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