Infection Prevention and Control in LTCHs

Nurse putting PPE on at long-term care home

Antimicrobial Stewardship

Antimicrobial stewardship is an interdisciplinary activity that promotes optimal antimicrobial therapy and is a strategy used to prevent excessive use of antimicrobials.

Overuse of antibiotics, particularly in the older adults, has been associated with an increased risk of harm. Fifty percent of antibiotics in long-term care homes are not needed. Residents in homes with higher antibiotic use experience an increased risk of antibiotic-related harm.

It is important for healthcare providers to assess the need for antimicrobials, the appropriate selection, dosing, route and duration of antimicrobial therapy if used.

Audit Tools (IPAC)

IPAC audits are an important tool to ensure infection prevention and control standards and practices are followed. The data derived from audits are often used to identify any gaps and barriers to compliance in your IPAC program. It will also help direct strategies to minimize the risk of infections in your healthcare setting. Facilities should complete IPAC audits regularly to identify areas of improvements and this will help with planning and evaluating training and education in your setting.

Disinfection and Sterilization of Medical Devices & Equipment

Reusable medical equipment and instruments that are not properly reprocessed may pose risks for transmission of infections in the community and healthcare settings. Proper reprocessing procedures must be implemented to maintain quality of care and to ensure the health and safety of clients and residents.

Equipment and instruments are classified as non-critical, semi-critical and critical and they must be thoroughly cleaned, disinfected, or sterilized based on the degree of risk involved in their use. It is essential to select a disinfection and sterilization method that is appropriate and compatible with the instruments.

Reprocessing is a multi-step process that require specialized education and training. Staff responsible must be trained to a level that is needed for the volume and complexity of the instruments to be reprocessed.

Best Practices for Cleaning, Disinfection and Sterilization of Medical Equipment/Devices In All Health Care Settings, 3rd edition , May 2013

Environmental Cleaning and Disinfection

Environmental cleaning is the cleaning and disinfecting of an environment to reduce transmission of infections. It should be performed routinely and consistently to protect all individuals and to provide a safe and healthy environment. It is an important component to infection prevention and control in all types of setting.

Effective environmental cleaning involves selecting the appropriate product, implementing policies and procedures, and providing regular training to staff. Having a clear approach will help staff understand their responsibilities and allow for consistency when performing environmental cleaning.

Long term care and retirement homes should be cleaned regularly (e.g., at least once a day) and more frequently during an outbreak using a health care grade cleaner and disinfectant with a Drug Identification Number (DIN).

Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings, 3rd Edition, April 2018

Hand Hygiene

Hand hygiene is one of the most effective ways to prevent the spread of infections in the community and in congregate living settings. It can be performed by using alcohol-based hand rub of at least 70% or by using soap and water when hands are visibly soiled. Hand hygiene is an essential part of infection prevention and control, and it is the responsibility of ALL individuals to maintain a safe and healthy environment.

Point of Care Risk Assessment and Personal Protective Equipment

Point of Care Risk Assessment (PCRA) is regularly performed by staff for their own safety as well as the safety of their clients and others in all congregate living settings. It involves reviewing work activities, evaluating possible risks, and applying appropriate control measures to minimize any risks.

PCRA is a component of Routine Practices (RP) and it is used with all clients at all times to reduce the risk of transmission of infections to and from the client. It must be completed before each interaction with a client and their environment.

Surveillance in Long-Term Care Homes

Surveillance is the routine ongoing collection and analysis of data in healthcare settings to identify trends and changes related to health condition or disease rates in patient/resident populations as well as the timely distribution of that information to those in a position to take action. Surveillance can also provide data to help assess the effectiveness of IPAC programs. Effective surveillance in a healthcare facility can help reduce the burden of disease by identifying concerning increases of healthcare associated infections (HAIs) early and inform those who are able to implement interventions such as IPAC audits or education.