Table of Contents III

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1 Table of Contents Acknowledgements... v Declarations of Conflicts of Interest... vi Foreword... vii Chapter 1: Understanding Infection Prevention in Long-Term Care...1 Chapter 2: Regulatory Surveys and CMS F tag 441 Compliance Chapter 3: Infection Prevention and Control Programs Marilyn Hanchett, RN, MA, CPHQ, CIC; Patricia Rosenbaum, RN, CIC Chapter 4: Surveillance, Epidemiology, and Reporting Chapter 5: Isolation Precautions Dolly Greene, RN, CIC Chapter 6: Nursing Care to Prevent Infections Marilyn Hanchett, RN, MA, CPHQ, CIC Chapter 7: Residents with Advanced Medical Needs Steven J. Schweon, RN, MPH, MSN, CIC, HEM Chapter 8: Seasonal Influenza Chapter 9: Occupational Health Chapter 10: Environment and Equipment Dolly Greene, RN, CIC; Steven J. Schweon RN, MPH, MSN, CIC, HEM Chapter 11: Infection Prevention for Interdisciplinary Services Patricia Rosenbaum, RN, CIC; Marilyn Hanchett, RN, MA, CPHQ, CIC Chapter 12: Life Enrichment and Support Services Chapter 13: Education and Training Irena Kenneley, PhD, APRN-BC, CIC Chapter 14: Transitions in Care Irena Kenneley, PhD, APRN-BC, CIC; Marilyn Hanchett, RN, MA, CPHQ, CIC Chapter 15: Emergency and Disaster Preparedness Dolly Greene, RN, CIC; Steven W. Hilley, RN Glossary Index III

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3 Acknowledgements The acknowledges the valuable contributions from each of the following individuals: Authors Lead Author: Steven J. Schweon, RN, MPH, MSN, CIC, HEM Infection Prevention Consultant Saylorsburg, PA Contributing Authors: Deborah Patterson Burdsall, MSN, RN-BC, CIC Infection Preventionist Lutheran Home/Lutheran Life Communities Arlington Heights, IL Dolly Greene, RN, CIC Director of Clinical Services and Education Diagnostic Laboratories & Radiology/ Mobilex USA Burbank, CA Marilyn Hanchett, RN, MA, CPHQ, CIC Sr. Director, Professional Practice Association for Professionals in Infection Steven W. Hilley, RN Infection Prevention Coordinator Yampa Valley Medical Center Steamboat Springs, CO Irena Kenneley, PhD, APRN-BC, CIC Assistant Professor/Faculty Development Officer Case Western Reserve University Cleveland, OH Infection Preventionist Consultant Broad Street Solutions San Diego, CA Patricia Rosenbaum, RN, CIC Infection Prevention Consultant PAR Consulting, LLC Silver Spring, MD Reviewers Amy Cotton, MSN, GNP, FNP, FNGNA, FAAN Past President, The National Gerontological Nursing Association Eastern Maine Healthcare Systems Brewer, ME Sherrie Dornberger, RN, GDCN, CDP, CDONA, FACDONA Executive Director National Association Directors of Nursing Administration in Long Term Care Mullica Hill, NJ Paul Drinka, MD, AGSF, FSHEA* Clinical Professor of Internal Medicine/ Geriatrics University of Wisconsin and Medical College of Wisconsin Madison, WI Darlene Fawcett, RN** Infection Control Practitioner Ontario Shores Centre for Mental Health Sciences Whitby, ON, Canada Jill E. Holdsworth, MS, CIC, EMT-B Infection Control Practitioner Inova Mount Vernon Hospital Alexandria, VA Kathy Horn, RN, CIC Consultant in Infection Prevention Upper Black Eddy, PA Jolynn Zeller, RN, BSN, CIC Coordinator, Infection Prevention Avera St. Luke's Aberdeen, SD Production Team Executive Editor: Marilyn Hanchett, RN, MA, CPHQ, CIC Sr. Director, Professional Practice Managing Editor: Anna Conger Sr. Manager, Practice Resources Copyeditors: Jim Angelo Director, Practice Resources Thomas Weaver, DMD Director, Professional Practice Cover Design: Sarah Vickers Art Director Book Design and Layout: Project Design Company Printing: Linemark Upper Marlboro, MD * Paul Drinka, MD, AGSF, FSHEA reviewed on behalf of AMDA - Dedicated to Long Term Care Medicine. ** Darlene Fawcett, RN reviewed on behalf of Infection Prevention and Control Canada. V

4 Declaration of Conflicts of Interest has nothing to declare. Amy Cotton, MSN, GNP, FNP, FNGNA, FAAN is President and Board of Directors Chair for National Gerontological Nursing Association (volunteer). Sherrie Dornberger, RN, GDCN, CDP, CDONA, FACDONA serves on the South Jersey Red Cross Board of Directors (volunteer). Paul Drinka, MD, AGSF, FSHEA has nothing to declare. Darlene Fawcett, RN has nothing to declare. Dolly Greene, RN, CIC has nothing to declare. Marilyn Hanchett, RN, MA, CPHQ, CIC has nothing to declare. Steven W. Hilley, RN is a member of the State Emergency Medical and Trauma Services Advisory Council, Statewide Trauma System Committee, and Hospital Preparedness Advisory Group and is Vice Chair of the Routt County Emergency Response Coalition and Northwest Colorado Hospital Emergency Coordination System. Jill E. Holdsworth, MS, CIC, EMT-B has nothing to declare. Kathy Horn, RN, CIC has nothing to declare. Irena Kenneley, PhD, APRN-BC, CIC has nothing to declare. is a member of the GOJO Industries consortium and speaker s bureau. Patricia Rosenbaum, RN, CIC has nothing to declare. Steven J. Schweon, RN, MPH, MSN, CIC, HEM has done consulting work for GOJO Industries and Crothall Healthcare and is a member of the Society for Healthcare Epidemiology of America Education Committee. Jolynn Zeller, RN, BSN, CIC has nothing to declare. VI

5 Foreword On behalf of APIC, I am delighted to introduce to you the Infection Preventionist s Guide to Long-term Care. This is the most comprehensive book that APIC has published on infection prevention and control in this unique practice setting. With more than 15,000 long-term care facilities (LTCF) in the United States and a national priority to prevent healthcare-associated infections (HAIs), APIC has leveraged member expertise and experience specific to infection prevention and control in long-term care to produce this book. APIC is committed to increasing its educational resources for long-term care to advance knowledge and competencies of healthcare personnel working in this setting and for the benefit of the residents under their care. This book presents the historical context and background on LTCF as an emerging national priority for preventing HAIs. In addition, it provides detailed explanations of the requirements and the challenges in this practice setting along with recommended actions, procedures, and checklists that can be implemented to improve infection prevention programs. When it comes to the how-to-implement infection prevention and control strategies and practices in this country, APIC is unparalleled. APIC is committed to patient and resident safety across the healthcare continuum. To support this commitment, APIC continues to bring forward practice resources and professional development for those working in long-term care settings. Together, we can improve quality and prevent infections. Katrina Crist, MBA Chief Executive Officer VII