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Five Steps to Improve Infection Control in Nursing Homes

Five Steps to Effective Infectionfluid management are critical for
Control in Long Term Caresuccessful outcome. In some cases, the
Joseph J. Tomaino, M.S., R.N.timely diagnosis of infection initiation
Probably no other category of illnessof antibiotic therapy can make the
has such major implications ordifference between life and death.
unpredictability of outcome for a healthIneffective management can result in
care provider than infection and septicextended periods of illness. Cost issues
shock. A "simple" urinary tractregarding antibiotic therapy can be
infection can evolve into urosepsis andcomplicated. A tradition step approach
a resource intensive course of therapyto antibiotics, starting with standard
in critical care. Urosepsis alone is theand 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 ofif they don't work may seem cost
this complication must be one of theeffective. But if going to the newer
health care provider's highest"big guns" earlier may result in shorter
priorities. Being vigilant to preventiveperiod of illness and need for critical
measures is imperative. Something ascare. On the other hand, if you jump to
simple as handwashing is critical to thethe "Big Guns" and they don't work,
spread of infection. But so often, thiswhere do you go next?
simple approach is neglected.These steps should be followed in the
As the health care provider tracks andcontinuing care setting to ensure that
trends lengths of stay and tries toinfections are controlled:
identify variances which result in a1. Monitor new admissions as well as
longer stay than anticipated, infectionexisting patients for evidence of
should always be considered. Wheninfections; if an infection is
looking at infections, it is importantidentified, determine if it is community
to differentiate between communityacquired (prior to admission to your
acquired and nosocomial infections. Forprogram) or nosocomial
example, when looking at pneumonia in a2. Begin a line listing of each
subacute setting, it is important toinfection so it can be tracked from
differentiate between an increase instart to finish, including the organism
pneumonia in the general populationcausing the infection, the sensitivity
during the flu season, and infectionsreport, the treatment used, and the date
which may be acquired in the facilityof resolution
due to care related issues.3. Identify patterns of infections that
The way to differentiate the two is linemay indicate they may be spread by the
listing of infections. For each patientfacility or staff; such patterns may
with an infection, list the site ofinclude several patients on a unit
infection, the organism, sensitivityhaving the same source organism with the
report, date of admission and date ofsame antibiotic sensitivity report
symptoms onset. Then categorize togetherindicating they shared the same source,
all of the patients with the same siteor a geographical distribution pattern
and organisms, then drop off theof an infection that may indicate the
infections which occurred within 48spread by poor hand-washing
hours of admission (not enough time for4. Follow state and local health
incubation of a nosocomial infection).department requirements regarding
Then take the patients with the samereporting of infections
site and organism and look at the5. Educate staff with information gained
sensitivity reports. If the sensitivitythrough above steps as to how they can
to antibiotics is variable, it isprevent the spread of infections in your
unlikely that the infections came from aparticular setting
single source. If on the other hand, theFollowing these steps will help ensure
sensitivities are identical, it isthat your patients and staff are
unlikely that they were randomlyprotected from unnecessary infections,
acquired community infections.and that you will enjoy higher success
Once sepsis occurs, aggressivewith your clinical outcomes.
monitoring, antibiotic therapy, and



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