The Preventionist

Basic Infection Prevention for Nurses and Healthcare Workers

8 Typical Duties of the Infection Preventionist in Long-term Care

Written By: Chris - • •

An experienced Infection Control Professional (ICP) may also be referred to as an Infection Preventionist. Infection Preventionists are for the most part, required to be a licensed Registered Nurses, however in Long-term Care, the job of Infection Control Nurse is frequently assigned to Staff Developers, who are either RNs or LVNs. This is a big job and really, out of fairness to all concerned, deserves to be filled by someone with at least some background in Infection Prevention and Control.  Consider 8 duties that may be assigned to the Infection Preventionist:

  1. Surveillance:In infection control, surveillance is the term used to describe the function of observing, gathering, investigating and reviewing information about the patient as it pertains to infection prevention and control.
  2. Patient Assessment:Accurately reporting signs, symptoms, and changes in condition and initiating isolation precautions as indicated.   
  3. Tracking and Trending: Tracking and trending information gathered from surveillance; Practicing outbreak prevention and investigation, monitoring rates of infection and communicating findings in the form of verbal and written reports.  
  4. Orientation and Staff Education: Educating staff, patients and families to Infection Prevention. Monitoring staff compliance with basic infection control principles such as; hand washing, isolation, transmission based precautions, and use of personal protective equipment (PPE).
  5. Monitoring Antibiotic Usage:  Reviewing and reporting antibiotic usage and trends of antibiotic resistance reported in antibiograms.   
  6. Revising Policies and Procedures: Participates in updating policies and procedures needed to maintain compliance with current recommendations from agencies of the federal and local government such as; OSHA, the CDC, state and local departments of health. 
  7. Conducting Environmental Rounds:Monitoring department compliance with Infection Control guidelines; conducting environmental rounds and consultation as needed.
  8. Monitoring Employee HealthThis may or may not be the direct responsibility of the Infection Preventionist in Long Term (LTC) or Acute Long Term Care (LTAC) but in Acute Care Hospitals the position is usually assigned to Employee Health Nurses. Responsibilities include annual physicals and tuberculosis screening for new hires and employees, offering influenza and Hepatitis B. vaccines, keeping accurate employee records, initiating workplace restrictions if indicated, becoming familiar with OSHA regulations and educating staff to Infection Control and Blood Borne Pathogens standards.

             Each facility will have their own policies and procedures regarding the expectations of the Infection Control Designee.  

 

 

What’s That on Your Hands?

Written By: Chris - • •

Bacteria are everywhere; they co-exist with us, occupying their own intrinsic colonies on our skin, nasal passages, mouths, well you get the picture. Many bacteria are vital to our good health, while other would-be intruders are capable of declaring war with our immune systems, depending on their virulence (relative strength) and our own current state of health. If we could see the bacteria that have colonized our bodies with the naked eye, it is safe to say we’d be washing our hands more often. 

Try to remember everything your hands touch every day. Then allow yourself the visual image of everyone else touching the same surfaces, people, places and things. If we don’t wash our hands, we transfer all of that to others, to ourselves and to our families as well. Not washing our hands, besides being inconsiderate, is potentially dangerous in a healthcare delivery setting. 

We use barriers such as gloves, gowns and masks and we place patients in isolation, but first, we should make a habit of diluting organisms on a consistent basis. The more we dilute potential pathogens, the less chance there is of transmitting bacteria viruses, fungi and fomites to ourselves and others. When we consistently wash our hands, we dilute the organisms. When we vaccinate ourselves, co-workers, residents, families and the community, we dilute the virulence of disease by preventing it all together. Regularly cleaning the immediate environment creates further dilution. 

Healthcare workers need to wash their hand or use hand sanitizers before:

  • Each patient contact
  • After each patient contact
  • Donning gloves
  • Passing medication
  • Performing treatments
  • Serving food
  • Assisting with drinking or eating
  • After using the rest room.

Well, we all know the drill. But are we compliant? Hand washing is the most important step we can take in reducing and diluting the number of pathogens our patients, families and co-workers are exposed to on a daily basis. Their lives are in our handsIt’s just that simple.

Preventing Healthcare Associated Infections (HAI) in Long-term Care

Written By: Chris - • •


The term Nosocomial Infection has more recently been changed to Healthcare Associated Infection or HAI. I find Health Care Workers continue to default to using Nosocomial. In any case, a HAI or Nosocomial Infection, is one that was not present on admission (POA) and develops 72 hours after admission to a healthcare facility, according to the Centers for Disease Control and Prevention (CDC).

Multiple factors contribute to the transmission of infectious organisms in hospitals, long-term care facilities, and rehabilitation centers; they include the type of infectious organism, the patient’s proximity to the source of infection, the means by which the organism could potentially be transmitted, and the status of the patient’s immune system.

Ultimately, it is the responsibility of the facility to develop policies and procedures designed to interrupt the transmission of infectious organisms from the source to the patient and to maintain a strong Infection Control Surveillance program. That is where you, the DSD, Infection Preventionist, or DON and your Infection Control Committee, come in. Preventing HAI in Healthcare Facilities CDC

 

 

 

 

Breaking the Chain of Infection…in Plain English

Written By: Chris - • •

Thinking in terms of interrupting the transmission of infectious agents is known as Breaking the Chain of Infection.

This term uses a metaphor to create a visual interpretation; each link depends on the last and the next, in order to continue. Break one link and there is no longer a connection. An example might be:

  • The 1st   link in the chain is the causative agent or pathogen, let’s use MRSA
  • The 2nd link is the reservoir or the house the pathogen lives in. In this case it’s living in the nares (nose) of a nurse but not causing her any
    clinical signs of infection. She is not even aware she has MRSA organisms in her nasal passages. 
  • The 3rd link is the portal of exit (the nurse rubs her nose, now the pathogen is on her hands). 
  • The 4th link is the mode of transmission or the route the organisms use to travel to their newest destination; in this case, the nurse’s unwashed hands. 
  • The 5th link is the portal of entry or the skin of the potential host, her patient. 
  • The 6th link is the susceptible host, the patient; susceptible is the keyword. If the patient has an altered immune system, and chronically ill people do, the organism stands a very good chance of gaining entrance and setting up shop at
    the first opportunity. 

So let’s see what happens. The nurse did not take the time to wash her hands before visiting her patient and so she transmits the MRSA to her patient’s skin while taking her blood pressure. 

The patient is a susceptible host because her immune status is impaired by her chronic medical conditions and diabetes. The patient’s arm itches, she scratches it and causes a small break in the integrity of her skin; the MRSA she picked up from the nurse gains entrance (portal of entry) and the patient develops an MRSA wound infection. 

Looking back we can see any one of the links in the chain of infection could easily have been broken, beginning with the nurse always washing her hands or using an alcohol sanitizer before and after visiting each patient.

The concept of breaking the chain of infection is not limited to long-term care; it can and should be used to prevent transmission of micro-organisms in all healthcare facilities and in the community as well. If we could see the multitude of organisms that are living on our hands and in our immediate environment, we would probably never stop washing our hands.

 

Preventing Flu

Written By: Chris - • •

The 2014-2015 Flu Season is upon us again. Flu Season usually (not always) reaches its peak during the months of December through February but the CDC recommends the vaccine be taken as soon as it becomes available. Why? Because it takes about two weeks for antibodies to develop once the vaccine is given. The sooner the vaccine is given the more protection one is offered. If a person waits until later in the season, they may be exposed to someone who already has the flu during the two weeks the body is trying to develop antibodies to the vaccine. Without enough time to develop antibodies, the vaccine would not be effective.

It is actually possible for a person to transmit the flu virus one day before they have developed signs and symptoms of the disease and before they realize they are ill. They remain infectious to others for 5 to 7 days after becoming sick. For these reasons, it is definitely more advantageous to receive the flu vaccine before flu season is in full swing. If a person has waited just go ahead and get the vaccine as soon as possible.

This year the Flu Vaccine contains these strains: Per the CDC, all of the 2014-2015 influenza vaccine is made to protect against the following three viruses:

  • an A/California/7/2009 (H1N1)pdm09-like virus
  • an A/Texas/50/2012 (H3N2)-like virus
  • a B/Massachusetts/2/2012-like virus. Some of the 2014-2015 flu vaccine also protects against an additional B virus (B/Brisbane/60/2008-like virus).

Remember, evidence based research has proven there is no “catching the flu” from the vaccine. The flu vaccine may not always be effective; in some cases the vaccine may be given after the person has been exposed. The vaccine is designed to prevent infection from the three circulating main viruses, but could miss effectiveness for a strain not covered in the vaccine. Taking the vaccine will reduce the chance of developing disease, it isn’t 100% effective but it substantially reduces the risk of developing a severe case of the flu which is so vitally important to those at high risk such as young children, the elderly and those with acute and chronic medical conditions. Be sure to visit the CDC website for more information CDC Seasonal Flu Web Site      

 

Contact me

Written By: Chris - • •

Remember, if you have questions, comments, or a subject you would like to discuss, you can send a message to me by going to the Contact page.

Adult Vaccine Schedule

Written By: Chris - • •

Every year at this time, we as Infection Preventionist, preach the importance of getting the Influenza Vaccine, but what of the other adult vaccines? Is your staff compliant? Do you keep track of your vaccinations? Are you up to date with your own adult vaccines? What about these:

  • Influenza (Flu) every year
  • Tetanus, diphtheria, pertussis (Td/Tdap)
  • Varicella (Chickenpox)
  • HPV Vaccine for Women
  • HPV Vaccine for Men
  • Zoster (Shingles)
  • Measles, mumps, rubella (MMR)
  • Pneumococcal (pneumonia)
  • Meningococcal
  • Hepatitis A
  • Hepatitis B

Here are some great links to the CDC Adult Vaccine Schedules

CDC Adult Vaccines

Adult Vaccine Schedule

CDC Influenza Handout

Picture courtesy of CDC:PHIL

 

ESBLS

Written By: Chris - • •

ESBL is the acronym for Extended Spectrum Beta Lactamase. If it sounds somewhat complicated it is; basically, ESBLs are bacteria that produce an enzyme capable of neutralizing the effectiveness of certain classes of Beta-lactam antibiotics such as, carbapenems, cephalosporins and certain penicillin derivatives. The end result is yet another type of Multi-drug resistant Organism (MDRO).

The bacteria are spread in the same way all organisms are transmitted depending on their site.  Those at highest risk are usually hospitalized patients who have been on extensive antimicrobial therapy and have already compromised immune systems.

What should be done about ESBLs in long-term care? If you are new to infection prevention, be sure to locate your facility policy for MDROS in your Infection Control Manual.  Hopefully, the policy will be up to date and based on the evidence based guidelines and recommendations available to long-term care facilities in your state. The CDC, your state Department of Public Health and APIC (Association for Professionals in Infection Control and Epidemiology) are the Big 3 support systems for Infection Preventionists. Visit their websites frequently.

If you aren’t sure or have questions, seek out the support of your DON, and the Infection Control Committee. Together, you can review, update and sign off on a current policy.  As soon as appropriate, announce the presence of an updated policy for MDROs (including ESBLS) to the staff and educate them to its definition, treatment and potential precautions.

Standard Precautions are THE place to start; utilize Transmission Based Precautions for infections that cannot be contained. Think about that.

Is an ESBL in the urine contained in a Foley bag, a diaper or as a continent patient?

If the source of the organism is contained, the patient’s hands are clean, they are wearing clean clothes and want to socialize, could they be managed with Standard Precautions?  What is the policy for your facility? Is your staff educated frequently to the principles of Standard Precautions?

CDC STANDARD PRECAUTIONS

CDC on ESBLS

 

Shingles

Written By: Chris - • •

There have been some comments regarding Shingles so lets review: Shingles in Long-term Care

Infection Prevention in Long-term Care

Written By: Chris - • •

What’s new in LTC Infection Prevention

  • McGeer’s Definitions of Infection for Surveillance in Long-term Care Facilities, written in 1991, has been revised and will be published sometime in September of 2012, (Am J Infect Control. 1991 Feb; 19(1):1-7 )
  • APIC (Association for Professionals in Infection Control and Epidemiology) is the Infection Preventionist’s National Professional Organization. In case you haven’t become a member or visited the The APIC website there is a new Infection Prevention educational training class; Continuing the Care, Infection Prevention in the long-term Care Setting. This class could be just what you need to find the educational support necessary to carry out your role as Infection Control Nurse, Infection Preventionist or Staff Developer, in your LTC facility. Here are links to:

Hope this is helpful to you LTC IPs!