Infection Control In The Long Term Care Facility. Leader Guide

Transcription

1 4515 Infection Control In The Long Term Care Facility Leader Guide

2 INFECTION CONTROL IN LONG-TERM CARE HCAF39 PROGRAM DISCRIPTION This program examines infection control in long-term care facilities, including linen management, and specific ways to prevent urinary tract and skin infections. This program follows OBRA recommendations for infection control training of nursing in long term care. Video running time: 25 minutes (2 contacts hours) Note to Facilitators: OBRA requires that every long-term care facility has an infection control program that includes investigating, controlling, and preventing infections, preventing the spread of infections, and the management of linens in the ways that prevent the spread or infection. Consistent with OBRA, this program addresses the role of the nursing assistant in preventing infections, recognizing signs of infection, and preventing the spread of infections. Hand washing is emphasized throughout the program. OBJECTIVES At the conclusion of this program, the Nursing Assistant will be able to: 1. Demonstrate proper hand washing technique. 2. Relate factors that increase long-term care resident s susceptibility to infection. 3. Identify three strategies to reduce the transmission of infections in nursing homes. 4. Discuss three specific measures to prevent urinary tract infections in long-term care residents. 5. Describe three specific measures to prevent soft tissue infections in long-term care residents. 6. Relate ways to manage laundry that prevent spreading infection. 2

3 The Nursing Process The nursing process is a systematic method of problem solving. It is based on the scientific method. The nursing process is called "process" because it is ongoing. These are the steps of the nursing process: Assessment: This is the systematic, ongoing collection of information from multiple sources. Assessment is done when a nurse interviews a client and the client s significant others. A physical assessment of the client is also completed observing the following: laboratory data, daily client actions, assessing the client s ability to carry out daily activities, symptoms and the client s response to treatment. In long term care, resident assessment instruments are used to provide a comprehensive multi-disciplinary assessment. Problem Identification or Nursing Diagnosis: Assessment data leads to identifying client strengths and client problems. These may be actual problems the client currently experiences, or potential problems that may occur with that client in the future. Problems are stated and related to a cause or influencing factor. Planning: The systematic steps that the nurse will enact, with others, to assist the client to meet the goals (or outcomes) that are set. For each problem, a measurable, specific goal is identified. The plan includes nursing actions, based on aspects of nursing theory, nursing science, other sciences, and research findings. The beliefs and values of the nursing profession as well as the values of the client are taken into account. Implementation: Carrying out the plan. Evaluation: This is the systematic process of examining each client goal-related outcome to determine if it were met and to revise the plan accordingly. Evaluation may also identify the resources that are needed for the client or the health care provider in their continuing plan of care. Professional Nursing Roles As the nurse carries out the nursing process, the nurse enacts a variety of professional roles. These are: clinician teacher client advocate leader These roles may overlap. In the clinician role, the nurse may provide direct "hands on" care, or may assess a client's needs and direct others to provide services to meet those needs. The nurse may conduct patient and family teaching in a teaching role. The nurse may also teach other health professionals when a multidisciplinary team addresses the client's needs. The nurse is a client advocate when collaborating with the client, finding resources for the client, and acting on behalf of the client. The nurse is a leader when planning and assigning the care of a client to others, maintaining overall responsibility and accountability for that care, assisting other members of the health care team to set and meet goals or when providing resources to other health care providers. 3

4 INFECTION CONTROL IN LONG-TERM CARE HCAF39 GLOSSARY OF KEY TERMS Bacteria: Disinfecting: Fungi: Infection control: Gastrointestinal infection: Personal protective equipment: Universal precautions: Urinary tract infection: Germs that invade living organisms or inanimate objects but are not viruses. To destroy many or all disease-causing microorganisms (except their spores) from an inanimate object by applying a liquid chemical to the surface. Organisms that include yeast, molds and mushrooms. Preventing the spread of microorganisms from one person to another. Microorganisms that invade the stomach or intestines. Gowns, aprons, masks, booties, scrub caps, goggles and special eyeglasses. Guidelines designed to protect workers with occupational exposure to bloodborne pathogens. Recommended by the Center for Disease Control in 1985 and mandated by OSHA in Invasion of the kidneys, ureters and bladder with microorganisms. 4

5 INFECTION CONTROL IN LONG-TERM CARE HCA (F) 13 PRE TEST Circle T if the following statements are true. Circle F if the statements are false. T F 1. On the average, every long-term care resident has one infection per year. T F 2. Confused residents may spread their infections by touching other residents, food or personal hygiene items. T F 3. When residents are bedridden, there is no need to wash their hands before they feed themselves. T F 4. Some medications that are used to treat disease can make it more difficult for the body to fight off infections. T F 5. Residents who are incontinent are likely to get an infection. T F 6. Residents who cannot move by themselves are likely to get an infection. T F 7. Nursing assistants must wash their hands and wear gloves before touching any containers that hold urine. T F 8. Residents who cannot take care of their own toileting needs are at risk of developing urinary tract infection. T F 9. When residents lie in one position for a long time, they are likely to get a pressure sore. T F 10. Soiled, wet sheets on a resident s bed are an easy place for bacteria to live, grow and multiply. 5

6 INFECTION CONTROL IN LONG-TERM CARE HCAF39 DISCUSSION QUESTIONS 1. What handwashing facilities are available in your facility? What types of soaps are used? 2. Are your residents vaccinated on a routine basis? For what type of infections are they vaccinated and when? What should the nursing assistants observe for in residents who are vaccinated? 3. What are your facility s procedures for the people on isolation precautions? 4. How does your facility control the spread of infection by people who visit infectious residents? 5. What does your facility use to identify infectious wastes? 6. What does your facility use it identify linens that have been by residents with infections/ what is your facility s policy and procedure on linen management? 7. What is your facility s policy on health care workers with communicable diseases or infected skin lesions in terms of working with residents? 6

7 INFECTION CONTROL IN LONG-TERM CARE HCAF39 POST TEST Choose the response that most accurately answers the following Questions: 1. Which of these is the most common infection in long-term care facilities? a. Herpes Zoster (Shingles) infections b. Urinary tract infection c. Infection of the blood (bactericidal) d. Tuberculosis 2. What can you do to prevent many different types of infections in long-term care residents? a. Make sure residents have good nutrition b. Make sure residents are kept clean and dry c. Make sure you wash your hands before and after any patient care d. All or the above 3. Why are long-term care residents likely to develop infections? a. Residents are sicker than ever, since they leave the hospital earlier b. Residents have IVs and catheters and other devices where micro-organisms can enter the body and cause infection c. Some micro-organisms cannot be treated with medication, they are drug resistant d. All of the above 4. How do urinary tract infections occur in long-term care residents? a. Residents do not clean themselves properly after having a bowl movement, so bacteria from the bowels enters the urinary tract. b. Residents drink a lot of fluids. c. Urine collection bags are kept below the level of the resident s bladder when the resident has a catheter d. Nursing assistants wash their hands and wear gloves before emptying urine devices. 5. When do you need to clean the resident s perianal area? a. In the morning, in the evening, and whenever the residents is incontinent. b. Only when the resident is showered or bathed. c. Only when the resident is incontinent. d. Only when the resident asks you to. 7

8 INFECTION CONTROL IN LONG-TERM CARE HCAF39 POST TEST (continued) 6. When the resident has a catheter: a. Only the nurse cleans the residents b. The catheter tubing should be placed under the resident s leg c. The urine bag can be emptied into any container d. The urine tubing is placed so that urine flows freely and the tubing is not kinked 7. A decubitus ulcer is a sore that occurs when blood cannot get to the tissues. It is caused by: a. Good nutrition b. Good body positioning c. Pressure d. Using special mattresses and cushioning 8. Redness is the first sign of decubitus ulcer. Where do you check for redness of the resident s skin? a. Heel b. Ischia c. Sacrum d. All of the above 9. When a resident soils his/her bed with a bowl movement, it is important that you : a. Scold him/her b. Wear gloves when you clean him/her, and when you strip his/her bed c. Pile the soiled linens on the floor d. Place the soiled linen on his/her bedside table while you change his/her bed 10. When a resident s room has an isolation precautions sign on the door, you should : a. Avoid going in the room b. Find out from the nurse what special actions you need to take c. Tell the resident s visitors that the sign is only for nursing staff d. Make sure you leave a big stack of clean linen in the room at all times 8

9 INFECTION CONTROL IN LONG-TERM CARE HCAF39 ANSWER SHEET PRETEST 1. T 2. T 3. F 4. T 5. T 6. T 7. T 8. T 9. T 10. T POST TEST 1. b 2. d 3. d 4. a 5. a 6. d 7. c 8. d 9. b 10. b 9

10 INFECTION CONTROL IN LONG-TERM CARE HCAF39 RESOURCE ADVISOR DEBORAH UNSWORTH, M.S. ARNP: Received her Bachelor of Science Degree from the University of South Florida and her Master of Science Degree from State University of New York. She has worked as a nurse since 1973 in the areas of med-surg, obstetrics and ER. She has been a nurse practitioner and women s health educator since 1990 and is currently the Director of Education at National Educational Video, Inc. NEVCO video educational programs are prepared using specific criteria designed by NATIONAL EDUCATION VIDEO, Inc. All educational programs are coordinated and reviewed under the direction of the NEVCO Director of Education, who is a master s prepared nurse. REFERENCES Didier, P., (2002). Promotion of hand hygiene: Magic, hype or scientific challenge? Infection Control and Hospital Epidemiology; 23(3). Guidelines for hand hygiene in health-care settings (Oct. 25, 2002). Weekly Report, 51 (RR-16)m Morbidity and Mortality Klusch, L., (2003). Infection control across the continuum of care. Extended Care Product News, 85 (1), 5-6. Simor, A. Bradley, S., & Strausbaugh, J. (2002). Clostridium difficile in long-term care facilities for the elderly. Infection Control and Hospital Epidemiology, 23 (11), Weinstein, R., (2000). Nosocomial infection update. Emerging Infectious Diseases, 4 (3), 1-7. While NEVCO strives to remain current with federal and state regulatory Requirements, the information contained in this Nevco program is always subject to governmental amendment. Therefore, we suggest that you contact your Federal and state authorities for any possible revision to the regulatory requirements. 10

11 INFECTION CONTROL IN LONG-TERM CARE HCAF39 Participant Evaluation of Objectives Please evaluate this program by circling the number that best represents how well this program met the following objectives: 1. Demonstrate proper handwashing technique. 2. Relate factors that increase long-term care patients' susceptibility to infection. 3. Identify THREE ( 3 ) strategies to reduce the transmission of infection in long-term care residents 4. Discuss THREE (3) specific measures to prevent urinary tract infection in long-term care residents. 5. Describe THREE (3) specific measures to prevent soft tissue infections in long-term care residents. 6. Relate ways to manage laundry that prevent spreading infection 4 = Excellent 3 = good 2 = average = poor COMMENTS: Do you feel personal objectives were met? Time required completing this program? minutes Return this form with the Participant Evaluation to your facilitator who distributed the learning materials. Thank you! 11

12 NEVCO Account # REQUEST FOR CERTIFICATES FOR CONTACT HOURS TYPE the NAMES, LICENSE NUMBERS AND JOB TITLES (RN, LPN, MSW, CNA, PT, etc.) of the people who are to be issued a certificate for contact hours for attending the continuing education program: (Facility Name) (Title and Number of Video Program) This request must be submitted along with the completed roster and evaluation sheets for the above named program NAME LICENSE NO. JOB TITLE

13 Must be completed by the facilitator EVALUATION OBJECTIVES: TIB Bank Center th Street N., Suite 207 Naples, Florida (800) Fax (888) FACILITATOR S EVALUATION (NEVCO Video Education Program) (1) To assess extent to which the program was appropriate, adequate and effective. (2) To identify, continue to develop and evaluate effective quality assurance activities. Title of Program Date Place of Employment Job Title Please evaluate the presentation by circling the number that best describes your rating. 4 Excellent 3 Good 2 Average 1 Poor ORGANIZATION OF COURSE Material was organized to facilitate learning The amount of material covered was adequate and accurate There was effective use of time to cover the subject CONTENT OF THE FACILITATOR S GUIDE List total number of objectives in this facilitator s guide List by number the objectives that were met The test material reflected the objectives listed Content can be used to improve nursing practice Content reflected knowledge level and needs of learner The material was current Evaluate Test Questions Pre-Test Discussion Questions Post-Test FACULTY PRESENTING (Video) The presentation was The presenter explained the material The presenter demonstrated knowledge of material OVERALL RATING I felt this teaching method was COMMENTS (Please make suggestions for future topics and additional comments about the presentation or instructor) Thank you for your time in completing this evaluation! We appreciate your comments and suggestions. The NEVCO Educational Staff 1995 Revised 10/2004

14 EVALUATION (NEVCO Video Education Program) TIB Bank Center th Street N., Suite 207 Naples, FL (800) Fax (888) Must be completed by every participant EVALUATION OBJECTIVES: (1) To assess extent to which the program was appropriate, adequate and effective. (2) To identify, continue to develop and evaluate effective quality assurance activities. Title of Program Date Place of Employment Job Title OBJECTIVES Total number of objectives in program Circle the number of objectives that WERE met Circle the number of objectives that were NOT met Please evaluate the presentation by circling the number that best describes your rating. 4 Excellent 3 Good 2 Average 1 Poor ORGANIZATION OF COURSE Material was organized to facilitate learning The amount of material covered was adequate and accurate CONTENT OF THE PRESENTATION The test material reflected the objectives listed Content and/or skills demonstrated can improve my ability to perform my job Content reflected knowledge level and needs of learner The material was current Time for questions was Effective use of time to cover subject was Graphics were beneficial NEVCO FACULTY (who prepared the program and/or appeared in interviews) The presentation was well prepared The presentation explained the material well The presenter demonstrated knowledge of material OVERALL RATING I felt this teaching method was Facilities and classroom were adequate COMMENTS (Please make suggestions for future topics, content of program and instructors) Thank you for your time in completing this evaluation! We appreciate your comments and suggestions. The NEVCO Educational Staff 1995 Revised 10/2004

15 PRINT OR TYPE TIB Bank Center th. Street N., Suite 207 Naples, FL (800) Fax: (888) CONTINUING EDUCATION ROSTER This form must be completed and returned to NEVCO. Keep a copy for your facility, but return the original to NEVCO. Account # Number and title of Video Program Dates Given Contact Hours Name of Facility Address of Facility City/State/Zip RN Facilitator Signature ROSTER OF PARTICIPANTS Participant Name Participant Signature License # Soc. Sec. # National Educational Video, Inc. TM is an approved provider of continuing education. State Board provider numbers: Florida NCE2896, Alabama , California CEP8803 and Kentucky This activity provided by National Educational Video Inc. is approved as a provider of continuing education in nursing by Alabama State Nurses Association, which is accredited as an approver of continuing education in nursing by The American Nurses Credentialing Center's Commission on Accreditation.

16 Participant Name Participant Signature License # Soc. Sec. #

17 599 9 th Street N., Suite Naples, FL Fax: Certificate of Completion This is to certify that Attended and Completed National Educational Video, Inc. TM Program Number and Title For contact hours On Date Facility / Agency Name Facility / Agency Address RN / Facilitator CERTIFICATE FOR ASSISTANTS ONLY National Educational Video, Inc.TM is an approved provider of continuing education. State Board provider numbers: Florida NCE2896, Alabama , California CEP8803 and Kentucky This activity provided by National Educational Video Inc. is approved as a provider of continuing education in nursing by Alabama State Nurses Association, which is accredited as an approver of continuing education in nursing by The American Nurses Credentialing Center's Commission on Accreditation.

18 CERTIFICATE OF COMPLETION For each participant who has successfully completed a continuing education program, please make a copy of the blank NEVCO Certificate (on reverse side) and fill in the following information: 1. Name of the learner 2. Program title and number 3. Number of contact hours 4. Date the program was completed 5. Name and address of your Agency / Facility 6. Signature of the RN / Facilitator responsible for offering the program