The Basics of Preventing Infection in Long Term Care Facilities

gloves and mask

Infections pose a significant threat to the frail elderly in long-term care (LTC) settings, often resulting in life-altering complications and even death. The incidence of infection is considerable, accounting for half of all hospital admissions for LTC residents1. The health implications are serious: When infection is the primary diagnosis, mortality rates can be as high as 40%.

The top three health-care acquired infections in the long-term care setting are those of the urinary tract, respiratory system, and skin and soft tissue. And infections, as a whole, remain a persistent problem in long-term care. Among the cases reviewed by Excelas from 2010 to 2012, infection was an identified issue in 35% of claims and litigation, on average (27% in 2010; 36% in 2011; and 41% in 2012).

Infection transmission occurs most frequently by direct contact between healthcare workers and residents, often leaving caregivers as the unwitting vehicle for transmission as they travel from person to person providing care. LTC facilities should be actively working to reduce the risk of infection in their residents by implementing a variety of simple safeguards:

  • Regular Hand Washing—Hand washing with soap and water, or an alcohol-based hand-hygiene product, is the #1 safeguard in reducing the risk for infection.
  • Protective Equipment—All blood, bodily fluids, secretions, mucous membranes, or body tissue are potentially infected and should be handled as such. Personal protective equipment (PPE) such as non-sterile gloves, a fluid-resistant gown, masks, and eye protection should be utilized for any healthcare activity to minimize exposure to body substances.
  • Disinfection Practices—Any equipment used for multiple patients, such as blood glucose monitoring devices or electronic IV pumps, must be properly disinfected between patient use.
  • Proper Linen Procedures—Proper handling of linen is essential in preventing the spread of infection. Dirty linen should be covered and must be clearly separated from clean linen. Once linen has been brought into one patient’s room, it should not be taken to, or used in, another patient’s room. All facilities must provide appropriate laundering for soiled linens.

Even when all of the available safeguards are properly implemented, infections can still occur. Once an infection is suspected or diagnosed, appropriate isolation precautions should be implemented to prevent further transmission. The nature of these precautions will depend on the infection that is suspected or diagnosed. Isolation precautions will fall into one of the following categories:

  • Contact isolation is implemented for infections that are spread by direct or indirect contact (i.e., the bacteria or virus can be acquired by touching the infected site or body fluids, or by touching contaminated equipment). Infections such as Clostridium difficile or scabies require contact isolation measures which should include a private patient room; use of gloves and gown upon entering the patient room and removal before leaving the room; thorough hand washing; and dedicated use of equipment including stethoscopes, walkers, etc.
  • Droplet isolation is implemented to prevent the spread of infections transmitted through respiratory secretions (e.g., coughing or sneezing) or contact with mucous membranes. Illnesses such as influenza require droplet isolation measures, which should include a private patient room, use of surgical mask by employees and visitors, and use of a surgical mask by patients who need to leave the room.
  • Airborne precautions are implemented for bacteria or viruses that are small enough to remain airborne for a prolonged period of time. Infections such as shingles or tuberculosis require airborne precautions, including placement of the resident in an isolation room. Isolation rooms are private, maintain a negative air pressure in comparison to hallways or other adjacent areas, require at least six air exchanges per hour, and vent the room’s air outside of the facility. Additional precautions, such as respirator masks for staff, may be required depending on the infection.

Consistently implementing these measures can help reduce the estimated 150,000 to 200,000 hospitalizations that happen annually as a result of infections, and the resulting $2 billion it costs to treat them. A reduction in infection rates will decrease the growing number of infection-related claims and related legal costs incurred by LTC companies. Together, the money saved may be redirected and better spent on other quality- and resident-centered initiatives—a win for both residents and LTC facilities.

To learn more about how to defend against claims related to infection control, talk to an expert at Excelas.

1 Background statistics and some general information in this post were taken from the webinar, Infection Control: The Down and Dirty of F-Tag 441, presented on August 15, 2013, by Relias Learning.

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