Infection Prevention and Control for Residential Care Centres

Introduction

A national survey of healthcare-associated infections and antimicrobial medication use in long-term care facilities in 2016 found that at any point in time about 1 in 25 residents have a healthcare-associated infection (HPSE, 2016).

What is HCAI?

Health Care Associated Infections (HCAI’s) is an infection that develops either as a direct result of healthcare interventions, such as medical or surgical treatment, or from being in contact with a healthcare setting. A number of these infections are no longer confined to the hospital setting and are increasingly prevalent in health and social care services in the community. They can have a huge impact on people, causing distress and anxiety, serious illness, disability and in some cases even death.

Examples include:

• Carbapenemase Producing Enterobacteriacae (CPE) – on its emergence in 2017 DoH declared a public health emergency
• MRSA
• C.diff
• Norovirus

How do we address HCAI’s?

HCAI’s are known to be avoidable if measures are taken to identify and address the work practices, equipment and environmental risks that have the potential to cause infection. These measures are collectively referred to as infection prevention and control and describe the practice of providing safe care in a clean environment.

What is Antimicrobial Resistance?

Antimicrobial resistance occurs when a micro-organism develops resistance to an antimicrobial medication that had been originally effective for treating infections caused by it. The extensive use, misuse and overuse of antimicrobial medications have contributed to increased antimicrobial resistance. (HIQA, 2018)

How do we address Antimicrobial Resistance?

By applying appropriate Antimicrobial Stewardship. Antimicrobial stewardship is about:

• only taking antibiotics when needed and as prescribed
• ensuring that every person:
  • receives the right antibiotics
  • for the right infection type
  • at the right time.

HIQA National Standards for Infection Prevention and Control for Community Services

Where did they come from?

The National Standards for infection prevention and control for community services, introduced in late 2018, complement and build on the infection prevention and control concepts outlined in these existing overarching standards:

• National Standards for Safer Better Healthcare (2012)
• National Standards for Residential Services for Children and Adults with Disabilities (2013)
• National Standards for Residential Care Settings for Older People in Ireland (2016).

The National Standards apply to all community health and social care services outside the acute hospital setting in Ireland, for example:

• Ambulance services
• Care delivered in the home
• General practices
• Dental practices
• Residential services for older people and people with a disability
• Day care services
• Pharmacies

What will the standards do for us?

The purposes of the new standards include:

• Offering a common language to describe safe and effective infection prevention and control practices;
• Enabling a person-centred approach by focusing on the people that use services and placing people at the centre of everything that the service does;
• Creating a basis for improving infection prevention and control practices and antimicrobial stewardship practices by identifying strengths and highlighting areas for improvement;
• Promoting principles that can be used in day-to-day practice to encourage a consistent level of infection prevention and control and antimicrobial stewardship across the country and across all community services;
• Promoting practice that is up to date, effective and consistent.

Areas for consideration:

• infectious diseases
• biological agents
• sharps injury prevention
• safety, health and welfare at work
• medical devices
• waste management including transport of hazardous materials
• data protection.

Key Infection Prevention and Control Measures

• Hand Hygiene: This is one of the most crucial infection prevention and control measures. Residential homes shall have hand hygiene facilities, appropriate to the setting, available such as clinical hand-wash sinks and alcohol hand-rubs for staff and visitors to use.
• Training: The residential home must ensure their staff have the competencies, training and support to enable safe and effective infection prevention and control and antimicrobial stewardship practices. Induction is a good time for new staff to learn / update their knowledge on the core principles of Infection Prevention and Control.
• Clean Equipment: The residential home shall ensure that equipment is decontaminated and maintained to minimise the risk of transmitting a healthcare-associated infection.
• Clean Environment: The residential home must ensure that care is provided in a clean and safe environment that minimises the risk of transmitting a healthcare-associated infection.

Whose responsibility is it?

The overall responsibility for infection prevention and control and antimicrobial stewardship and implementation of these National Standards rests with the senior management of that service.

HCICareTools.com

Do you have a policy and procedure developed for infection prevention and control practices? If not, check out our policies on HCICareTools.com.

(HPSE, 2016) HSE Heath Protection Surveillance Centre. Point Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in Long-Term Care Facilities, 2016.

(HIQA, 2018) National standards for infection prevention and control in community health and social care services, Health Information and Quality Authority, 2018. https://www.hiqa.ie/sites/default/files/2018-09/National-Standards-for-IPC-in-Community-services.pdf