Infection Control Basics

Infection Control Basics:

Healthcare‐Associated
Infection Control
Infections (HAI) in Long Program
Term Care Facilities Infrastructure
Infectious Disease Epidemiology Section
Office of Public Health
Louisiana Dept of Health 800‐256‐2748
www.infectiousdisease.dhh.louisiana.gov

Objectives of IC in LTCF Principle Functions of Infection

The goal of infection control is to prevent transmission of infection:
Prevention Programs
1. To obtain and manage critical data and information, 
including surveillance for infections
2. To develop and recommend policies and procedures
3. To intervene directly to prevent infections and interrupt the 
transmission of infectious diseases
• Explain why infection prevention and control is important in assisted living  4. To educate and train healthcare professionals (HCP), 
facilities and nursing homes
patients, and nonmedical caregivers
• Describe transmission and chain of infection  
• Differentiate infection, colonization and contamination
• Understand precautions and isolation
• List  infections and risk factors in the elderly
• Explain why surveillance is important
• Explain how to identify and report an outbreak

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Being a Successful Infection

Infection Prevention Team
Preventionist
• The core of the infection prevention and control program is  • Improve leadership strategies and pursue opportunities for 
the infection preventionist self‐development
• Occupational health can also participate on the team • Work with the IPC to create policy changes that are data‐
• Team is responsible for carrying out all aspects of the infection  driven and patient‐centered
prevention and control program • Possess multiple skills necessary to meet the demands of the 
• Facility may have an infection prevention committee (IPC) that  evolving healthcare environment
functions at the central decision‐making and policy‐making 
body for infection prevention
• IPC advocates for prevention and control of infections at the 
facility
• IPC must be multidisciplinary
• Dissemination of information is a crucial component of the IPC

Role of Infection Prevention

Organizational Support
Professionals
1. Collection and analysis of infection data • Use basic healthcare epidemiology and other quality 
2. Evaluation of products and procedures improvement tools to improve patient outcomes
3. Development and review of policies and procedures • Useful for transitioning evidence‐based practices into work 
4. Consultation on infection risk assessment routine
5. Education efforts directed at interventions to reduce  • Administrative Support
infection risks • Schedule regular meetings with administrators to whom you are 
6. Education of patients and families responsible
7. Implementing changes mandated by regulatory, accrediting  • Maintain liaison between the program and administration
and licensing agencies • Increase awareness of the institution’s leaders of infection 
8. Application of epidemiological principles directed at  prevention and control program activities
improving patient outcomes
9. Antimicrobial management
10. Provision of high‐quality services in a cost‐efficient manner

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Quality of an Infection
Long‐term Care
Prevention and Control Program
1. Establishing a reliable, focused surveillance program based on  • Long‐term care (LTC) is an umbrella term that encompasses 
the annual risk assessment several different types of facilities to provide care for 
2. Streamlining data management activities individuals 
3. Analyzing HAI rates • Generally referred to as long‐term care facilities (LTCF)
4. Aiming for zero HAI rates • Spans the spectrum of care from providing short‐term, 
5. Educating staff regarding prevention strategies episodic skilled nursing and residential support  to chronic 
care management
6. Identifying opportunities for performance improvement
• The number of adults in the United States over the age of 60 
7. Taking a leadership role on performance improvement teams will rise by nearly 25% by 2030
8. Developing and implementing action plans that outline the 
steps needed to accomplish each objective
9. Evaluating the success of action plans in accomplishing the 
goals and objectives of the infection prevention plan

Long Term Care Facilities

• LTCF: Facilities that provide health care to people that are unable 
to manage independently in the community

LTCF v. Hospital Surveillance • Nursing Homes: Facilities with in‐patient beds providing nursing 

and other services to patient not in acute phase of illness

of Healthcare‐Associated • Some residents for years
• Few temporary post‐acute care residents

Infections • Other LTCF:
• Long Term Acute Care facilities (LTAC)
• Psychiatric Hospitals
• Other Mental Health facilities
• Rehabilitation hospitals
• Pediatric LTCF

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Key Differences: LTC v. Acute LTACH Risk Assessment

• Key difference and challenge is the concept of residence • Annual risk assessment determines goals and objectives for 
• LTCF offers socialization through common activities  infection prevention and control program
• LTCFs generally have common air circulation, which may  • Important to identify the highest risk concerns and target 
contribute to infection transmission of pathogens that are  efforts to specifically address those areas
airborne • Ongoing review throughout the year allows the IP to 
• Emerging, significant risk factor in LTCFs involves enhanced  determine if the strategies are effective
infection risks for colonization or infection with multidrug‐ • Communication is vital for an infection prevention program
resistant organisms (MDRO) • IPCC members should meet on a regular basis to review 
surveillance data, identify areas of concern, plan 
interventions, define outcome measures, and review/develop 
policies

The HAI Problems in LTCF and Hospitals are different

Infection Prevention and Resource/Clientele Hospitals LTCF
Control in the LTACH Residence Short, few days Lengthy, years
Patients All ages Elderly mostly
• LTACH: Long‐term acute care hospital
Illness Acute Chronic
• Early identification of MDRO or Clostridium difficile infection  Recovery Expected Not expected
and colonization is imperative to limit the risk of transmission 
Access to lab, imaging… Easy More difficult
• One study showed that 64% of patients in LTACHs were  Ration Nurse to Patient High Lower
colonized with MRSA, VRE, or both
Socialization Low importance High importance
1‐LTCF provide care in resident‐centric environment . Provide a home‐like 
environment with limited medical care support.

2‐LTCF provide care for patients coming from acute care hospital for short‐term of 
more “hospital‐like” environment critical for positive resident outcomes. 

3‐Many are combinations of both 

Therefore Infection Control Guidelines must be adapted to LTCF conditions. 
Guidelines for specific procedures may remain identical 

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HAI in Louisiana
Variable Hospitals Nursing Homes
Number 250 (120 Acute) 280
Beds 35,000
Admissions 500,000

Infection Control in
Patient days 2,200,000 9,000,000
HAI rates /1,000 patient days 3 to 14 2 to 14 
UTI rates / 1,000 patient days 0.2 to 3.5

LTCF
Pneumonia rates / 1,000 patient  0.20 to 3.3 0.3 to 2.5
days
BSI rates / 1,000 patient days 0.8 to 3.0
SSI rates / 1,000 patient days 0.03 to 8.0 ‐‐‐
Total infections 16,000 23,000 to 54,000

Death rate / 1,000 patient days 0.60 0.04 to 0.70

Deaths 1,300 360 to 6,300

Device Utilization in Nursing Homes SHEA/APIC Guidelines

Utilization rates for: Smith PW, Bennett G, Bradley 
Urinary Catheters 5% of patients S, Drinka P, Lautenbach E, 
Marx J, Mody L, Nicolle L, 
Stevenson K, July 2008 
Proportion of nursing homes offering: SHEA/APIC Guideline: 
Infection prevention and 
Infusion therapy 42%
control in the long‐term 
Peripherally inserted central lines 22%  care facility. Am J Infect 
Parenteral nutrition 46% Control 2008;36:504‐35.

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Requirements /Recommendations Infection Preventionist & IC Committee

for Infection Control Program • Responsible for directing infection control 
• Familiar with LTCF & resident care 
problems 
• Skilled Nursing: 1987 Omnibus Reconciliation Budget Act 
(OBRA)  • Written job description of IC duties  
• Nursing Homes: Medicare & Medicaid. Requirements for LTCF • With sufficient time and administrative 
support
‐HCFA. Final rule. Fed. Register 1991; 56:48826‐80
• Sufficient IC knowledge base to carry out 
• Occupational exposure to bloodborne pathogens—OSHA. Final 
responsibilities 
rule. Fed Regist 1991;56:64004‐182.
• Canada’s recommends 1 IP /150 to 250 
• Friedman C et al 1999.  Requirements for infrastructure and 
long term beds
essential activities of infection control and epidemiology in 
out‐of‐hospital settings: a consensus panel report. APIC/SHEA. 
Infect Control Hosp Epidemiol 1999;20: 695‐705.

Scope of Infection Control

Prevention of Hospital Acquired (Nosocomial) Infections
IC COMMITTEE
STANDARD PRECAUTIONS IC POLICIES SURVEILLANCE
Handwashing Nosocomial infection
Barrier precautions Surveillance system
Sharps disposal ISOLATION Antibiotic sensitivity
PRECAUTIONS
COMMUNICABLE DISEASE
ENVIRONMENTAL
CONTROL IN HOSPITAL

Definitions
CONTROL Reporting of disease
Physical facility MRSA….
Patient care equipment Preventive treatment of exposed
Water, Air, Food SPECIAL PROCEDURES
Solid waste, Liquid waste Cardiovascular access lines
EMPLOYEE HEALTH Wound care
CD Reporting Urinary catheter
STERILIZATION
HBV screening & immunization Artificial ventilation ….
IC supports CSS
BBFE
TB (Central Sterilization & Supply)
MMR, Varicella
Work restriction HOUSEKEEPING
Prophylactic Rx: Mng, Pert, TB, HAV, HBV, HIV LINEN

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What is a Nosocomial Infection?

• An infection which is acquired during hospitalization and which  To establish a nosocomial infection,
was not present or incubating at the time of admission
meeting the definition criteria is
• An infection which is acquired in the hospital and becomes 
evident after discharge from the hospital
sufficient. There is no need to have
proof beyond the shadow of a doubt
• A newborn infection which is the result of passage through the 
birth canal

Case Definitions
What is a Nosocomial Infection?
CDC/NHSN surveillance definition
Practically ‐ to establish that an infection is hospital acquired,   of health care-associated infection
and criteria for specific types of
SHOW THAT the patient: infections in the acute care setting
Teresa C. Horan, MPH,
Mary Andrus, RN, BA, CIC,
1. HAS AN INFECTION, not a simple colonization and Margaret A. Dudeck, MPH
Atlanta, Georgia
2. WAS NOT infected at the time of admission
Am J Infect Control 2008;36:309-
32.
3. HAD SUFFICIENT TIME to develop infection

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Outbreak Investigations
• Three elements required for transmission: source 
susceptible host  mode of transmission
• Outbreaks are prevented by the elements basic to an infection 
prevention and control program in all healthcare settings
• Hand hygiene programs General Principles of
Epidemiology
• Standard and Transmission‐Based Precautions
• Identification and isolation measures
• Communicate with the health department early in an 
outbreak

Education Epidemiology
• Study of the distribution and determinants of disease and 
• Education can promote compliance when employees  other conditions in human populations
comprehend the impact an HAI or MDRO transmission will  • Population‐based and is useful for describing health‐related 
have on the patient phenomena
• HCP, ancillary department staff, medical staff, and visitors  • Epi methods are used in the measurement of a disease, its 
must also be educated determinants, and its distribution in a particular population in 
question
• Primary purpose of epidemiology is to aid in the 
understanding of the cause of a disease by knowing its 
distribution

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Use of Epidemiology in
Portals of Entry and Exit
Healthcare Portals of Exit Portals of Entry
• The goal is to complete prevention of a disease before any 
manifestation of that disease occurs Respiratory tract Respiratory tract

• Early diagnosis and treatment Genitourinary tract Genitourinary tract

• Prevention strategies to reduce the risk of transmission,  Gastrointestinal tract Gastrointestinal tract
including barrier precautions, immunizations of HCP, and 
cleaning, sterilizing, and disinfecting Skin/mucous membrane Skin/mucous membrane
• Applications of disease prevention using information gathered Transplacental (mother to fetus) Transplacental (mother to fetus)

Blood Parenteral (percutaneous via 
blood)

The Chain of Infection Resources

• Bodily‐Bartrum M, Franck J, Spaulding L and Zeller J. Chapter 
61 – Long‐term care. Association for Professionals in Infection 
Control and Epidemiology Text. 2015.
• Friedman C. Chapter 1 – Infection Prevention and Control 
Programs. Association for Professionals in Infection Control 
and Epidemiology Text. 2015.
• Knox Sh. Chapter 62 – Long‐term acute care. Association for 
Professionals in Infection Control and Epidemiology Text. 
2015.
• Tweeten S. Chapter 10 – General Principles of Epidemiology. 
Association for Professionals in Infection Control and 
Epidemiology Text. 2015.

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Questions?

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