Infections are a major cause of hospitalization and death, and as many as 380,000 people die of infections in long-term care facilities every year. 1 These infections include urinary tract infections, diarrheal diseases, antibiotic-resistant staph infections, and more many of which are preventable. Infection prevention and control initiatives in senior care facilities are an essential element of providing safe, high-quality care to residents. Further, strong infection control efforts can help reduce organizational risk and potentially decrease costs. Use this checklist 2 to evaluate your senior care facility s infection prevention and control efforts and identify areas for improvement. Safety Culture Do facility leaders support a culture of safety in which staff members are empowered to remind others about infection prevention and control and raise concerns without fear of punitive action? Does the commitment to resident safety require that each staff member accept personal responsibility for infection prevention every day? Has the facility designated a qualified infection preventionist to direct and oversee strategic efforts aimed at curbing infections and improving quality of care? 3 When infection control lapses occur, are the incidents investigated and are corrective actions taken? Does the facility have a process for collecting, reviewing, and acting on data and quality measures related to infection prevention and control? Infection Prevention and Control Program Does the facility have an infection prevention and control program that includes evidence-based policies and procedures for infection prevention, infection control, monitoring, and communication? Does the facility s infection prevention and control program include emergency preparedness protocols for infectious outbreaks?
Checklist: Infection Prevention & Control in Senior Care 2 Infection Prevention and Control Program (continued) Does the infection prevention and control program include written competencies for infection prevention practices, including staff safety procedures and cleaning, disinfection, and sterilization processes? Are staff members responsibilities relative to infection control included in their job descriptions? Is the facility s infection prevention and control program assessed at least annually and is compliance with policies and procedures documented? Do facility leaders, the infection preventionist, and the administrative team stay current on infection prevention and control guidelines and best practices to ensure the facility s program is up to date and effective? Training and Education Has the infection preventionist received specialized training and education on infectious diseases processes and infection prevention and control strategies and techniques? Are all new staff members (including full-time employees, contractors, temporary staff, and volunteers) educated about infection prevention and control strategies and techniques? Is education and training on all aspects of infection prevention and control conducted at least annually or according to state and federal requirements? Is compliance with all infection prevention and control protocols monitored and documented, and are employees given feedback about their performance? Antibiotic Stewardship Does the facility have an antibiotic stewardship plan that defines antibiotic use protocols and a system to monitor antibiotic use? 4 Has the facility implemented practices to improve antibiotic prescribing and use? Does the facility have access to a pharmacist, physician, or other healthcare provider who has expertise in antibiotic prescribing? Do clinical providers and nursing staff receive facility-specific reports on antibiotic use and outcomes?
Checklist: Infection Prevention & Control in Senior Care 3 Occupational Health Does the facility require adherence to Occupational Safety & Health Administration bloodborne pathogen standards? Is a protocol in place to implement postexposure evaluation and follow-up? Does the facility offer annual influenza vaccinations for all healthcare personnel? Does the facility offer hepatitis B vaccinations to personnel at risk of occupational exposure? Is a tuberculosis (TB) screening required upon hire and annually thereafter (or as required by state law or a risk assessment) for healthcare personnel at risk of TB exposure? Hand Hygiene Does the facility have written hand hygiene policies based on best practices? Are adequate and readily accessible supplies including soap, water, paper towels, and alcohol-based hand rub always available? Are residents and their families encouraged to wash their hands, be mindful of infection control efforts, and ask questions or remind staff members if they think an appropriate action has not been taken? Reusable Medical Instruments and Devices Are reusable and single-use disposable devices clearly differentiated? Do facility leaders reinforce that single-use disposable devices should not be reused under any circumstance or in any situation? Has the level of sterilization or disinfection needed for each reusable instrument or device been determined (i.e., is the device critical, semi-critical, or noncritical)? Does the facility have written policies and procedures for reprocessing reusable devices, including methods for sterilization, high-level disinfection, and low-level disinfection?
Checklist: Infection Prevention & Control in Senior Care 4 Reusable Medical Instruments and Devices (continued) Are policies, procedures, and manufacturer s reprocessing instructions for reusable medical devices posted in reprocessing areas? Have standards for routine maintenance of sterilization equipment (according to manufacturer s instructions) been established? Injection Safety Does the facility s infection prevention and control program include protocols for injection safety, including finger sticks and point-of-care testing? Do injection protocols adhere to the Centers for Disease Control and Prevention s infection control guidelines for assisted blood glucose monitoring and other point-of-care testing? Are adequate injection safety supplies available at the facility (e.g., single-use vials and sharps containers)? Does the facility track provider and staff access to controlled substances to prevent drug diversion? Respiratory Hygiene Does the facility have procedures to contain respiratory secretions in residents who have respiratory infection symptoms? Are adequate hand hygiene and respiratory safety supplies located in appropriate places (e.g., entry ways, resident care areas, etc.)? Does the facility have signs posted at entrances and within the facility reminding personnel, residents, and visitors of appropriate safety precautions if they have respiratory infection symptoms? Personal Protective Equipment Does the facility have sufficient and appropriate personal protective equipment (PPE) available and accessible to personnel (e.g., gloves and face masks)? Are personnel educated about specific clinical conditions for which the use of PPE is required? Is PPE removed and discarded before leaving resident rooms or care areas?
Checklist: Infection Prevention & Control in Senior Care 5 1 Centers for Disease Control and Prevention. (2017). Nursing homes and assisted living (long-term care facilities [LTCFs]). Retrieved from https://www.cdc.gov/longtermcare/ 2 This checklist is based largely on the following resource: Centers for Disease Control and Prevention. (2016, September). Infection prevention and control assessment tool for long-term care facilities (Version 1.3.1). Retrieved from www.cdc.gov/infectioncontrol/pdf/icar/ltcf.pdf 3 Designating an infection preventionist is required under the Centers for Medicare & Medicaid Services Rules of Participation for Long-Term Care Providers (42 CFR, 483.80 Infection Control). The requirement goes into effect vember 28, 2019. 4 Developing an antibiotic stewardship program is required under the Centers for Medicare & Medicaid Services Rules of Participation for Long-Term Care Providers (42 CFR, 483.80 Infection Control). The requirement goes into effect vember 28, 2017. This document should not be construed as medical or legal advice. Because the facts applicable to your situation may vary, or the laws applicable in your jurisdiction may differ, please contact your attorney or other professional advisors if you have any questions related to your legal or medical obligations or rights, state or federal laws, contract interpretation, or other legal questions. MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO, Inc. and MedPro RRG Risk Retention Group. All insurance products are underwritten and administered by these and other Berkshire Hathaway affiliates, including National Fire & Marine Insurance Company. Product availability is based upon business and regulatory approval and may differ between companies. 2017 MedPro Group Inc. All rights reserved.