Long-Term Care

Infection control surveillance in your SNF

LTC Clinical Pearls: Powered by HCPro's Long-Term Care Nursing Library, June 11, 2013

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Infection surveillance is the foundation of the infection control program in long-term care. The purpose of an infection surveillance program is to identify infections, plan control activities, and prevent outbreaks. Effective surveillance consists of data collection, data analysis, data reporting, and decision making. The need for infection control must be balanced with the residents’ quality of life, and need for socialization and mobility. The facility must have an ongoing system for collection of information about infections in the facility.

At the very least, conduct surveillance weekly and obtain data through communication with the staff and a review of lab reports and 24-hour logs, or other reporting tools. Pay particular attention to culture and sensitivity reports, treatment orders, and physician progress notes. Walking rounds and staff-communication clipboards at the nurses’ station may assist in this effort. Collect surveillance data to calculate and analyze infection rates, looking for patterns, trends, and unusual occurrences. Surveillance data may also be used for planning infection control activities, staff education, and to detect outbreaks. When reviewing infections, consider specific individual factors such as age, underlying diseases, treatments with antimicrobials, corticosteroids, or other immunosuppressive agents, irradiation, and breaks in the first line of defense. Mechanisms caused by operations, anesthesia, and indwelling catheters will also increase the risk for infection.

Infection control practices and isolation precautions are designed to prevent transmission of microorganisms by many different routes in healthcare facilities. Because agent and host factors are more difficult to control, interruption of transfer of microorganisms is directed primarily at transmission. Most recommendations for interrupting the spread of infection are based on this concept. In long-term care, the use of standard precautions provides the foundation for the standard of care. It is important for the designated infection control practitioner to understand the difference between universal precautions, body substance isolation, and standard precautions. Many individual workers use a combination of these systems rather than using standard precautions exclusively. Standard precautions have been available for more than 10 years and provide the highest level of protection. Older systems and combinations of systems must be eliminated. Having a supply of gloves in each room is essential to resident care.

Documentation stating, “Universal precautions in use” is a red flag to a medical-legal reviewer, and often is used as proof that the facility did not provide care in keeping with the current standards.

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