The Lowdown
Fall 2022

An Educational Resource for Long-Term Care

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​​​Welcome to the fall edition of The Lowdown, an educational resource for long-term care. This edition is dedicated to safety and provides information to help promote a safe, positive environment for you and your residents. Happy reading!

Infection Prevention Is Everyone’s Business!

Good infection prevention practices prevent harm and increase resident safety. These practices, such as hand hygiene, cough and sneeze etiquette, and injection safety, help provide a safe environment for residents, visitors, and staff.1,2

Everyone has a vital role in the prevention of infection. Staff must be educated on good infection prevention practices and monitored for compliance. Teamwork and good communication also assist by helping build a culture of safety. Resident harm can occur if staff are hesitant to report poor infection prevention practices. Staff members should feel comfortable reporting safety concerns without fear of retribution. Residents and family members play a role by practicing good infection prevention, including hand hygiene, the appropriate wearing of PPE, not visiting when sick, and being up to date on vaccinations.1,3

Practices staff can follow to decrease transmission of pathogens and reduce the risk of infection include 1
 

​​Aspiration Pneumonia

Aspiration pneumonia is a lung infection that occurs when foreign material, such as food, stomach acid, or vomit, is inhaled into the lungs. This aspirated material can damage the lung tissue, causing inflammation, and pathogens that may be present in the aspirated material can infect the lungs, causing pneumonia. The elderly are at higher risk of aspirating from factors due to underlying comorbidities and aging, such as swallowing difficulties, poor cough and gag reflex, gastric reflux, and poor immune response.4,5,6

Strategies to prevent aspiration include:4,5,6
  • Teach residents techniques for optimizing cough and airway clearance.
  • Avoid unnecessary medications that reduce the level of consciousness.
  • Maintain the head of the bed at 30 degrees or greater unless contraindicated.
  • Encourage ambulation.
  • Provide subglottic suctioning.
  • Consult with speech or swallowing professionals when appropriate.
Holistic prevention strategies include:6
  • Administer vaccines and immunizations.
  • Provide smoking cessation counseling.
  • Institute environmental infection control measures.
  • Encourage personal hygiene, including hand hygiene.
  • Evaluate the residents’ risk for aspiration.
  • Provide dementia screening.
  • Assess the residents’ nutritional status.
  • Encourage routine professional dental care.

The Patient Safety Authority (PSA) has an educational poster for your use available here.

PSA Learning Management System

The PSA has a free, online education platform that delivers high-quality patient safety education to healthcare professionals. One of the available educational offerings is The Basics of Infection Prevention in Long-Term Care. This course is ideal for infection preventionists practicing in a long-term care facility within Pennsylvania. This program consists of 10 modules focusing on legislative and regulatory requirements and basic concepts of disease processes, infection prevention, and process improvement. Access the LMS at https://patientsafetyeducation.org/.

Drug Diversion

Drug diversion is a resident safety and infection prevention event. According to the U.S. Drug Enforcement Administration (DEA), the abuse of controlled substances is a serious problem, and healthcare providers are as likely as anyone else to abuse drugs. Drug-impaired healthcare providers are a source of controlled substance diversion. Healthcare providers have easy access to controlled substances; some will divert and abuse these drugs to self-medicate, relieve stress, or improve mental alertness and work performance.7​

If a healthcare provider tampers with injectable drugs, they must do so quickly to avoid detection. A sterile technique likely is not used, and the needle used to inject the drug is not replaced. If the healthcare provider is infected with hepatitis B virus, hepatitis C virus, and/or HIV, the exposed residents are at risk of developing an infection.4

Facilities should have a drug-diversion program that includes:4
  • Policies to prevent, detect, and report drug diversion
  • Observation and audit processes for controlled substances
  • Immediate attention to suspicious audits
  • Collaborative relationships with public health and regulatory officials
  • Staff education on drug diversion
If drug diversion is detected, assess harm to residents, consult with the Pennsylvania Department of Health, and promptly report it to law enforcement.

References
  1. Agency for Healthcare Research and Quality (AHRQ). A Unit Guide To Infection Prevention for Long- Term Care Staff. AHRQ website. https://www.ahrq.gov/hai/quality/tools/cauti-ltc/modules/resources/ guides/infection-prevent.html#section1. Published March 2017. Accessed August 24, 2022.
  2. Green D. Standard and Transmission-Based Precautions. In: Franck JN, Bodily-Bartrum M, eds. Infection Prevention Guide to Long-Term Care. 2nd ed. Association for Professionals in Infection Control and Epide- miology, Inc; 2019:66–78.
  3. Siegel JD, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection Control Practices Advisory Commit- tee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. Centers for Disease Control and Prevention website. https://www.cdc.gov/infectioncontrol/ guidelines/isolation/index.html. Updated 2018. Accessed August 24, 2022.
  4. Momosaki R. Rehabilitative Management for Aspiration Pneumonia in Elderly Patients. J Gen Fam Med. 2017;18(1):12-15. DOI: 10.1002/jgf2.25. PMID: 29263982; PMCID: PMC5675146.https://www.ncbi.nlm.
  5. nih.gov/pmc/articles/PMC5675146/#:~:text=Aspiration%20pneumonia%20is%20a%20common,often%20 require%20long%E2%80%90term%20hospitalization.
  6. Luk JK, Chan DK. Preventing Aspiration Pneumonia in Older People: Do We Have the “Know-How”? Hong Kong Med J. 2014;20(5), 421–427. https://doi.org/10.12809/hkmj144251
  7. Metheny, N. Preventing Aspiration in Older Adults With Dysphagia. Hartford Institute for Geriatric Nurs- ing. https://hign.org/consultgeri/try-this-series/preventing-aspiration-older-adults-dysphagia. Updated 2018. Accessed August 24, 2022.
  8. U.S. Department of Justice – Diversion Control Division. Drug Addiction in Health Care Professionals. Drug Enforcement Administration. https://www.deadiversion.usdoj.gov/pubs/brochures/drug_hc.htm. Updated December 12, 2019. Accessed August 24, 2022.