Infection control in a long-term care facility is the art of balancing the measures that need to be taken to reduce the risk of infection to a frail and vulnerable population while at the same time ensuring there is minimal disruption to quality of life.
The two objectives may seem at odds, but I believe they can co-exist. First, let’s look at the challenges presented by the elderly in long-term care. They are a group at risk for developing infections and complications from infections. Moreover, they are likely to have some degree of cognitive impairment, complex and multiple health conditions, hearing and/or visual impairment, and their first language may not always be English.
The elderly are sensitive to a disruption in routine. Unlike the acute care setting where patients generally stay for shorter periods and are mostly confined to their hospital room, long-term care clients are quite likely to be moving around their environment, attending group activities and taking meals together.
MRSA Ñ methicillin resistant staphylococcus aureus Ñ is case in point. It is one of the more common bacteria to prey upon the elderly. A crafty bacterial organism, it can colonize on a body and not cause harmful symptoms. Despite this benign state, MRSA is a medical condition like any other and must be treated with appropriate precautions. MRSA can spread through direct contact. When a carrier transmits MRSA to another person, the organism has the potential to cause an infection in its new host. MRSA is resistant to many antibiotics. This limits the choice of antibiotics that can be used to treat infections and often these antibiotics have side effects and are more expensive. When implementing precautions to prevent the spread of infections, the Infection Control Team must be mindful of the impact these measures will have on clients and on staff. It’s much harder to maintain precautions for clients, especially those who are cognitively impaired. They often don’t understand why they can’t leave their floor, or why they can’t attend their usual group activity programs. They will likely experience some change to their daily routine when infection control precautions are implemented and this can trigger distress and anxiety.
To minimize such discomfort, the care team assesses each client to determine what he or she is allowed to do during precautions. Many factors are considered, including the client’s hygiene, cognitive status, level of function, needs and desires, and whether they have personal caregiver assistance. In my experience, such individual assessments help to minimize the disruption to quality of life.
Implementing precautions will impact staff workload. There will be additional cleaning of equipment and the living environment, supplies to set up and keep stocked, extra handwashing, more time spent communicating with different departments and client families to notify them and explain precautions. Inconsistent messaging or poor communications among departments can undermine the efforts of infection control and cause unnecessary frustration to many.
I can’t emphasize enough that a critical component of a successful infection control program is effective communications, including consistency of messaging. When precautions are implemented, staff from various departments, such as nursing, housekeeping, therapeutic recreation and social work, need to be informed in a timely manner and given consistent information. Health care aides, personal caregivers and families of affected clients need to be informed as well. Infection Control works closely with Public Affairs to develop messaging and post advisories on all affected floors and at main entrances to the centre, if necessary.
At the end of the day, if staff, families and caregivers understand their responsibilities during precaution status, and clients experience the least disruption possible in their daily routine, then I’ve achieved that fine balance between reducing risk and maintaining a quality of life for clients.