Infection Control practices in Long term care

[Nascar nurse]

Now that I am more involved with the admission process than ever.. I have noted that we seem to have a very high rate of residents coming to use with VRE and MRSA. Seems our local hospital is doing nares cultures and rectal cultures as a standard procedure w/ treatment for everyone. This is presenting a real challenge with bed availability as we just don't have enough private rooms (in our facility and in the surrounding LTC's either). I'm also not completely sure we are up to standard on our current infection control procedures. So, some questions for all of you.. PLEASE RELATE TO LONG TERM CARE practice only as I know the hospital does things much differently.

1. Are you all still routinely giving private rooms to multi-drug resist residents, cohorting residents, or are you even diligently paying attention to this?

2. Do you follow contact precautions, ie: signs on doors, bins in room, mask/gown as needed? I personally think this is over the top sometimes, (I have always been one to preach garbage is garbage..dirty laundry is dirty laundry), BUT on the other hand I see far to many CNA's leaving rooms with arms loaded with dirty linen/not bagged and hugged next to their uniform. Maybe if we had the bins, etc at least they wouldn't carry the yucky stuff all thru the hall on the shirts?

3. Are your local hospitals routinely screening everyone they send? Doing anything different because of it.

Thanks, I know wediscussed this in part recently, but I couldn't find it when I searched.

[LeeAnna328]

The tape on the floor doesn't say anything nor does it indicate anything to anyone other than the nursing staff. It is no different that placing a "contact precautions" or "droplet precautions" or whatever sign on the door. Why would tape be any more insulting than that?

[Havin' A Party!, ASN, RN]

Agree the tape wouldn't be more "offensive" than the usual signage employed.

Just think the tape might make the room / floor appear unkempt. With our facility's traffic, that tape, in a short while, will look filthy.

[CapeCodMermaid, RN]

We don't allow signs of any kind except "Please see the nurse before entering the room." I constantly have to go around and take down signs which say DEAF IN RIGHT EAR, VISUALLY IMPAIRED and the like. The surveyors would slam us for any of this.

[Havin' A Party!, ASN, RN]

The thing is the tape makes no outward communication or announcement whatsoever. In that sense, it would seem to be even less obtrusive publicly than the "Please See the Nurse Before Entering" sign at the door.

The tape sounded like a good idea to me, except for my previous comment. It would help those that have a poor sense of distance, or who may casually forget the recommendations provided (presuming they've even obtained the same) once they've been in the room for a time and for various reasons. The preceding may apply to both staff and non-staff.

[CapeCodMermaid, RN]

What happens if the patient moves? How about a 3 foot diameter hula hoop around the patient's midsection?

[Havin' A Party!, ASN, RN]

Naaah... that hula hoop wouldn't work. It would only demarcate a distance of 18" around the resident. Besides that, sitting down on the toilet would likely be a challenge... and just ponder all those spilled urinals by the bed.

And "if the patient moves": it's OK. As stated, the tape is merely intended as a memory-jogger.

But if infection control and safety are truly the goals, perhaps another tool would be appropriate.

[expltcrn]

there are cdc guidelines which address mdro's in ltc (multi-drug resistant organism) infections.

here is the link: http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroguideline2006.pdf

and here is a great excerpt.

v.a.5.c.ii. in ltcfs, consider the individual patient's clinical situation and

prevalence or incidence of mdro in the facility when deciding

whether to implement or modify contact precautions in addition to

standard precautions for a patient infected or colonized with a

target mdro. category ii

v.a.5.c.ii.1. for relatively healthy residents (e.g., mainly independent) follow

standard precautions, making sure that gloves and gowns are

used for contact with uncontrolled secretions, pressure ulcers,

draining wounds, stool incontinence, and ostomy tubes/bags. (78-

80, 85, 151, 367, 368) category ii

39

v.a.5.c.ii.2. for ill residents (e.g., those totally dependent upon healthcare

personnel for healthcare and activities of daily living, ventilatordependent)

and for those residents whose infected secretions or

drainage cannot be contained, use contact precautions in

addition to standard precautions.(316, 369, 370) category ii

c diff precautions should also include shoe covers, disposable equipment in the room while under treatment (i.e. bp cuffs, etc.), and suggest availability of the sani-cloths plus that specifially kill the c. diff spores for surfaces. you would treat the isolation stricter due to the nature of the bug (easy to transmit, difficult to kill).

here is a great faq on c diff. http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/cdiff_tagged.pdf

no hand sanitizers? go back to handwashing until hand sanitizer issue fixed! post and re-post handwashing signs too just to remind staff.

as for the 3 foot rule, the force of the cough aerosolizes (fine mist) the expectorate with the buggies, which you can inhale right in if you were up close and personal without the mask! and that is the stuff you can't easily see nor duck from! 3 feet is the scientific measure i think from their studies on distance of expectorate and misting (yukky stuff)

[southernbeegirl, BSN, RN]

There's one thing I want to mention that has always been annoying to me.

Because it's a home there are no hand sanitizer dispensers at easily usable intervals, or upon entry and exit.

Well, that's marvelous, but our NH recently had a GI bug gallop through it, 50+ out of 80 residents got it.

Find a way to put up sanitizer dispensers! I had to be on and off the unit frequently during this epidemic and had no way to easily clean my hands. That strikes me as a silly paeon to "it's a home," while meanwhile I've seen the same silliness with full PPE for MRSA in the nares.

our facility has the hand sanitizer mounted on the walls in the hallway between every other room.

i've seen the same for MRSA in the nares too. totally frustrating.