Long-Term Care Survey Alert

Published on Thu Oct 01, 2009 PDF

Take steps to prevent bacterial contamination from common equipment and procedures.

Are hidden sources of infection lurking in your facility? Take a close look to see if your residents could be at risk from any of these common practices.

1. Staff takes equipment and charts into residents' rooms. "The problem with so many electronic devices in healthcare is that manufacturers don't provide directions on cleaning or disinfecting" them, says Sharon Jacobs, RN, MS, CIC, manager of infection prevention and control at St. Clair Hospital in Bower Hill in Pittsburgh, and a spokesperson for the Association for Professionals in Infection Control and Epidemiology.

Action step: Discourage staff from taking certain items, such as personal  digital assistants (PDAs) into patients' rooms. St. Clair Hospital, for example, even discourages clinicians from taking the patient's chart with them into the room.

If you do need to take an item into the patient's room to provide care safely, then place the item in a plastic bag, Jacobs suggests. "We teach staff how to remove the item from the bag before going onto the next patient," she adds. "Such items might include a bar code reader for administrating medications or blood glucose monitoring devices. You can read the bar code through the plastic bag or insert a blood glucose strip [in a glucometer] without contaminating the entire device." Then you clean the glucometer as you normally would, she adds. "We prefer staff members not take PDAs into the room unless needed, but they could take the PDA in a plastic bag into the room."

2. Wound care includes use of the whirlpool. The problem with whirlpools is that you can't completely prevent biofilms from forming in the nooks and crannies, such as the jets, pipe fittings or drains -- even when you run antiseptic through the system, cautions Mary Arnold Long, MSN, RN, CRRN, CWOCN-AP, ACNS-BC, a clinical nurse specialist at Drake Center in Cincinnati, Ohio.

When you turn the whirlpool on after cleaning it, the biofilm ends up propelled back into the whirlpool. Thus, "the majority opinion among those in the wound-care community is that use of whirlpools [for wound care] should be strongly discouraged."

Alternative: The current standard of practice is to use pulsatile lavage or ultrasound mist to aid in wound debridement because those [treatments] don't involve the potential" for wound contamination, Long says.

3. Staff don't follow infection control measures when providing pulsatile lavage. Use of this modality for wound debridement has been shown to cause aerolization of bacteria. But caregivers performing pulsatile lavage can significantly reduce infection risk if they wear personal protective equipment, including a face mask, and isolate the patient during the procedure, says Long. Then wipe down surfaces with a disinfectant after the procedure, she advises.

Resource: For infection control guidelines for pulsatile lavage used by Johns Hopkins, visit www.nosoweb.org/pdf/IC_Precautions_PulseLavage.pdf.

4. Caregivers or housekeeping staff handle soiled linens improperly.Staff shouldn't shake the soiled linens or hug them to their body prior to placing them into the soiled linen bag, advises Jacobs.

The newly revised F441 infection control survey guidance for nursing homes recommends using standard precautions for handling linen, even for linen in isolation rooms. The guidance recommends double bagging if the outside of the bag is visibly contaminated or wet all the way through to the outside. Facilities should use leak-resistant bags for linens contaminated with blood or other bodily substances, the guidance advises.

Watch out: Make sure you look for contamination of the outside of the bag requiring double bagging, advises Kristin Lueschow, RN, RRT, WCC, a consultant with Boyer & Associates Inc. in Brookfield, Wis. While the F441 guidance doesn't require it, Lueschow personally advises healthcare staff to double bag linens and other items for people on isolation.

"When I did a dressing change, I'd always double bag," she adds.