The Preventionist

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An Infection Preventionist (IP) is usually required to be a licensed nurse, RN or LVN, depending on state regulations. Some of the duties of the Infection Preventionist may include:

Surveillance: Surveillance for our purposes, 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.

Patient Assessment: Accurately reporting signs, symptoms, and changes in condition and initiating isolation precautions as  indicated.

Tracking and Trending: Tracking and trending information from  surveillance; Practicing outbreak prevention and investigation,  monitoring rates of infection and communicating findings in the form of verbal and written reports.

Orientation and Staff Education: Educating staff, patients and families about preventing the transmission of infectious organisms; monitoring staff compliance with basic infection prevention principles such as; hand washing, isolation, transmission based precautions, and use of personal protective equipment (PPE).

Monitoring  Antibiotic Usage: Reviewing and reporting antibiotic usage and trends of antibiotic resistance reported in antibiograms.

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.

Environmental Rounds: Monitoring department compliance with Infection Prevention Guidelines; conducting environmental rounds and consultation as needed.

Monitoring  Employee Health: This may or may not be the direct responsibility of the Infection Preventionist. 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 Prevention  and BBP Standards.

Each facility will have their own policies and procedures regarding the expectations of the Infection Prevention Designee (IP).  Responsibilities may be shared and hopefully, the nurse will be given the support they need to do their job efficiently and with satisfaction.

Contact me

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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

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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

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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

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

Infection Prevention in Long-term Care

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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!

Isolation Precautions in Long-term Care

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Scenario:

A 78 year old female is admitted from the hospital status post Total Knee Replacement. Orders are to complete IV antibiotics and begin Physical Therapy. Two days following admission, signs and symptoms consistent with C. Difficile develop. The Don and DSD place the patient on contact isolation, the physician is notified of a change in condition, and she orders Flagyl.


A room with two other female patients is all that is available; there is no option for a private room.

That sounds predictable.

  1. How should a patient with C. difficile be managed in this scenario?

  2. If the patient is using a bedside commode, where is it sanitized?

  3. Must the Health care workers don gown and gloves when entering the room if they are not caring for the patient with C. Dif?

  4. May the patient with C. dif. go to the shower? Go to activities, participate in therapy?

  5. If not, when may the patient resume activities?


These are questions that frequently come up in LTC facilities. In many cases, facilities separate the affected patient from other patients and they do not share a common bathroom; instead, a bedside commode is utilized while the patient is symptomatic.


Some facilities interpret Contact Precautions as strictly applying to a patient confined to their room while there are active signs and symptoms of a transmissible disease, in this case active diarrhea.


In the case of C. Difficile, once the diarrhea has resolved, do you allow your patients to go out of the room on Standard Precautions as long as they are alert, able to comply with hand hygiene protocols and any potential source of contamination is contained?

What are your policies & procedures regarding the management of C. dif patients and isolation?


I couldn’t give you the answers to the above questions because I don’t have access to your policies and procedure. First of all you must be familiar with your policies & procedures regarding the management of C. Dif patients and Isolation precautions.


It’s vitally important for you, the ICP, DON or DSD to know where your manual is and to be actively engaged in its compliance with standards of care as supported by the CDC, APIC and your State Department of Public Health; these guidelines need to be specifically focused on the care of Long-term Care patients.


Comments for The Preventionist

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There have been several questions regarding where comments may be submitted. There is a comments section on the about me page and I have made a new one available under Contact as well. Thanks. Will post again soon.

Breaking the Chair of Infection, in Plain English

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Thinking in terms of interrupting the transmission of infectious agents in long-term care situations 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 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 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.

Picture courtesy of www. blingcheese.com

Healthcare Acquired Infection Prevention (HAI) in Long-term Care

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The term Nosocomial Infection has more recently been changed to Health Care Acquired 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 develops 48 to 72 hours after admission to a healthcare facility, according to McGeer’s Criteria (McGeer’s, 1991)

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

References:

McGeer A, Campbell B, Emori TG, Hierholzer WJ, Jackson MM, Nicolle LE, Peppler C, Rivera A, Schollenberger DG, Simor AE, Smith PW, Wang E. Definitions of Infection for Surveillance in Long Term Care Facilities. American Journal of Infection Control 1991; 19(1):1-7.

PHIL ID # 10068
Photo Credit: Janice Haney Carr, Centers for Disease Control and Prevention

PHIL ID # 10045
Photo Credit: Janice Carr, Centers for Disease Control and Prevention

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