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New CDC Guidelines For Long-Term Healthcare Facilities

The Centers for Disease Control and Prevention (CDC) have determined that the rate of hospital-associated infection (HAI) has decreased in recent years.¹ However, hospitals make up only one part of the nation’s health system. That’s why the CDC is testing strategies to help prevent the spread of infection at long-term care (LTC) facilities as well. In particular, the efforts are aimed at stopping the so-called antibiotic-resistant "superbugs" that kill thousands each year.²

Infections Affect Thousands in Long-Term Care

According to the CDC, antibiotic resistance is one of the biggest public health challenges of our time. In a recent report, the agency found that more than 2 million people in the US get an antibiotic-resistant infection each year, and at least 23,000 die as a result.² Infectious outbreaks are a serious issue for patients in long-term acute care facilities, nursing homes, and skilled nursing facilities. For example, a study of long-term care facilities discovered 1,600 outbreaks across 12 states over a 4-year period.² Long-term care patients often move back and forth between hospitals and post-acute care facilities, putting a greater number of people at risk, possibly contributing to the alarming 65% of nursing home residents versus the 15% of hospital patients harboring drug-resistant organisms.³

The CDC Addresses the Issue

To help LTC facilities lower the rate of infections and cross-contamination stemming from moving patients between settings, the CDC has earmarked $8 million towards helping long-term facilities make needed improvements.³ The CDC initiative also includes a campaign to promote hand-washing and increased communication about which patients carry the drug-resistant organisms.² Early results are promising—after just 18 months, researchers saw a 25% decline in drug-resistant organisms in nursing home residents and a 34% reduction in patients of long-term acute care hospitals.²

Actions LTC Facilities Can Take to Increase Infection Control

The CDC has issued guidance to help LTC facilities help prevent the spread of novel or targeted multidrug-resistant organisms (MDROs).⁴ Standard Precautions are based on the principle that all blood, body fluids, secretions, and excretions (except sweat) may contain transmissible infectious agents. These precautions include:

• Use of personal protective equipment (PPE), such as gloves, masks, and clothing
• Hand hygiene
• Safe injection practices
• Respiratory hygiene and cough etiquette
• Environmental cleaning and disinfection
• Reprocessing of reusable medical equipment

The CDC recommends Contact Precautions when pathogen transmission is not completely interrupted by Standard Precautions alone. Contact Precautions may require:

• The use of gown and gloves upon every entry into a resident’s room
• Private rooms
• Dedicated equipment, such as stethoscopes and blood pressure cuffs
• Restricted access to a patient

Enhanced Barrier Precautions may be warranted when exposure to blood and body fluids is anticipated, as well as during high-contact resident care activities such as dressing, bathing, providing hygiene, assisting with toileting, or wound care. Examples of Enhanced Barrier Precautions include:

• Wearing gloves and gowns before high-contact care activity
• Changing PPE before caring for another resident
• Using face protection if performing an activity with risk of splash or spray

When implementing any of these precautions, it’s critical to ensure that staff members are aware of the facility’s expectations about hand hygiene, gown and glove use, participate in initial and refresher training courses, and have access to appropriate supplies. Facilities should ensure each resident room has:

• Clear signage posted of necessary precautions
• PPE immediately available
• Access to alcohol-based hand sanitizers
• Trash cans inside and near the exit for discarding PPE after removal

Facilities should regularly monitor and assess adherence to procedures in order to determine the need for additional training and education for residents and visitors. To find out more about infection control, visit www.alimed.com/infection-control/

References:

1. https://gis.cdc.gov/grasp/PSA/HAIreport.html
2. https://www.cdc.gov/drugresistance/index.html
3. https://www.npr.org/sections/health-shots/2019/04/02/707842736/enter-title
4. https://www.cdc.gov/hai/pdfs/containment/PPE-Nursing-Homes-H.pdf