A great deal of information has been published concerning HAIs infections in the long-term-care facility (LTCF). However, application of hospital infection control guidelines to the LTCF is often unrealistic in view of the differences between the acute settings in hospitals and the LTCF and the different infection control resources. It could be argued that while the Infection Control Program (ICP) is well established at Mater Dei Hospital the situation in SVPR is of inadequate standard. Standards and guidelines specific to the LTCF setting are not currently available in Malta. Since the numbers of HAI’s are several, in this assignment only the most important recommendations and strategies are discussed that apply to the clinical practice at SVPR.
Infection Control Program
Infection control programs (ICP) are among the first organized efforts to improve the quality of healthcare delivered to patients (Nicolle, 2000; Pittet, 2005). A number of authors have discussed the component of infection control program in LTCF (Goldrick, 1999, Nicolle, 2000). However, there are many limitations that affect the type and extent of programs developed. Most authors feel that an infection control program should include some surveillance for infections, an epidemic control program, education of infection control methods, policy and procedure formation and review, an employee health program, a resident health program, and monitoring of resident care practices. The program must also cover environmental review, antibiotic monitoring, product review, and reporting of disease to public health authorities (Goldrick, 1999; Friedman, 1999).
There are three principal goals for healthcare infection control programs regardless of the setting; to protect the patient/resident, to protect the healthcare worker- workers, visitors and others in the facility and to accomplish the previous goals in a timely, efficient, and cost-effective manner, whenever possible. Achieving these goals is the driving force behind every recommendation and action of the infection control program (Friedman, 1999).
It is critically important that there is sufficient infection control nurses provided in all hospitals. It has been shown that a ratio of 1 full time infection control nurse per 250 hospital beds is necessary for full efficacy (Strausbaurgh & Joseph, 2000). However, the current situation in SVPR is that one infection control nurse has the responsibility to cater for the 1200 residents. Hence, more full time infection control nurses are needed. Therefore it is suggested that a more active, effective, facility wide infection control program should be established to help prevent the development and spread of infectious diseases in SVPR.
In order to achieve the main goal of preventing or reducing the risk of HAIs, a hospital infection control program should have the following oversight functions and responsibilities (Friedman, 1999). * Surveillance, either hospital-wide or targeted
* Education about prevention of infections (eg, by hand disinfection) * Outbreak investigations
* Cleaning, disinfection, and sterilization of equipment and disposal of infectious waste * Hospital employee health, specifically after exposure to either bloodborne or respiratory pathogens * Review of antibiotic utilization and its relationship to local antibiotic resistance patterns * Prevention of infections due to intravascular devices
* Development of infection control policies and procedures * Oversight on the use of new products that directly or indirectly relate to the risk of nosocomial infection
Education and training
The value of education of the LTCF ICP has long been recognised, and surveys confirm this need (Smith et al., 1992). It has been also discussed that one of the most important roles of the ICP is education of personnel in basic infection control principles. It is recommended that...