Battling Bugs: Keeping Care Homes Safe from Infections
Healthcare-associated infections (HAIs) pose a significant threat to care home residents. Not only do they increase morbidity and mortality, but they also add considerable strain on healthcare resources to manage conditions that are often preventable. Older adults in care homes are particularly vulnerable due to their weakened immune systems, pre-existing conditions, the frequent use of immunosuppressive medications, and reliance on invasive devices like urinary catheters.
Antimicrobial Resistance: A Growing Challenge
Diagnosing infections in older people is often difficult, as they tend to exhibit atypical symptoms when unwell. As a result, there is a higher tendency to use empirical antibiotics in care home settings. Unfortunately, this practice contributes to a rising issue: antimicrobial resistance (AMR). Not only does AMR increase infection risks within care homes, but it also extends to the wider community due to frequent visits from family members and the many healthcare interactions residents have.
In 2019, antimicrobial resistance contributed to nearly 5 million deaths globally, severely limiting our ability to treat common infections. Care home residents with resistant infections are at even greater risk of acquiring HAIs, making it crucial to adopt effective infection control measures.
What is Infection Control?
Infection control is key to reducing the incidence of HAIs, sepsis, and the global impact of AMR. But what exactly does it involve? In simple terms, infection control refers to the actions we take in healthcare settings to prevent or control the spread of infections among residents and staff. It is the responsibility of all healthcare workers, regardless of role or setting, to ensure infection control is a priority.
The Chain of Infection
Infections occur when a microorganism transfers from a source or reservoir to a susceptible host, a process known as the chain of infection. Infection control aims to break this chain by implementing a hierarchy of controls that disrupt the transmission pathways.
Hierarchy of Controls
The hierarchy of controls is an evidence-based framework designed to prevent, reduce, and control infections in healthcare environments. By systematically applying these controls, we can mitigate infection risks more effectively.
Levels of Infection Control Precautions
Different pathogens have different transmission methods, and understanding these is key to applying the appropriate infection control precautions. There are three main transmission categories: contact, droplet, and airborne.
Contact Transmission and Precautions
Contact transmission is the most common route for HAIs, occurring through direct patient contact or indirectly through contaminated objects. Common examples of infections transmissible though contact include C. difficile, norovirus, MRSA, scabies, and herpes simplex.
WHO’s 5 Moments for Hand Hygiene
To prevent contact transmission, hand hygiene following the WHO’s 5 Moments for Hand Hygiene is essential, along with regular cleaning and disinfecting of equipment and frequently touched surfaces. If there is a risk of direct contact with a patient or contaminated surface, disposable gloves and aprons should be worn and disposed of properly.
Droplet Transmission and Precautions
Droplet transmission occurs when an infected person spreads pathogens through coughing, sneezing, or talking. Droplets are propelled through the air and land on the conjunctivae, mouth, nasal mucosa or pharynx mucosa of another person, subsequently causing infection. Airborne precautions are not required as droplets do not remain in the air for long.
To reduce the risk, healthcare workers should maintain at least 1 metre of distance from infected individuals and wear a fluid-resistant surgical mask, gloves, and aprons. Infections such as influenza, rubella, mumps, and whooping cough are commonly transmitted this way.
Airborne Transmission and Precautions
Airborne transmission involves pathogens that can remain suspended in the air for extended periods, posing a significant risk of inhalation. Proper ventilation is critical in these cases, and healthcare workers should use FFP3 masks when caring for people with airborne infections such as tuberculosis, measles, or varicella-zoster.
Appropriate Use of PPE
Personal Protective Equipment (PPE) is essential in many situations but must be used correctly. Over-reliance on PPE when it is not necessary can lead to issues such as contact dermatitis for healthcare workers, reduced hand hygiene compliance, and unnecessary environmental waste.
For example, gloves are not required for tasks that do not involve bodily fluids or when there is no known risk of infection transmission. Ensuring appropriate use of PPE helps maintain safety while also managing costs and reducing environmental impact.
Further Reading
For more detailed guidance, Healthcare Ireland’s Infection Prevention and Control Policy is accessible to all staff through the Library on the EVOLVE Platform. Additional information is available on the Public Health Agency website.
References
Bennett, N., Tanamas, SK., James, R., et al (2024), ‘Healthcare-associated infections in long-term care facilities: a systematic review and meta-analysis of point prevalence studies’, BMJ Public Health, 2(1). https://bmjpublichealth.bmj.com/content/2/1/e000504#sec-36
Carpenter, L., Miller, S., Flynn, E. (2024), ‘Exposure to doxycycline increases risk of carrying a broad range of enteric antimicrobial resistance determinants in an elderly cohort’, Journal of Infection, 89(4). https://doi.org/10.1016/j.jinf.2024.106243
Manoukian, S., Stewart, S., Graves, N., et al (2021), ‘Bed-days and costs associated with the inpatient burden of healthcare-associated infection in the UK’, Journal of Hospital Infection, 114(1). https://doi.org/10.1016/j.jhin.2020.12.027
Royal College of Nursing (RCN), (2017), Essential Practice for Infection Prevention and Control: Guidance for nursing staff. Available online: https://www.bing.com/ck/a?!&&p=c66764e967f2bb75JmltdHM9MTcyOTU1NTIwMCZpZ3VpZD0yNTk0M2NjNS1iZDRiLTYyMTMtMzE5Ni0yOWQwYmNmMDYzMjcmaW5zaWQ9NTI5Nw&ptn=3&ver=2&hsh=3&fclid=25943cc5-bd4b-6213-3196-29d0bcf06327&psq=what+is+infection+control&u=a1aHR0cHM6Ly93d3cucmNuLm9yZy51ay8tL21lZGlhL3JveWFsLWNvbGxlZ2Utb2YtbnVyc2luZy9kb2N1bWVudHMvcHVibGljYXRpb25zLzIwMTcvbm92ZW1iZXIvcHViLTAwNTk0MC5wZGY&ntb=1 Last accessed 22nd October 2024
World Health Organization (WHO), (2023), Antimicrobial resistance. Available online: https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. Last accessed 22nd October 2024