27 Dec 2018
Keeping infection control in aged care facilities
This article first appeared in the Australian Ageing Agenda Magazine, November - December edition.
Dr Noleen Bennett, Infection Control Consultant at the Royal Melbourne Hospital's Victorian Healthcare Associated Infection Surveillance System Coordinating Centre at the Doherty Instittue, answers the Australian Ageing Agenda's questions on keeping infection at bay in aged care facilities.
What are the best-practice methods for preventing and controlling infections in aged care facilities?
Standard precautions to be used at all times for all residents in all situations are required to achieve a basic level of infection prevention and control. They include appropriate hand hygiene, the use of personal protective equipment (PPE), safe handling and disposal of medical devices, routine cleaning and managing spills, reprocessing of reusable instruments and equipment, respiratory hygiene and cough etiquette, aseptic non-touch technique, waste management and appropriate handling of linen.
Residents suspected or confirmed to be infected with agents transmitted by contact, droplet or airborne routes require the continued application of standard precautions plus transmission-based precautions.
Transmission-based precautions include appropriate use of PPE by staff, residents and visitors, resident-dedicated equipment, allocation of single rooms or cohorting of residents, enhanced cleaning and disinfecting of resident’s environment and safe transferal of residents within and between facilities.
What is the key hygiene issue in residential aged care?
Hand hygiene is the most effective means of preventing transmission of infections. The World Health Oganisation (WHO) notes hand hygiene should be performed by staff in all health care settings at the right moments. They are before touching a resident or a procedure such as changing a drainage bag, after a body fluid exposure risk and after touching a resident or their surroundings, for example after personal care or making a bed.
Incidental, minor, unplanned contact, for example hugging, may occur daily in aged care homes. In view of this, the strict implementation of the WHO hand hygiene recommendations in these homes is not always considered realistic. The recommendations also do not address the importance of resident hand hygiene in preventing and controlling infections.
Core elements of a hand hygiene program should at least include provision of alcohol-based hand rub at the pointof-care and education for staff, residents and visitors. As a minimum, residents should be encouraged to perform hand hygiene before eating and after toileting.
How can monitoring be used effectively within infection prevention and control programs?
An effective infection prevention and control program includes the coordinated collection, collation, analysis andreporting of process and outcome data related to infections. Processes include, for example, hand hygiene and vaccination compliance. Outcomes may include significant organism infections that are resistant to antibiotics such as methicillin resistant Staphylococcus aureus (Golden staph) and vancomycin resistance enterococcus (bacteria).
Importantly, a monitoring or surveillance program enables timely and useful information to be fed back to key stakeholders including residents, staff and visitors. This feedback empowers stakeholders to more effectively leadand manage their infection prevention and control programs because they are appropriately informed about the need for and impact of any interventions. Interventions may include changes in clinical policies and practices, or education for staff, residents and visitors.
Can you tell us about the quality indicator surveillance program being implemented in Victoria?
As of 2017, all Victorian public sector residential aged care services are required to participate in a state-wide surveillance program. Key data are collected and submitted by infection control practitioners or clinical nurses to the Victorian Healthcare Associated Infection Surveillance (VICNISS) Coordinating Centre. This data includes influenza, pneumococcal and zoster (or shingles) vaccination compliance among residents, influenza vaccination compliance among staff, antimicrobial prescribing practices and infections due to methicillin-resistant Staphylococcus aureus, vancomycin resistant enterococcus and Clostridium difficile.
The role of the VICNISS Coordinating Centre, in collaboration with the Victorian Department of Health and Human services, is to support the public sector residential aged care facilities by:
- developing standardised surveillance modules
- developing secure information technology infrastructure
- collating, analysing and reporting surveillance data in a timely manner
- setting targets and triggers for change to ensure early detection of potential opportunities for improved performance
- providing as necessary expert infection control and infectious diseases education and advice.
Can you point to any online infection control and prevention resources important to aged care?
Some important resources can be found online that provide a basis for aged care homes to develop detailed and relevant protocols and processes for their infection prevention and control and antimicrobial stewardship program.
- National Health and Medical Research Council 2010 Australian guidelines for the prevention and control of infection in healthcare
- Australian Commission on Safety and Quality in Health Care 2018 Antimicrobial Stewardship in Australian Health
- Australian Commission on Safety and Quality in Health Care 2014 Antimicrobial Stewardship Clinical Care Standard
- Australian Aged Care Quality Agency 2018 Guidance and Resources for Providers to support the new Aged Care Quality Standards.