Preventing Infections

Many nursing homes are cited each year for not following appropriate infection control practices. By not doing so, they promote the spread of the cold and flu virus, eye infections, and urinary tract infections. They also can contaminate pressure sores, causing infection that in some cases can lead to amputation, sepsis (blood infection), and death.

Hand washing is the single most important way to prevent infection, but is often not completed appropriately. When you are in the nursing home, watch how staff are washing their hands. This is how it should be done according to the Centers for Disease Control (CDC):

• Wet hands first
• Apply liquid soap
• Use plenty of friction
• 15-second hand wash (surveyors frequently cite facilities for not washing for 15 seconds)
• Rinse
• Dry hands
• Turn off faucet with paper towel (it is dirty and you will see many staff contaminating their hands by not doing so)

Alcohol based products are commonly used in the nursing home because they are quick and easy to carry in the pocket or have containers that may hang on the wall in the hallway. The CDC states that these are not as effective as washing hands with an antimicrobial soap and water for reducing bacterial counts on the hands of nursing staff.

These are the following times you should see staff washing their hands to know they are doing their best to prevent infections:

• When hands are visibly dirty
• Before providing any personal care (including taking a pulse or blood pressure)
• After providing any personal care
• Before inserting urinary catheters and intravenous catheters
• After contact with any body fluids and wound dressings
• If moving from a dirty site (buttocks) to a clean site (face) during care
• After removing gloves
• Before eating and after using a restroom
• Before serving food

What else might I notice in the nursing home environment that should cause me concern regarding infection control practices?

• Heavy perfumes and air fresheners that may be covering odors
• Strong smells of urine and bowel movement
• The soiled linen hamper and housekeeping cart not separated from the clean linen cart and food cart by at least one room’s width
• The water pitcher not covered at the resident’s bedside
• In semi-private rooms (more than one resident in a room), pitchers and drinking glasses not marked or color-coded so residents can tell them apart
• Placing used meal trays back on the food cart when uneaten trays are still on the cart
• Placing lab specimens in the refrigerator with food and beverages
• Failing to cover oxygen equipment when not in use; oxygen machines should be clean and free of dust and dirt
• Failing to cover bedpans, urinals, and other soiled items when carrying them
• Catheter bags hung from the bed or wheelchair so they are touching the floor
• Touching the spout of the catheter bag against the container into which it is emptied

Resource

CDC. (2002). Guideline for hand hygiene in health-care settings. MMWR 2002; 51(No. RR- 16).