Infection Control in Long Term Care: Design for Change in Practice Project

Cindy Bennett Click to edit Master subtitle style Chamberlain College of Nursing NR 451: Capstone Course 10/8/2011

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What is the problem?

The identified problem was the lack of infection control prevention awareness in Long Term Care Facilities (LTCF). This was noted while visiting a local hospital that used multiple mediums to make visitors and staff aware of infection control. The concern was that without increased awareness, the residents residing in the LTCFs were not

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How Can we Make a Difference?

A superior plan for infection control in the LTCF will educate internal and external customers on the need for continued vigilance (CDC,2007). Infection control is the single most important aspect for disease prevention. By utilizing all available medium, the rates of

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Formulating the Plan

A hand-washing statistical review in the Journal of Applied Microbiology supported the theory that improved hand-washing had considerable impact on infection prevention(Barker, 2001). The infection rate for the group who participated in good hand-washing decreased by 50%. This is irrefutable proof that hand washing does decrease respiratory infections. Randomized controlled trials reviewed in The Journal of the American Geriatrics Society identified that elderly patients benefitted from good oral hygiene as it reduced respiratory tract infection (Sjogren, 2008).

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Summary of Relevant Literature

The MMWR Advisory Committee did a study in 2008 that compared illness outcomes for the elderly who received the flu vaccine to those who did not. The outcomes were supportive of receiving the flu vaccine annually for elderly patients. An impressive 58% efficacy rate against influenza was evidence that supports this project of change. A review of random surveys in four LTCFs indicated that the reason people did not receive the flu vaccine was in most part due to 2 reasons: misconceptions concerning the vaccine and inability to receive it easily (Kimura, 2007).

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Summary of Relevant Literature

The outcomes of Kimuras study was creation of a Vaccine Day to increase ease of receiving the vaccine, and educating customers on the vaccine itself. The goal was to eliminate the negative reasoning associated with flu vaccination. With just these 2 interventions, vaccine

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Summary of Literature continued

A valuable tool for completion of the project was the information obtained for Administrative controls. Those administrative controls were to make sure staff came to work only when healthy and to promote the process by ensuring all items were available. Having ample tissues, hand sanitizers, soap and towels is one of the most important parts of the project (CDC, 2011). The administrative

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Utilizing Demings Circle of Performance Improvement

The stakeholders are all staff, families and customers who will benefit from

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Demings Circle of Performance Improvement

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Plan for the Change in Design

P (Plan) was the plan for each department. Nursing hung posters throughout the building of how to hand wash effectively. Specific areas were in the bathrooms and nurses stations. Housekeeping applied hand sanitizers to strategic areas in the building and devised a schedule to make sure they were kept full. They also planned to increase fomite disinfection. Central supply increased the order of soap, towels, tissues and ordered small bottle of hand sanitizer to keep at the nurses station for staff to keep in their pockets. Administration sent CDC education on flu prevention and vaccination to families and issued the education to all staff and residents. They made it available for all vendors and external customers. Part of the signage in the facility was

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Project Details - Do

D (Do) was each department head in serviced all their staff and the recited expectation on their personal responsibility. The Administration sent the CDC influenza control education out via mail for families and via paychecks for employees. Posters were sent to local businesses to inform of vaccine day. A final check was done by the teams on making sure posters were up, hand sanitizers were attached and full, vaccine was ordered, and nurses (volunteers)had their schedules for vaccine day.

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Project Details - Check

Check = obtaining feedback from staff as well as internal/external customers. The staff had a great buy in and central supply informed the team there was an increase in paper towel and soap usage. This was directly related to increased usage, thus increased infection control prevention. A list was formed for those who wanted the flu vaccine on the established vaccine day. Other facilities in our company were asking for our results.

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Project Details Act and Follow up

A (ACT) = weekly follow up with the committees and staff on continued implementation of the project. At the end of each month during the flu season, comparisons will be made against the results from last year. The results from the number of people who receive the flu vaccine on vaccine day October 14, 2011 will be compared with the number of people who received the vaccine October 2010. IT will give the Performance Improvement Team number graphs for true comparison. Follow up assessment= If at any time there is a drop in efficiency of the project, begin the cycle at the planning stage.

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Summary of Project: Design for Change in Practice the design for change in practice In summary,

concerning increased infection control was assessed, planned, and fully implemented in two facilities on September 30, 2011. Vaccine day is scheduled for October 14, 2011, with a second one projected for November 2011.

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the month of March. Evaluation of the plan will occur monthly in Performance Improvement Committee Meeting that includes the medical Director When evaluation of who already signed up for the flu vaccine was completed, we were up to 92% of staff. Our goal is 100%. We have not quite met the goal, but we still have a few days left prior to our vaccine day. The identified non-compliant 8% have not yet turned their consent sheets in, so it is not yet counted as a negative, just slow response.

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Resolution of the Problem/Concern The plan will continue implemented continued to bewhich will go through throughout the flu season,

Evidenced Based Practices Support

The entire solution and change in design plan was supported by Evidenced-Based Practices. The interventions also make good sense, therefore it was readily accepted by staff. Massive education to the staff that included EBP was successful. Education to the residents on their rights concerning infection control proved to be positive as staff were reporting in the weekly review meeting that residents were asking staff to wash their hands before touching them.

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Next Steps

Because each intervention is supported by Evidenced Based Practice (EBP), it will be easier to promote other projects by citing EBP. Through massive education, the facility now associates EBP with common sense as well, thus making staff understand and support EBP. Staff have been exposed to web-sites and search engines where EBP is cited.

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Next Steps

This project is already scheduled to be shared with the entire region at our companies December Regional meeting. In attendance will be other LTCFs and Corporate representatives. New projects are reviewed and those projects chosen are adopted as addition to the annual Corporate Performance Improvement Calendar. I feel confident this one will be chosen. This program has already been added to the facility annual Performance Improvement Plan.

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The Process Used to Complete the Project

Rosswurm and Larrabees Model for change to Evidence-Based practice (Rosswurm & Larrabee,1999)guided me with a framework to systematically gather Evidence-based information to support this change in practice. The implemented project utilizes the best evidence in practice and changed infection control awareness in the Long Term Care Facility. In the end, the project promotes better health and wellness for our seniors.

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Abstract

Infection control remains the single most important aspect for disease prevention. Within the boundaries of the Long Term Care Facility (LTCF), infection control education remains inferior to that of the acute care facilities. While assessing the need for change in practice, we realized a design for change was needed specific to increasing education for a superior plan regarding infection control (CDC, 2007). External data obtained from local hospitals were far superior to the internal education supported in the LTC sector. In the LTCF, the elderly are highly susceptible to influenza (flu) and those around them should be conscious of ways to help their loved ones remain healthy (Girabaldi, 1999). Through education of internal and external customers, we can decrease the

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References

Advisory Committee et al (2007). Prevention and control of influenza. MMWR, 56(RR06), 1-54. Retrieved on September 19, 2011, from Google Scholar.

http://www.cdc.gov/MMWR/Preview/mm Barker, J., Stevens, D, Bloomfield, S. (2001). Spread

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References

Girabaldi, RA (1999). Residential care and the elderly: the burden of infection. Retrieved September 10, 2011, from http://www.ncbi.nlm.nih.gov/pubmed/10658754 Jefferson, T, D. M.A. (2010, July). Physical intervention to interrupt or reduce the spread of Respiratory viruses: a Cochrane review. Retrieved September 10, 2011, from http://www/ncbi.nlm.nih.gov/pubmed/20648717 Sjogren, P., Nilsso, E., Forsell, M., Johansson, O., Hoogstraate, J. (2008). A systemic review of the preventive effect of oral hygiene on pneumonia and respiratory tract infection in elderly people in hospitals and nursing homes: effect estimates and methodological quality of randomized controlled trials. Journal of the American geriatrics society, 56(11) 2124-2130. Retrieved September 20, 2011, from Google Scholar. http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2008.01926.x/full

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