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