| Five Steps to Effective Infection | | | | fluid management are critical for |
| Control in Long Term Care | | | | successful outcome. In some cases, the |
| Joseph J. Tomaino, M.S., R.N. | | | | timely diagnosis of infection initiation |
| Probably no other category of illness | | | | of antibiotic therapy can make the |
| has such major implications or | | | | difference between life and death. |
| unpredictability of outcome for a health | | | | Ineffective management can result in |
| care provider than infection and septic | | | | extended periods of illness. Cost issues |
| shock. A "simple" urinary tract | | | | regarding antibiotic therapy can be |
| infection can evolve into urosepsis and | | | | complicated. A tradition step approach |
| a resource intensive course of therapy | | | | to antibiotics, starting with standard |
| in critical care. Urosepsis alone is the | | | | and less expensive ones and then |
| major cause of death of adults over 65. | | | | advancing to newer, more expensive ones |
| It is for this reason that prevention of | | | | if they don't work may seem cost |
| this complication must be one of the | | | | effective. But if going to the newer |
| health care provider's highest | | | | "big guns" earlier may result in shorter |
| priorities. Being vigilant to preventive | | | | period of illness and need for critical |
| measures is imperative. Something as | | | | care. On the other hand, if you jump to |
| simple as handwashing is critical to the | | | | the "Big Guns" and they don't work, |
| spread of infection. But so often, this | | | | where do you go next? |
| simple approach is neglected. | | | | These steps should be followed in the |
| As the health care provider tracks and | | | | continuing care setting to ensure that |
| trends lengths of stay and tries to | | | | infections are controlled: |
| identify variances which result in a | | | | 1. Monitor new admissions as well as |
| longer stay than anticipated, infection | | | | existing patients for evidence of |
| should always be considered. When | | | | infections; if an infection is |
| looking at infections, it is important | | | | identified, determine if it is community |
| to differentiate between community | | | | acquired (prior to admission to your |
| acquired and nosocomial infections. For | | | | program) or nosocomial |
| example, when looking at pneumonia in a | | | | 2. Begin a line listing of each |
| subacute setting, it is important to | | | | infection so it can be tracked from |
| differentiate between an increase in | | | | start to finish, including the organism |
| pneumonia in the general population | | | | causing the infection, the sensitivity |
| during the flu season, and infections | | | | report, the treatment used, and the date |
| which may be acquired in the facility | | | | of resolution |
| due to care related issues. | | | | 3. Identify patterns of infections that |
| The way to differentiate the two is line | | | | may indicate they may be spread by the |
| listing of infections. For each patient | | | | facility or staff; such patterns may |
| with an infection, list the site of | | | | include several patients on a unit |
| infection, the organism, sensitivity | | | | having the same source organism with the |
| report, date of admission and date of | | | | same antibiotic sensitivity report |
| symptoms onset. Then categorize together | | | | indicating they shared the same source, |
| all of the patients with the same site | | | | or a geographical distribution pattern |
| and organisms, then drop off the | | | | of an infection that may indicate the |
| infections which occurred within 48 | | | | spread by poor hand-washing |
| hours of admission (not enough time for | | | | 4. Follow state and local health |
| incubation of a nosocomial infection). | | | | department requirements regarding |
| Then take the patients with the same | | | | reporting of infections |
| site and organism and look at the | | | | 5. Educate staff with information gained |
| sensitivity reports. If the sensitivity | | | | through above steps as to how they can |
| to antibiotics is variable, it is | | | | prevent the spread of infections in your |
| unlikely that the infections came from a | | | | particular setting |
| single source. If on the other hand, the | | | | Following these steps will help ensure |
| sensitivities are identical, it is | | | | that your patients and staff are |
| unlikely that they were randomly | | | | protected from unnecessary infections, |
| acquired community infections. | | | | and that you will enjoy higher success |
| Once sepsis occurs, aggressive | | | | with your clinical outcomes. |
| monitoring, antibiotic therapy, and | | | | |