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