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Healthcare: Infection Control Cheat Sheet by

control     healthcare     infection


Infection control is all the buzz in health care today, and nowhere is it more important than when caring for long-term care residents with open wounds or compro­mised immuni­ties. Let’s take a look at three practical, immedi­ately applicable ways you can stop practicing infection control and start contro­lling infections in the long-term care setting.
Andrea Salzman is founder of Aquatic Resources Network. She has worked interm­itt­ently in the skilled nursing and home health settings


Keep skin intact.
Intact skin is the first line of defense against infection, so prevent skin breakdown before it happens. Keep your residents’ skin dry, clean and elastic by applying a good moistu­rizer on a regular basis. Encourage residents with diabetes to wear socks and shoes at all times while out of bed, and teach them and your staff to inspect danger zones, such as the skin between toes.
Implement pressure relief.
If a resident is bed-bond or wheelc­hai­r-b­ound, implement a pressu­re-­relief program and follow it without deviation. It only takes a few hours to start a pressure ulcer so have your physical therapist teach residents some simple pressu­re-­relief techniques they can follow throughout the day.
Prevent skin irrita­tion.
Encourage residents to take frequent trips to the bathroom and perform good perineal care afterw­ards.
Inspect skin often.
Perform skin inspec­tions on a regular basis, taking special note of the most common breakdown areas (heels, sacrum and other bony
Improve nutrition.
Have your nutrit­ionist ensure at-risk residents are consuming adequate calories and getting enough protein in their meals for cellular regene­ration.


Push fluids.
Make fluids available at all times to your residents, unless medically contra­dicted. Encourage drinking. Be aware that many residents won’t drink fluids, especially in the evening, as they know they will not be able to make it to the bathroom in time. Require your staff to answer call buttons rapidly so residents aren’t forced to make this choice.
Encourage indepe­ndent toilet­ing.
When approp­riate, allow residents to walk or wheel to their own bathrooms indepe­nde­ntly. When residents are told they are not allowed to make the short trip to the bathroom without waiting for assist­ance—or worse, are wheeled to the bathroom by time-c­runched staff—they lose muscle strength and bladder control. This starts a cycle of incont­inence which is hard to break and feeds into further risk of additional UTIs and skin breakdown.
Downgrade cathet­eri­zat­ion.
Eliminate catheters as soon as possible after hospit­ali­zation or other medical events. When possible, consider interm­ittent
cathet­eri­zation as an altern­ative to an indwelling catheter. If you plan to use leg bags, be aware that these are often abused by residents and staff. Leg bags must be connected, cleaned and stored with great care.

Avoiding Respir­atory Infections

Provide immuni­zat­ions.
Test all new residents for tuberc­ulosis and immunize residents for influenza each fall, unless medically contra­ind­icated. Require staff to have a baseline health assessment performed before they start work. Gather inform­ation on their immuni­zation status
and the history of any relevant infectious diseases, such as TB. Perform TB testing on staff yearly.
Restrict transm­ission.
Promote handwa­shing among staff and visitors by placing a hand-foam station in the entrance corridor and outside every resident’s room. Don’t let staff come to work sick and ask family and friends not to visit when they are contag­ious.
Control outbreaks.
Even a single verified case of certain diseases (TB, influenza, etc.) should activate your outbreak control plan. When approp­riate, isolate the infected person; otherwise initiate respir­atory precau­tions. Search for additional cases immedi­ately.
Sanitize equipm­ent.
Keep your respir­atory equipment immacu­late; if it goes in the nose or throat, take the time to make sure it is clean. Use disposable covers for thermo­meters and ensure that other non-di­spo­sable equipment is properly cleaned, disinf­ected or steril­ized.
Promote exerci­se.
Encourage out-of-bed and out-of­-chair time to help your residents clear secretions and maintain respir­atory health. Have your staff implement a walking or exercise program for all residents who are able. For those who are unable to walk, chair aerobics are an option.
Limit aspira­tion.
At meal time, be on the lookout for risky eating or drinking behaviors. Ask your speech and language pathol­ogist to provide staff with tips for spotting aspiration or choking behaviors. Generate a referral to the SLP for residents who exhibit such behaviors.

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