamwork is key. Plan a multidisciplinary meeting to get perceptions of what and where infection control risks are. Administrators, bedside nurses, unit nurse managers, therapists who are regularly at the facility, as well as the medical director should be included in this meeting. The goal is to have good representation of all disciplines that are employed at the facility and involved in resident care. Consider including the dietary manager as well as the maintenance and/or facility engineer.

Once the meeting is scheduled, prepare for it. Have an agenda with all the discussion items timed out so that the meeting time is used efficiently. Before the meeting, ask the attendees to review the previous year's records for documentation of infection control problems. Were there any outbreaks or clusters of infection? What were the problems and issues related to infection control during the previous year? Was there a water problem? Was there a problem with the water in the whirlpool? Were there pest control issues? A simple risk assessment includes five components:

  • Look at the resident population. Are there characteristics that put them at risk for infections? For example, is it a rehab facility that experienced several post-op total knee/hip infections? Or is this a pediatric long-term care population? Were a large number of patients admitted from the hospital with multidrug resistant organisms (MDROS) such as methicillin-resistant staphylococcus aureus (MRSA) or vancomycin-resistant enterococcus (VRE)?

  • Look at the services provided such as ventilator support, physical therapy including whirlpool, IV therapy, hospice or dementia unit. Maybe the facility has an active population that goes into the local community often or has an intergeneration program for schoolchildren.

  • Look at the risks such as ventilator-associated pneumonia, antibiotic-associated diarrhea, peripheral inserted central catheter (PICC) line associated bloodstream infection and employee illnesses.

  • Look at risk level. Quantify the risks either by numbering them in order of severity or frequency of occurrence. Identify and call out the biggest infection control issues. By prioritizing, it becomes apparent which problems need to be addressed and a plan can be developed to do so.

  • Look at prevention strategies. What can be done to decrease risk to the staff and residents? How can the infection rate be decreased? What issues should the team stay on top of and what issues can be let go of (just a little)? What processes need to be implemented to sustain improvement? Is a more robust hand hygiene program necessary? Should the environmental cleaning process be revisited? Does the policy and procedure for post-op dressing changes need to be addressed?

Infection prevention programs can make or break a facility along with the staff that oversees it.

Following completion of the risk assessment, formulate the infection control plan and annual goals-SMART goals, or Specific, Measurable, Aligned, Realistic and Time bound. In the continuum of infection control, the outcomes of the measures taken to decrease infections are tracked through surveillance.

INFECTION SURVEILLANCE

Investigate, prevent and control infections throughout the facility based on the risks identified through infection surveillance. Total house surveillance identifies every infection that occurs in the facility, and classifies those infections into categories of urinary tract, upper respiratory, lower respiratory, gastrointestinal, skin and soft tissue and surgical site infections.

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