Reducing HAIs and improving LTC resident health

More than 5 million Americans reside in nursing homes, skilled nursing facilities and assisted living facilities. These long-term care facilities (LTCFs) provide a variety of services, both medical and personal care, to people who are unable to manage independently in the community.

Data about infections in LTCFs are limited, but the most recent statistics in medical literature estimate:

• 1 to 3 million serious infections occur every year in LTCFs.
• Infections include urinary tract infection, diarrheal diseases, antibiotic-resistant staph infections and many others.
• Infections are a major cause of hospitalization and death; as many as 380,000 people die of infections in LTCFs every year.

Common infections in long-term care settings are becoming more difficult to diagnose. This longer process can lead to multiple issues for residents, including ongoing discomfort, chronic poor health and a higher risk of hospitalization or even death. Unfortunately, one-third of all deaths in seniors result from infectious diseases, according to the American Academy of Family Physicians. Seniors are more susceptible to infection due to a weakened immune system, and seniors with dementia may be at even greater risk.

This life-threatening epidemic demonstrates the need for improved infection control in healthcare facilities. Although significant progress has been made in preventing healthcare-associated infections (HAIs), additional steps need to be taken to control and mitigate this high risk of infection. HAIs are preventable and often caused by poor facility conditions or human error. The Centers for Disease Control and Prevention research shows that when facility staff and vendor employees are aware of infection problems and take specific steps to prevent them, HAI rates can decrease by more than 70 percent. Successfully decreasing HAI rates involves all departments working together toward improving care, protecting patients and saving lives.

Lacking infection control training

LTCFs are required to maintain infection control and prevention programs to comply with federal regulations. The expectations for those programs are outlined in the Centers for Medicare and Medicaid Services’ Interpretive Guidance for Infection Control. Unfortunately, most LTCFs lack adequately trained and committed personnel to fulfill all the infection control needs.

A New Hampshire study found that there are 75 percent fewer Infection Preventionists (IPs) in long-term care facilities than in acute care facilities. More commonly, the IPs in LTCFs have multiple responsibilities and can only devote limited time to infection prevention practices. According to the same study, only 10 percent of the assigned Infection Preventionists in LTCFs have any specific Infection Control Prevention training, whereas 95 percent of acute-care IPs have the appropriate training.

A LTCF can implement a facility-wide training model that can be accessed by vendors 24/7 to ensure that the staff is well-educated to make a difference and improve patient care. Address issues that healthcare staff members encounter on a daily basis to eliminate reoccurrence. Every vendor employee that enters the facility should have completed the training courses and learned about their role in HAI prevention.

Reducing HAIs in LTCFs provides multiple benefits to residents, staff and vendors, including healthier residents, happier resident families, less disruption and financial burden for families of residents and stabilized financial benefit for the facility.

Transmitting infections

The two most common mechanisms of infection transmission in a long-term care facility involve direct contact via person-to-person or contaminated objects. LTCFs provide an ideal environment for acquisition and spread of infection. LTCF residents are more susceptible to infection when sharing sources of air, touchable surfaces, food and healthcare in a crowded institutional setting.

Many pathogens associated with HAIs survive on various surfaces such as common area furniture, remotes and light switches. As a result, frequently touched surfaces play a key role in transmitting infections between persons. The disinfection of surfaces is vital in infection prevention planning.

Moreover, visitors, staff and residents constantly come and go throughout the facility, increasing the likelihood of bringing in contaminated pathogens from outside sources. Reducing the number of entrances that staff, families and vendor employees use to enter a LTCF will minimize the risk of spreading potential bacteria to residents inside.

In addition, lack of proper use of disinfectants can also mean dangerous fungi and bacteria are not killed. Chemicals designed for disinfecting require different “dwell” times, or the amount of time the chemical agent must remain wet on a surface to be effective in eliminating the pathogens. Proper application requires training and then additional reinforcement of training to assure an effective kill-rate.

Prolonged lengths of stay, limited capacities for diagnosis and ineffectual infection-control programs often allow outbreaks to propagate and persist for many months. The transfer of infected or colonized residents, which is a common occurrence, may export outbreaks to other facilities, including hospitals and medical centers.

Improving facility profits

In addition to providing quality needs to the residents, long-term care facilities must thrive financially. A healthy bottom line for care providers means adequate staffing, healthy facilities and effective programs for the residents. Unfortunately, reimbursement programs have been cut so drastically that financial survival has to be the first focus for LTCFs.

Financial stability of a LTCF can mean the difference between an improved lifestyle for residents versus a questionable environment and negative outcomes.  There are not credible statistics supporting the difference between profit versus loss and how residents benefit from a well-managed and profitable facility. Even non-profits that are financially healthy mean improved facilities, happy residents and a positive workforce.

The most common areas where LTCFs spend money that is beneficial to the residents are:

• Hiring and maintaining additional staff members
• Education programs for staff improvement
• Repairs to facilities for safety and comfort
• Environmental issues

One loosely defined study makes the case for non-profit long-term care facilities providing more hours of attendant focus per resident versus for-profit facilities. The report also attempts to make the case for improved outcomes and fewer deaths. However, when closely reviewed, the infection rate in for-profit facilities was less, even though the age of the resident was older when compared to a non-profit facility.

Based on my personal experience in all types of nursing home facilities, I have found the financially stable non-profits and for-profit are basically the same. Both have visibly cleaner, healthier facilities, along with staff members that follow a plan for patient care.

Facilities in financial trouble due to older buildings, a high percentage of resident dependency on government reimbursements and high employee turnover rates suffer when it comes to offering quality care.

Conclusion

Combating HAIs requires concentrated efforts by all LTCF personnel and its outside vendors. Taking a multidisciplinary approach to manage HAIs can mitigate the risk of spreading life-threatening infections. Proactive risk management can decrease HAI rates, improve patient satisfaction scores–and most importantly–save patient lives.

Thom Wellington is the co-founder of Infection Control University and CEO of Wellington Environmental. He is member of APIC and ASHE, and has more than 25 years of experience in managing infection risk. He can be reached at thom@infectioncontroluniversity.com.

I Advance Senior Care

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