Infection Prevention and Control in Long-Term Care Homes

Antimicrobial stewardship

Antimicrobial stewardship is an interdisciplinary approach to promoting optimal antimicrobial therapy. This strategy aims to prevent the excessive use of antibiotics, which is particularly critical in older adults. Overuse of antibiotics in long-term care homes (LTCHs) increases the risk of antibiotic-related harm. Research shows that 50 per cent of antibiotics in LTCHs are unnecessary, and residents in facilities with higher antibiotic use are at greater risk for adverse outcomes.

Key considerations for healthcare providers:

• Assess the need for antimicrobial therapy before prescribing

• Select appropriate antimicrobials considering:

• Drug choice

• Dosage

• Administration route

• Duration of therapy

Resources for antimicrobial stewardship:

• Antimicrobial Stewardship Essentials

• Antimicrobial Stewardship Essentials: Checklist for Long-Term Care (PDF)

Audit tools for IPAC compliance

IPAC audits are essential to ensure infection prevention and control (IPAC) standards are met. Audits identify gaps and barriers to compliance, guiding strategies to reduce infection risk and improve training programs.

Recommended IPAC audit tools:

• IPAC Canada Audit Toolkit

• Hand Hygiene: Just Clean Your Hands (educational materials, promotional materials and audit tools)

• Personal Protective Equipment: Audit Tools

• IPAC Self-Assessment Audit for Long-Term Care and Retirement Homes

• IPAC Checklist for Long-Term Care and Retirement Homes

Disinfection and sterilization of medical devices and equipment

Improper reprocessing of reusable medical equipment increases the risk of infection transmission. Proper cleaning, disinfection, and sterilization are critical to ensuring resident safety.

Equipment classification:

1. Non-critical: Requires low-level disinfection.

2. Semi-critical: Requires high-level disinfection.

3. Critical: Requires sterilization.

Best practices:

• Select appropriate reprocessing methods based on the classification

• Ensure staff are trained to handle the volume and complexity of reprocessing tasks

Reference:
Best Practices for Cleaning, Disinfection, and Sterilization of Medical Equipment/Devices in All Health Care Settings, 3rd Edition (May 2013)

Environmental cleaning and disinfection

Routine and consistent environmental cleaning reduce infection transmission. Effective cleaning involves:

• Choosing the right products: Use healthcare-grade cleaners with a Drug Identification Number (DIN).

• Implementing procedures: Clear policies for regular cleaning and outbreak protocols.

• Staff training: Ensure staff understand their responsibilities and procedures.

Cleaning frequency:

• Daily cleaning of LTCH and retirement home facilities

• Increased frequency during outbreaks

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

Hand hygiene

Hand hygiene remains one of the most effective measures to prevent infection spread.

Techniques:

• Alcohol-based hand rub (70 per cent alcohol): When hands are not visibly soiled.

• Soap and water: When hands are visibly soiled.

Resources for hand hygiene:

• Just Clean Your Hands (Public Health Ontario)

• Wash Your Hands Poster (PDF)

• How to Hand Wash (Video)

• Clean Your Hands Poster (PDF)

• How to Hand Rub (Video)

• How to Wash Your Hands Poster (PDF)

• How to clean your hands poster (PDF)

Point of Care Risk Assessment (PCRA) and PPE

PCRA helps staff assess risks and apply appropriate controls before interacting with residents.

Guidelines for PCRA:

• Conduct PCRA before each interaction

• Follow Routine Practices (RP) to reduce infection risk

• Use appropriate Personal Protective Equipment (PPE) based on the assessment

Resources for PCRA and PPE:

• Additional Precautions Signs

• Donning and doffing PPE: Instructional Cards (PDF)

• Donning PPE: Video Resource

• Doffing PPE: Video Resource

• Personal Protective Equipment: Audit Tools

• Point of Care Risk Assessment Poster (PDF)

Surveillance in long-term care homes

Surveillance involves ongoing collection and analysis of infection-related data to detect trends and inform interventions.

Benefits of surveillance:

• Early detection of healthcare-associated infections (HAIs)

• Assessment of IPAC program effectiveness

• Guidance for audits and education

Surveillance tools:

• Long‐Term Care Surveillance Toolkit (IPAC Canada in Collaboration with Public Health Ontario)

• Health Care Associated Infections - Due Diligence (PHAC)

Managing residents with symptoms

For respiratory symptoms:

• Follow IPAC protocols for managing and isolating residents with respiratory symptoms

• Use appropriate PPE and hand hygiene practices

For enteric symptoms:

• Implement cohorting strategies where appropriate

• Maintain strict environmental cleaning protocols to reduce spread