Why infection control in aged care is important
First of all, let’s talk about infection prevention and control (IPC).
The basic elements of an infection prevention program are designed to prevent the spread of infection in healthcare settings. When these elements are present and practiced consistently, the risk of infection among patients and healthcare personnel is reduced. (Centers for Disease Control and Prevention).https://www.cdc.gov/hai/prevent/infection-control-assessment-tools.html
Let’s be honest, aged care facilities are healthcare settings as well as the residents’ home. They don’t just stop in when they need care, they are there 24/7. Facilities employ health personnel to care for the residents and these frail, aged residents are at high risk of illness and even death if they acquire an infection. This means that it is the job of aged care facility staff to help reduce infections.
Why are audits important?
Aged care facilities are required to be compliant with Aged Care Quality and Safety Commission Standard 3: Personal Care and Clinical Care. Standard 3 requirement means ‘Minimisation of infection-related risks through implementing Standard and Transmission-based precautions to prevent and control infection’. This is where infection prevention and control audits come in.
Infection control auditing means checking actual practice against a standard. It should permit reporting of noncompliance or issues of concern by either healthcare workers (HCW) or the Infection Control Team (ICT). Providing results of the audit to staff enables them to identify where improvement is needed. An audit is a quality improvement process that seeks to improve patient care and outcomes through the systematic review of care compared with explicit criteria, and the subsequent implementation of change. An audit can help improve healthcare service by providing a blame-free mechanism for changes in practice.
What does the IPC audit checklist cover?
You might have visions of the mother-in-law coming over with a white glove to check your curtains for dust, but an infection control audit is more involved than that. While our IPC audit checklist is far shorter than our clinical audits, it’s a convenient, powerful tool that you can use at any time.
1. Standard precautions
You need to keep in mind that the questions are about compliance with standard precautions in all areas. This takes a critical eye. For example, in laundry management, it might seem obvious to keep linen in storage cupboards rather than in the residents’ rooms. But is the storage cupboard fit for purpose? Is it clean? Are staff handling dirty linen in a way that will keep it clean and minimise pathogen spread? Are staff performing effective hand hygiene after handling linen? Thinking about how the room is used will help you perform a more thorough check.
As part of standard precautions, PPE needs to be used appropriately. Selecting the PPE to be used should be based on an assessment of the risk of transmission of the infectious agent.
When considering hand hygiene, remember that it’s not just about hand hygiene compliance. Ask whether there are hand basins with soap and water and paper towel conveniently located. Is ABHR available in all care areas? How about other areas such as the facility entry, common areas etc.?
For sharps management, investigate whether staff are compliant with the processes of sharps management. Don’t forget to check whether the sharps bins are stored correctly, and whether they meet Australian standards.
When aseptic technique is being performed, annual assessment of staff who perform the aseptic technique needs to be undertaken annually to ensure staff are competent.
2. Environmental Cleaning
Environmental cleaning is a major section as it includes the environmental cleaning in all clinical areas including clean and dirty utility rooms, the common areas, the residents’ rooms and bathrooms, the laundry, and the kitchen. Ask yourself the hard questions: are all the surfaces, furniture and equipment being cleaned properly? Are the correct products being used? Are the cleaners wearing proper PPE and changing it appropriately?
The same can be said for dust on all surfaces. This includes places such as on windowsills, skirting boards, hand railings, and on top of furniture like wardrobes, TVs etc. You might think that a little dust is okay, but dust can contain and spread moulds, bacteria and dust mites that are harmful to the resident. You may need to get down on your hands and knees to check under the beds and find some way to check shelves and horizontal surfaces up high.
3. Transmission-based Precautions
Transmission-based precautions should be used when standard precautions alone are insufficient to halt the transmission of a microorganism. Transmission-based precautions are applied in addition to standard precautions. There are three types of transmission-based precautions used, dependant on the form of transmission.
Contact precautions areused to reduce the risk of spreading the microorganism by direct or indirect contact. Assess what PPE is required. Consider the body substances the microorganism is present in. Is an apron required?
Droplet precautions are used to reduce the spread of microorganisms that can be transmitted by respiratory droplets. Once again, assess what appropriate PPE is needed. Do you need goggles as well as a surgical mask?
Finally, airborne precautions, assess what sort of mask is required, do staff need to wear a P2/N95 mask as well as their goggles? Or do they instead wear a face shield?
If you do have an outbreak and need to put transmission-based precautions in place in addition to standard precautions, do staff know where the outbreak kit is? Is there a checklist of all items in the outbreak kit? Is the outbreak kit audited/checked regularly to ensure all items required in the kit are there, and in date?
The IP&C audit looks at vaccine management compliance where vaccine fridges are in place. Is there a proper vaccine fridge? Are the medicines in the fridge being stored correctly? Is the fridge temperature being monitored and recorded as per legislation? Remember that vaccine fridges should only be used for vaccines, and not for other medications or food.
Similar consideration should be given for maintenance. Is regular maintenance being undertaken by the right people, and in the right way? Equipment, whether clinical or furniture, may no longer be fit for purpose if poorly maintained. Cracked rubber surfaces can harbour harmful pathogens, and other damaged equipment may harm residents.
5. Competency assessment compliance monitoring
Competency assessment compliance monitoring is a way of ensuring that not only are the tasks above being done correctly, but also properly. When were your staff last tested in their competencies? Is there a process in place for regular testing? What corrective measures were taken (i.e. education) for staff who did not successfully complete their competencies?
Infection control is a big topic, and to imagine that you could do it justice with a short checklist is ambitious at best. However, regular checks with a targeted tool like our IPC audit checklist make it easier to keep on top of the key issues. The best way to ensure comprehensive compliance with infection control policies and procedures is regular environmental audits with Bug Control. Not only can we help you fix any problems with your processes and point out issues, but we can help you refine your policies as well. If you’re looking for more support for your IPC Lead, you’ve found it. Read more about Bug Control audits here.