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Infection Prevention and Control Practice in Aged Cares

Table of Contents

1.0 Introduction. 3

1.1 Objectives of the Structure of the Project 4

2.0 Background and Context 4

2.1 Contexts of the Two Issues. 5

2.2 Staffing and Resources. 6

2.3 Project team.. 6

2.4 Current Practices. 6

2.5 Workplace Readiness. 7

3.0 Strategy. 7

3.1 Stakeholders’ Analysis. 8

3.2 Stakeholders’ Engagement 9

3.3 Intervention Strategy. 9

3.4 Barriers and Obstacles. 10

3.5 Communication Strategies. 11

4.0 Evaluation. 11

4.1 Method. 13

5.0 Conclusion. 14

References. 15

Infection Prevention and Control Practice in Aged Cares

1.0 Introduction

Geriatrics in aged care facilities and with multiple comorbidities are at high risk of contracting infections. This is attributed to the proximity with the healthcare givers and the continuous contact between them and the residents (Lim, Stuart, & Kong, 2015). Therefore, the Aged Care Quality Standards direct that the facilities implement effective measures to minimize the infections-based risks to all stakeholders, including patients and the workforce. Two primary approaches to achieving this are having precautions and standards preventing the infections and implementing optimal care while reducing the antibiotics’ rising resistance. Another core approach for infection prevention and control is antimicrobial stewardship, which according to the World Health Organisation (WHO), involves a combination of activities to foster responsible antimicrobials use (WHO, 2019a). Residential facilities for the aged should ensure good hygiene practices, including antimicrobial stewardship, to prevent the risks of infections associated with increased comorbidities and deaths.

From experience, while working at an aged care facility, several issues increase the infection risks. Two particular issues have been reluctance in upholding the facility’s hygiene practices by both the patients and the health caregivers and etiquette, such as during coughing. Concerning the hygiene practices, the deficiencies resulting in infections include regular changing of the beddings, cleaning the spills, and implementing advanced techniques such as anti-touching techniques. These two challenges have resulted in a high number of infections acquired through ingestion and open wounds. Adverse cases have included a diabetic patient developing an infection in the foot wound due to uncleaned spills. Considering the etiquette, failure to cover the mouth while coughing and disposing of the dirty personal items have resulted in every individual in the facility getting a cold when there is an outbreak. The seriousness of the situation is based on the infections acquired by the healthcare givers due to failure to wear the personal protective equipment (PPE) and adhering to the safety standards.

1.1 Objectives of the Structure of the Project

This report involves how the two issues can be addressed. The paper is structured in three main sections. The background places the two cases in context and uses an audit to demonstrate the intervention’s importance. It also involves a detailed analysis of the resources and staffing to establish the facility’s readiness for change. The strategy section involves the intervention, including the stakeholders, implementation, and evaluation of the strategies’ barriers and communication. The third section is the evaluation, outlining how the effectiveness of the intervention is measured.

2.0 Background and Context

Infection prevention and control (IPC) is based on the various standards and the minimum requirements. According to WHO (2019b), minimum requirements should be put in place at the facility and national level to protect and reduce the rate of infections to different stakeholders, including patients, healthcare providers, and visitors. The Centres for Disease Control and Prevention (CDC), on the other hand, outlines the standard precautions to ensure the infections are kept at a minimum and apply to patient care (CDC, 2018). They include hand hygiene, personal protective equipment, respiratory hygiene, sterile devices and instruments, safe injection practices, and clean and disinfected environmental surfaces. This report is based on these requirements, standards, and literature findings.

2.1 Contexts of the Two Issues

The facility’s primary issue is upholding the hygiene practices from both the healthcare workers and the patient. Using the CDC’s precautions, this issue falls under three categories of hygiene, using PPEs, and clean and disinfected surfaces (CDC, 2018). The issue, from WHO’s minimum requirements is categorized under the second component. Some of the key factors that should be acknowledged and applied at the facility level are ensuring hand hygiene, decontaminating the environment, waste management, and following the basic principles in preventing transmissions. From experience at the facility, failure to change the beddings, yet they have spills accumulate microorganisms, resulting in infections. Touching various surfaces by various individuals, such as during washing hands, resulting in a fast spread of the diseases. The issue of failure to follow the standard procedures can also be explained from the awareness context. The majority of patients do not profoundly understand how hygiene can be ensured, contributing to the spread of infections.

The second issue involves etiquette for both the healthcare providers and the patients. According to Gianchetti et al. (2019), the healthcare settings are characterized by multiple opportunities for getting influenza, among other infectious illnesses, due to failure to adhere to the etiquette behaviors, such as when sneezing. Some of the approaches to prevent the spread of these infections include wearing face masks, hand hygiene, and covering the mouth when sneezing or coughing. Chavis and Ganesh (2020) argued that respiratory pathogens are transmitted easily between people when hygiene practices and etiquette are not followed consistently. The importance of educating both the patients and healthcare providers about etiquette is aimed at enlightening them about how to protect their close contacts from getting infections. This issue is also identified through observation of both patients and the healthcare workers.

2.2 Staffing and Resources

The literature, observation, and standard precautions by WHO and the CDC inform the project’s three objectives. These include training and education of the healthcare providers and patients about etiquette and the use of PPEs, ensuring proper hygiene practices, including regular cleaning of surfaces, and implementing technology in various activities, such as anti-touching techniques to hand sanitization and the lighting system. Staffing involves the healthcare workers and the facility’s management. Several resources are required for the project, including financial and human. The human resources including the training and education personnel to educate the patients and employees about the best hygiene practices and workplace etiquette. The financial resources are essential in purchasing the PPEs, supporting the educational programs, and installing the advanced ICT systems.

2.3 Project team

The project team comprises both internal and external stakeholders. According to Oh and Choi (2020), the project team should compose competent individuals across various areas. These include the healthcare providers and the technical team. Project leadership also plays a vital role in its success. In this project, the collaboration between the facility’s management and the employees is the foundation of meeting its goals and objectives. Another stakeholder in the project team is the patient, also involved in the awareness programs for etiquette and hygiene practices. Each participant in the project team should have clearly identified roles. This will ensure that the responsibilities are effectively executed and there is no conflict in the roles.

2.4 Current Practices

The current organizational practices from observation are the foundation of the high rates of infections when they arise. The facility is for aged patients, all genders. There are different categories of individuals, including those with healthcare conditions and the disabled. Although hygiene practices are according to the facility’s culture, they are not followed adequately resulting in infection challenges. For instance, the healthcare providers must wear personal protective equipment, including gloves and surgical masks. This protects the healthcare workers from spreading or acquiring the infections. Another organizational need is the cleanliness of the surfaces, including the switches and taps for cleaning hands. Touching by various individuals may easily spread the microorganisms. The uncleaned spills result can also spread the microorganisms resulting in infections. Considering the etiquette, people, including the healthcare workers and the patients do not cover their mouths when sneezing or coughing. These aspects are the foundations of the easy spread of respiratory pathogens.

2.5 Workplace Readiness

Organizational readiness is based on the availability of adequate resources to implement the project and the cooperation by the company’s employees to implement the new practices. There should also be individuals with adequate expertise to manage the new changes introduced to the organization, including the ICT systems. The current assessment of the facility is that it has sufficient financial resources to implement the project. However, the employees will need to be engaged and introduced to the changes. Engaging them and involving them in the decision-making process is essential in mitigating the resistance to change. Another foundation of the workplace readiness to change is the employees embracing the education programs, based on equipping themselves with adequate knowledge to improve their competence.

3.0 Strategy

Three interventions are proposed for these issues. These include education programs regarding infection prevention and control, implementing advanced ICT in hygiene practices, and observing the hygiene protocols. The education programs focus on the importance of the PPEs and etiquette, such as cleaning. The ICT systems are implemented in the lighting systems and anti-touching technique. The hygiene protocols include regular cleaning of the surfaces and ensuring environmental hygiene. According to Shaban et al. (2020), infection prevention and control education are the simplest and most effective approaches in addressing the challenge. Notably, specific programs should focus on the use of PPEs, from gloves to face masks. All stakeholders, including patients and healthcare providers, are involved in the education programs. Various education approaches can be applied, including simulation and lectures. The simulations are essential in the practical awareness about the lecturers. In this case, the simulation may involve the correct wearing of the PPEs and their disposal and how to sneeze or cough.

Considering the implementation of ICT approaches, they include automating various activities. Otter et al. (2013) described background surfaces as the main influencing factors in transmitting pathogens and increasing infections. The use of technology ensures that individuals do not touch the common areas. Two key examples are automating the hand washing process and the switches for the lighting systems. The hygiene protocols emphasize hygiene practices, including regular cleaning, constant drying of the spills, and washing the beddings. In case there are infections, all stakeholders should be notified and taken through urgent procedures. As a standard care practice, the aged individuals should be continuously reminded how to ensure hygiene, including washing their hands and observing the required etiquette.

3.1 Stakeholders’ Analysis

A stakeholders’ analysis is used to categorize needs and ensure they are adequately met in the project. According to Franco-Trigo et al. (2017), stakeholder analysis is essential in developing tailored products and services. There are three stakeholders in the infection and prevention control, including the facility’s management, the healthcare providers, and the aged using the services. The facility’s management is involved in the decision-making process, approving the required resources for the project and ensuring that the intervention is implemented to benefit the facility. The healthcare providers as stakeholders are involved in the planning and implementation process of the intervention. They are participants in the education programs, both learning and teaching others, including the patients, about safe hygiene practices. They are also essential in wearing the PPEs and are central in preventing the spread of infections. The aged individuals are the primary beneficiaries of the intervention. Also, they are part of the education programs and are significant players in implementing hygiene practices. Another key stakeholder is external, including the training personnel and vendors for the ICT systems.

3.2 Stakeholders’ Engagement

The stakeholders are engaged in various ways and levels. Primarily, the healthcare providers are engaged during the planning process. They are also involved in implementing the intervention. Failure to engage them is a risk factor to the resistance to change. According to McKay, Kuntz, and Naswall (2013), engaging the stakeholders involves providing them with adequate information about the intervention. This allows them to participate in the evaluation and make improvements that can enhance the strategy. For instance, engaging the healthcare providers in the ICT systems allows for identifying the training needs in their use. On the other hand, engaging the patients allows for the identification of the key issues in their participation in the process and how it can be improved.

3.3 Intervention Strategy

The intervention strategy involves five stages. The first phase focuses on setting objectives for infection improvement and control. This ensures that the aims are aligned with the identified organizational needs. The second stage involves gathering adequate information regarding the intervention. This entails collecting both internal and external information. The internal information consists of the facility’s needs and capabilities in relation to the intervention. Some of the key details are the availability of financial and human resources. External information entails data regarding the vendors, standards, and precautions as informed by WHO and CDC (WHO, 2019b; CDC, 2018). The third stage involves developing the intervention plan. The stage involves prioritizing the actions, such as training, followed by the implementation of the ICT systems. The fourth stage is the implementation of the developed plan. It involves putting the plan into action. The final step is the monitoring, evaluation, and control, which allows making improvements in the intervention and determining if the objectives of the strategy have been met.

3.4 Barriers and Obstacles

The barriers and obstacles in infection prevention and control emanate from various areas. According to Mitchell et al. (2019), the main barrier in infection prevention and control includes the stakeholders’ limited interests, especially the patients. Other potential barriers include limited resources, both financial and human, in implementing the stakeholders’ intervention and resistance. The intervention involves training programs and installing ICT systems to automate various activities, including hand washing and lighting. These interventions require adequate resources, including human and financial. Sufficient analysis should be conducted to evaluate these resources’ availability and how they can be utilised in the intervention. Addressing the issue of interests involves engaging the stakeholders to show them the importance of the intervention and how it will promote their quality and safety at the facility.

3.5 Communication Strategies

Communication strategies are vital in project management. As described by Oku et al. (2017), poor communication can hinder the effective delivery of the improvement strategies. There are three communication strategies essential in this intervention. They include face-to-face, virtual, and written. Face-to-face communication applies in the education programs and engaging the project team members during the implementation process. Virtual intervention is applied when the face-to-face approach is challenging, such as seeking clarification from the team members and when an individual is not near the facility. The written communication approach involves exchanging letters and other documents; such as invoices between the parties. Applying different communication strategies ensures a flawless flow of information among the stakeholders.

4.0 Evaluation

Several interventions are put in place to prevent the rate of infections in aged care facilities. Besides identifying and minimizing the risk factors for pathogen transmission, exemplary practices and precautions are vital in promoting both the patients’ and the healthcare providers’ awareness. According to the World Health Organisation (2018), the importance of preventing infections in aged care facilities includes ensuring that the individuals’ immune system is not compromised, reduces prolonged and multiple hospitalizations, and addresses frailty and immobility issues. IPC is also important in ensuring the hygiene and cleanliness of the facility.

There are three core objectives in this project. These include enhancing the patients’ and healthcare providers’ awareness about infection prevention and control, automating the hygiene practices through implementing ICT approaches, and observing the hygiene protocols. The evaluation, therefore, should be based on meeting these objectives. Notably, the intervention is informed by previous facility observations, including the individuals’ etiquette, spills, and failure to observe the infection prevention and control precautions and standards as noted by CDC and WHO (CDC, 2018; WHO, 2018b). The evaluations are based on specific objectives and targets. Considering the awareness aspect, it involves evaluating whether the healthcare providers and patients are observing the safety principles as trained through lectures and simulations. This objective is evaluated based on three aspects. These include the correct use of the PPEs, etiquette in one’s behaviors and actions, such as coughing, and urgent actions in case there is an infection outbreak.

The automation and improvement of the hygiene practices objectives are evaluated based on the individuals’ understanding of using these approaches and consistency in using the identified IPC approaches. According to Mitchell et al. (2019), among the barriers in implementing infection prevention and control approaches is consistency in observing the measures. Therefore, healthcare providers and the facility’s management should ensure that IPC proposals are continuously followed. For example, the anti-touching technique is applied in handwashing and controlling the lighting systems. Therefore, all stakeholders, including the healthcare workers and patients should observe these measures and learn to use the systems for consistency. This is further promoted through continuous reminders to the individuals about the measures. The third objective involves ensuring the hygiene policies and protocols are observed, including regular cleaning of the patients’ beddings, cleaning the spills, and maintaining cleanliness at the facility. Similar to the ICT and automation approaches, consistency should be observed in implementing the hygiene practices and protocols.

4.1 Method

The implementation of the measures above involves both qualitative and quantitative approaches. The quantitative approach involves collecting numerical data about the improvements, whereas the qualitative measure entails using textual information to measure the intervention’s effectiveness. As Noyes et al. (2019) noted, the use of both qualitative and quantitative approaches is based on collecting sufficient information for informed decision-making. Besides, the numerical data is complemented by the textual information. Three approaches will be used in the evaluation method. These include questionnaires, observation, and interviews.

The questionnaire approach entails using close-ended questions. This will mainly target the healthcare providers to evaluate their awareness of the concepts trained about IPC. The questionnaire will involve nominal and Likert scales, depending on the specific aspect in question. Some of the questions in the questionnaire will focus on the training programs. The questionnaire will be essential in measuring how well the healthcare providers grasp the concepts. The observation method will focus on a long-term evaluation of how the hygiene practices are implemented. These include the regular cleaning of the beddings and cleaning the spills. The observation involves filling in a form that comprises the IPC indicators. The interviewing approach involves engaging the patients for a discussion about the improvements from the intervention. The interviews contain open-ended questions. This allows the patients to offer suggestions regarding the intervention and how it can be improved. The combination of the questionnaire, interview, and observation allows for a comprehensive review of the intervention.

5.0 Conclusion

Infection prevention and control are vital in aged care facilities to promote the health and welfare of geriatrics. According to WHO and CDC, several precautions and standards should be observed in infection prevention and control. From experience at an aged-care facility, infections emanated from three areas. These include continuous touching of surfaces, lack of observing the hygiene protocols, and reluctance in adhering to the IPC approaches. Therefore, the intervention project involves education programs about the IPC, automating the hygiene practices, including anti-touching techniques, and emphasizing the adherence to the hygiene protocols. Several aspects are essential in implementing these approaches. These include financial and human resources, effective communication, and stakeholder engagement. The stakeholders include healthcare providers, patients, and the facility’s management. The intervention’s effectiveness is evaluated through quantitative and qualitative methods, through questionnaires, observation, and interviewing. Insights from these methods will be essential in making improvements to the intervention.

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