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Stemming contagious outbreak

September 1, 2010
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Infection control update from an APIC veteran

Did you miss out on the Association for Professionals in Infection Control and Epidemiology (APIC) Annual Conference this past July in New Orleans? Long-Term Living Editor Kevin Kolus caught up with Patricia A. Rosenbaum, RN, CIC-and a 20-year active member of APIC-on the trending topics affecting providers.

Were there any discussions at this summer's APIC conference concerning long-term care?

Rosenbaum: This year there was an overall objective, which is using scientific-based and evidence-based information to create policies and procedures for use in healthcare facilities. It is important for people in long-term care to have the same goal as hospitals do, and that is to reduce the infection rates to zero.

One issue that was talked about at the conference specifically about long-term care was the implementation of isolation precautions in LTC facilities and how you customize those precautions. In hospitals we place people in isolation precautions, without even thinking about it, for their entire stay. Since residents in long-term care may be there for the rest of their lives, you can't isolate. So the isolation presentation talked about the things you'd need to consider when placing your resident on precautions or not placing them on precautions.

Infection preventionists [IPs] need to have a program that determines which residents will need isolation precautions, with the primary goal of preventing transmission. This kind of program includes good hand hygiene protocol, ensures environmental services are doing a good job cleaning a facility, and identifies infections when they occur. IPs must also ask, if a resident has to be put on special precautions, how do I determine if he or she needs transmission-based precautions tailored to how the organism travels? The critical concern for the IP in long-term care is making that assessment of the resident and determining what type of precautions to take if they have an infection or colonization of multidrug-resistant organisms.

What do the changes to F-tag 441, Infection Control, mean to providers?

Rosenbaum: The wording remains the same, however the instruction and intent and spelling out of indicators to surveyors has been edited. So what they've done is they've taken F-tags 442, 443, 444, and 445 and made them a part of 441. And they did that for a reason: It makes it easier for surveyors to see the whole picture of infection control at a facility.

Providers should have already been complying with this tag, and if you're an IP in a facility, you already know what to have in place. Based on new information that has come to light, this change helps the IP create a better program. If the IP needs to make changes, he or she can in turn go to his or her administrator for the resources. And I can give you an example of that. One of the things they talk about in the new 441 change concerns the judicious use of antimicrobials in a facility. To me that would say I should be using an antibiogram so I know what antibiotics are used in my facility. And what kind of microorganisms are we seeing in our facility? That's important because not all facilities are the same, so they may have their own set of organisms with their own sensitivity to antibiotics. A pattern will emerge when you are following this. It then becomes very important for the medical director and the administrator to also be aware of this antimicrobial use in the facility and this should be reported at infection control meetings.

Patricia A. Rosenbaum


Providers should also be doing process surveillance. This is different from outcome surveillance where you are collecting data, seeing how many infections are in the facility, what kind of infections. Process surveillance involves observing if people are using hand hygiene correctly. If you have residents on precautions, staff should be observed to see if they are putting on gowns properly, if they are wearing masks, if they are putting on gloves and taking them off and using them in the appropriate manner. My bets are that most people are doing hand hygiene observations-I don't know about the rest.

The CDC recently reported a 28% drop in cases of MRSA contracted in hospitals from 2005 to 2008. Is there a takeaway here for other healthcare providers?

Rosenbaum: It is important in this respect: You know there has been a very vigorous, aggressive campaign in acute-care settings to prevent the transmission of multidrug-resistant organisms, particularly MRSA. What this is telling us is that it works. That if you put these things in place and you practice good hand hygiene and good preventive strategies, you can control these resistant organisms, or you can decrease them. This should be a heads up in long-term care, although the environment in long-term care makes it difficult because we cannot isolate everyone, but we can encourage-not even encourage, we must insist on good hand hygiene and good environmental cleaning.

Patricia A. Rosenbaum, RN, CIC, is currently an independent consultant in infection prevention and control and has more than 22 years experience in long-term care. Rosenbaum has also been a member of the APIC Board of Directors, completing her third term in 2007. Long-Term Living 2010 September;59(9):48

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