Eli's Hospice Insider

Proper hand washing may sound small, but the infection prevention pay-off is big.

Your patients' immune systems are already compromised. Of course you want to do your best to prevent and control infections that could impact their quality of life. Give your plan a check up with this expert advice.

The hospice provider conditions of participation require=you to "maintain and document an effective infection control program that protects patients, families, visitors, and hospice personnel by preventing and controlling infections and communicable diseases." But what does this mean in practical terms?

"A hospice must develop and implement an infection control program in the same way that home health agencies, hospitals, and all other health care providers do," says Lynda Laff, RN, BSN, COS-C with Laff Associates in Hilton Head Island, S.C.

Your documented infection control plan or policy must include at least the following information, Laff says:

Implementation of standard precautions.

How and what types of infections are logged, validated, treated and monitored. This should include a regular aggregation of infection statistics and data that identifies the incidence of infection and any action plans taken.

The type(s) of protective equipment and supplies used by the staff and when these supplies and equipment are supposed to be used.

What staff must use protective supplies and equipment. This includes hand washing supplies first and foremost. Ideally, this will include all direct care staff who go into the home, including MSW,clergy, etc.

How the hospice identifies patients with drug resistant organisms and any protocols they may have for caring for these patients.

What type(s) of equipment are used to protect against airborne organisms.

How the hospice management educates staff and families about infection control prevention and control.

How the hospice monitors compliance with infection control policies and plans.

The first step in an effective infection prevention and control plan is to make certain you're up-to-date on the most current infection control guidelines such as recommendations for appropriate hand washing products as well as the "standard precaution" guidelines, Laff says.

You'll also need to acquire protective equipment such as gloves, aprons, anti-bacterial hand wash and towels, appropriate masks to prevent airborne contamination, and goggles, Laff says.

Once you have the appropriate infection-control gear in place, you'll need to create and maintain an infection control log to identify patients with infections, verification of infection (wound culture, throat culture, antibiotic ordered, etc.), and monitor infection incidence between patients and staff, Laff says.

In a facility, it's easy for staff to follow infection control instructions posted outside a patient's room. But in the home, there's no handy card to follow, says Joanne Tate, RN, BSN, CHPN director of education for Seasons HealthCare Management in Rosemont, IL. For that reason, it's especially important to teach the staff and family how to contain infections, especially those that are resistant to antibiotics, she says.

The hospice patient's immune system is compromised due to overall decline in health status. Many body systems are affected by the terminal diagnosis, including the immune system, so your first goal is to prevent patients from getting an infection in the first place, Tate says. "An infection would add to their discomfort and in hospice, and our goal is comfort," she says.

But on the other hand, if the patient has an infection, your goals will be to minimize the effects of that infection for the patient and to prevent the transmission of that infection by the caregivers, Tate says. Infection prevention techniques include hand washing immedicately after touching the patient or anything in the pateint's care area.

Tip: Daily cleaning of frequently touched surfaces with a 10:1 bleach solution is especially effective in preventing the spread of infection, Tate says. Pay special attention to siderails, faucets, swichplates and door knobs.

The family needs to know how to minimize the transfer of infection, too, Tate says. Teach them transmission-based precautions such as use of a face mask/sheild when the patient has a respiratory condition, she says. Also instruct family on using proper PPE for contact precautions such as gloves, a gown, and face mask/shield when drainage from wounds or excrement is not contained.

Bottom line: Since patients in hospice are generally deteriorating, their ability to fight infections is diminished and therefore, eliminating or curing an existing infection is more difficult than in patients with a non terminal prognosis, Laff notes. This fact makes prevention even more important since the patient's susceptibility to infection will naturally be higher than in a non-terminal patient.