How healthcare providers can implement practices that address HAIs in post-acute care.
One of the major challenges faced by post-acute care providers is the prevention and management of infections acquired in healthcare settings.
Healthcare associated infections (HAIs) are a substantial issue across the healthcare industry that delay patient recovery, reduce favorable patient outcomes and pose risks to healthcare staff. In long-term care (LTC) facilities, including long-term acute care hospitals, inpatient rehabilitation facilities and skilled nursing facilities, where individuals are being treated or work in proximity, the risk of spreading HAIs increases significantly.
On any given day, about one in 31 hospital patients has at least one HAI, according to the Centers for Disease Control and Prevention (CDC), with 1 in 43 nursing home residents contracting at least one infection associated with their healthcare.
“HAIs are infections that develop during the receipt of medical care,” said Dr. David P. Calfee, director of the Healthcare-Associated Infections Division, Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality (AHRQ). “HAIs that are among the most common in long-term care facilities include urinary tract infections, respiratory tract infections such as pneumonia, bronchitis, influenza and other respiratory virus infections, and skin and soft tissue infections.”
HAIs can spread through person-to-person contact, hand transmission, contaminated medical equipment and treatment environments, and more. Effective infection prevention practices are critical to protecting vulnerable patient populations in post-acute care settings.
“Infection prevention is important in all healthcare settings,” said Dr. Calfee. “Residents and patients in long-term care and other post-acute care facilities frequently have medical conditions that place them at higher risk of infection and of poor outcomes from any infection that develops.”
HAIs in post-acute care settings
HAIs are a serious threat to the safety of patients, residents, and LTC physicians and staff. Patients can become infected with HAIs while receiving or soon after treatment, according to the CDC. Certain healthcare procedures can expose a patient to bacteria and viruses that cause HAIs that can then spread between patients, providers, staff and visitors through unclean hands or improper use (or reuse) of medical equipment.
AHRQ has compiled a resource and a review of standard precautions for LTC physicians in “A Unit Guide to Infection Prevention for Long-Term Care Staff,” calling healthcare providers to be aware of the signs and symptoms of infection, consistently ask patients how they are feeling, become familiar with what is and isn’t normal for a patient, and report any symptoms of infection immediately.
“Symptoms and signs at the site of infection are often present in patients,” said Dr. Calfee. “These include symptoms such as dysuria in residents with urinary tract infections; cough, shortness of breath, sore throat, and/or nasal congestion in respiratory tract infections; and pain, redness, swelling, and/or drainage in skin and soft tissue infections.”
HAIs can be caused by a variety of different microbes and include central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), surgical site infections (SSI), ventilator-associated pneumonia, and more. Other types of common infections in LTC include respiratory infections such as pneumonia and COVID-19, gastrointestinal infections, and skin infections such as bedsores.
“Non-localizing symptoms and signs, such as fever, hypothermia, hypotension (low blood pressure), hyperglycemia, and delirium, may be present in residents with infections, but these findings can also be due to non-infectious processes,” said Dr. Calfee. “Thus, when these are identified, evaluation for both infectious and non-infectious causes is warranted.”
According to the AHRQ guide, physicians should break the chain of infections by detecting, diagnosing and treating infections quickly, not rushing to use antibiotics, as they could cause antibiotic-resistant infections, and carefully following facility policies on infection prevention.
Prevention of HAIs in LTC
Healthcare staff can reduce the risk of infection to themselves and other patients by practicing proper hand hygiene, wearing gloves and other personal protective equipment, keeping the healthcare environment clean, properly disinfecting surfaces and medical equipment and handling waste safely.
“Strategies that may be helpful in implementing and sustaining effective infection prevention practices include periodic education and training, observations of infection prevention-related practices when indicated, and environmental cleaning and disinfection with feedback to frontline staff, and identification and resolution of barriers to implementation of recommended practices,” said Dr. Calfee.
Patients and visitors should also be involved in the prevention of infections, according to the AHRQ guide. Patients and visitors play a role in increasing the safety of the entire facility by practicing infection prevention themselves, and in supporting healthcare teams in prevention practices.
“Efforts to build a strong culture of safety and to optimize communication among staff, residents, and residents’ family and visitors can strengthen a hospital or health system’s infection prevention program,” said Dr. Calfee.
AHRQ’s Comprehensive Unit-Based Safety Program (CUSP) and Team Strategies & Tools to Enhance Performance & Patient Safety (TeamSTEPPS) program can help facilities pursue such improvements, says Dr. Calfee.
The Comprehensive Unit-based Safety Program (CUSP) is a method that can help clinical teams make care safer by combining improved teamwork, clinical best practices, and the science of safety. The Core CUSP toolkit gives clinical teams the training resources and tools to apply the CUSP method and build their capacity to address safety issues.
TeamSTEPPS is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare teams, including patients and family caregivers.
Ultimately, reducing the incidence of HAIs depends on the commitment of post-acute care providers implementing a variety of strategies and procedures across the facility.
“Improving teamwork, communication, and safety culture may help to improve infection prevention, other aspects of care, staff engagement, and staff satisfaction in post-acute care facilities,” said Dr. Calfee.