The basics of improving infection control: Renee Patterson, CSP, tells how recently developed JCAHO guidelines and methods can help facilities move in the right direction.

Infection control and prevention in the long-term care facility (LTCF) must include everyone who is part of the operation: residents, staff, volunteers, visitors, and healthcare providers that interact with the facility. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recognizes that infection control must be a priority for LTCFs, particularly because of the challenges they face with residents transferring to and from other healthcare institutions and because older adults may not exhibit the same signs and symptoms of an infection as younger adults. LTCFs must address transmission of infectious agents not only from residents to staff, visitors, and volunteers, but also from staff, visitors, and volunteers to residents. Device-related infections, such as those involving feeding tubes, must be addressed, as well. Additionally, each LTCF has risks unique to the community it serves.

What is expected of the LTCF in infection control? JCAHO has several standards for preventing and controlling infections that might help guide improvement. These standards include:

* having an effective infection control program in place as part of reducing the risks of healthcare-acquired infections (HAIs);

* being able to identify infection risks specific to the LTCF's specific community, services, programs, and location;

* ensuring that goals and priorities are set to address those risks;

* establishing strategies to address those goals;

* establishing an effective surveillance program;

* being able to evaluate the infection control program to ensure that the program is accomplishing those goals effectively;

* being prepared to respond to potential outbreaks or an influx of infectious patients;

* having a method of working with various departments/functions to have a more comprehensive infection control program;

* ensuring that the infection control program is managed effectively; and

* ensuring that adequate resources (e.g., information systems, laboratory support, and adequate equipment and supplies) are available for the program.

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LTCFs have a variety of infection control programs for their residents, and these programs may involve participation by residents, visitors, and staff. The main goal of infection control is to prevent HAIs from occurring and, when they do occur, to prevent them from spreading throughout the facility and the community. This is also JCAHO's goal. As such, JCAHO has a new tracer methodology to replace its traditional accreditation survey methods. Using JCAHO's new tracer methodology, which goes beyond traditional record review, a surveyor may trace a potential high-risk resident in the facility (such as a person with a feeding tube) or may determine the population to be studied based on MDS information.

In addition to the resident tracer, the surveyors will likely do a system tracer. In this tracer the surveyors may ask staff about hand hygiene and compliance measures, how signs and symptoms of infection are reported, standard precautions, isolation procedures, dressing change procedures, trended data, resistant organisms (if any), the state of employee health, provisions for patient family education, and more. The JCAHO tracer also includes Environment of Care/Safety elements, as well as a facilities management review, checking for compliance with existing building codes and such.

Key system items to be reviewed for infection control include compliance with National Patient Safety Goal 7A on the Centers for Disease Control and Prevention's hand hygiene guidelines, released in 2002; adequate resources for infection control; surveillance systems and methodology; policies and procedures addressing a variety of infection control topics, including equipment storage, cleaning, and disinfection; a formal written and implemented infection control plan; and ensuring the staff member managing the infection control program is qualified to do so.

Preparation for a JCAHO survey, and therefore for effective infection control, ultimately comes from always being "survey ready." However, that is more a goal than a reality for many institutions. As a result, it is important that all of the key players work together to address each specific item of each element, as described within each JCAHO standard, to ensure that the facility always has its best foot forward.

Thus, develop a game plan for addressing each item, then share that plan with staff. It is important that staff know the plan and why it is there; they need to know what it is they should be doing and why they should be doing it. They don't necessarily need to know the details of a written standard.

Once the plan is in place and staff have been educated about it, try conducting mock surveys within the facility. These work best unannounced because it will give the mock surveyors a chance to see what happens on a daily basis in the facility, not just when staff know that a survey is coming. Include some staff members in this survey process; it will give them the opportunity to learn more about the process, and hopefully they will share that knowledge with their coworkers.

Further staff awareness can be developed through means such as continual education of staff via meetings, flyers, posters, and the like. Readiness also can be enhanced by educating residents and visitors, for example, about the importance of hand hygiene and encouraging residents to ask their caregivers if they've washed their hands. Teach caregivers that this question is not an insult, but rather is intended to ensure that everyone stays safe, including themselves.

With education and change to protocols comes monitoring. Develop methods for monitoring facility-wide adherence to a variety of programs. Share the results with staff and use the results as an opportunity for further education and improvement.

Above all, don't forget the basics. We sometimes tend to focus on complying with individual items too much and forget that the bottom line is the care and health of everyone in the facility. If residents, staff, and visitors are happy and healthy, that in itself is a good sign that we are on the right path.

Renee Patterson, CSP, is Infection Control Manager with the Ingham Regional Medical Center, Lansing, Michigan, a subsidiary of McLaren Health Care Corporation. For further information, phone [phone]. To send your comments to the author and editors, e-mail [e-mail]. To order reprints in quantities of 100 or more, call [phone].