Standard Precautions to Breaking the Chain of Infection in Assisted Living
The spread of COVID-19 has made it apparent how quickly diseases can transmit and mutate. Individuals who reside in assisted living and other care communities are often at a higher risk of being susceptible to infection. It's important to understand how we can all be considered a vehicle for infectious organisms. Yet, we can all play an active role in stopping the spread of infectious diseases by breaking the links in the chain of infection.
What is the chain of infection?
The chain of infection is the sequence of events leading to an individual becoming infected. The transmission of infection depends on six elements that link together like a chain, each link playing a unique role. For an infection to develop, each chain link must be connected. If any link is broken, then the chain is broken, and the infection cannot be transmitted.
The 6 elements that make up the chain:
- Infectious Diseases - Infectious diseases are caused by microorganisms such as viruses, bacteria, fungi, and parasites. Some common infectious diseases are influenza, norovirus, c. diff, and MRSA.
- Reservoir - A reservoir is where the microorganism lives and reproduces. Depending on the organism, it can live on the surface for hours or even days. Reservoirs can include humans, animals, food and water, door handles, toilet seats, human feces, and respiratory secretions.
- Portal of Exit - The portal of exit is where the organism leaves the reservoir. This can be through the respiratory tract such as the mouth or nose, intestinal tract, urinary tract, blood, or other bodily fluids.
- Mode of Transmission - The mode of transmission is how an organism transfers from one carrier to another. There are direct and indirect modes of transmission. A direct mode is when an infected host comes in direct contact with a susceptible host. An indirect mode is when the organism is on an intermediate carrier, such as environmental surfaces that an infected person has contaminated. Airborne transmission is indirect when the organism is suspended by dust or droplets in the air. Droplets or dust can remain suspended for long periods and blow over great distances.
- Portal of Entry - The portal of entry is the opening where the infectious organism enters the host's body. Some examples are an open wound, cracked skin, mucus membranes such as nose and mouth, and tubes in the body such as catheters.
- Susceptible Host - A susceptible host is a person at risk of developing an infection from the disease. Not everyone who comes in contact with a disease will become sick. Some factors make a person more likely to become infected with a disease, such as age, underlying chronic health issues, conditions that weaken the immune system, certain medications, and having invasive devices like a feeding tube.
Since a lot of individuals in assisted living and other care communities have one or more of these risks, care staff should follow standard precautions to protect not only those residing in the community but coworkers and individuals in their lives who may be at risk as well. Community staff can help prevent the spread of infection by considering how they act as a vehicle for the infectious agent.
Standard Precautions to Follow
- Good Hand Hygiene - Proper hand hygiene is the easiest and most effective way to prevent the spread of infection. Knowing when to perform hand hygiene is a critical component. Some examples of when to perform hand hygiene are before having direct contact with someone's skin, before administering medications, after having contact with bodily fluids (even if gloves were worn), after glove removal, and after coughing, sneezing, or using tissues.
- Cleaning and Disinfecting - Cleaning is the process of using soap and water to remove germs, dirt, and impurities from surfaces. This process does not kill germs, but it removes the number of germs. Disinfecting is when chemicals are used to kill germs on surfaces or objects. Make sure to always follow community procedures when cleaning and disinfecting.
- Personal Protective Equipment - Personal Protective Equipment (PPE) is used to protect yourself as a barrier from contact with infectious organisms and blood-borne pathogens. Examples of PPE are gloves, masks, gowns, goggles, and face shields. It's important to correctly apply or remove PPE and dispose of the items in a designated area deemed appropriate by your community's procedures.
- Respiratory Hygiene and Coughing Etiquette - Respiratory hygiene and coughing etiquette include covering your mouth and nose while practicing the proper hand hygiene techniques above. Incorporating PPE, such as masks and gloves, can provide additional protection.
- Safe Specimen Collection - Certain materials have the potential to cause infection if not handled properly. Safe specimen collection requires using appropriate PPE, methods, and standards to collect and store specimens to avoid contact with them safely.
- Regulated Waste - Regulated waste is anything that can contain infectious materials such as contaminated sharps and lab waste containing blood or bodily fluids. Sharps are considered objects that can penetrate the skin like needles, lancets, and disposable razors. Warning labels are required on containers of regulated waste, including refrigerators containing blood or potentially infectious materials and other containers used to store, transport, or ship infectious materials. Never bend or recap sharps and always dispose of them immediately in a container designed for them.
- Safe Laundry Handling Procedures - Safe laundry handling procedures include collecting and moving soiled items, washing, drying, and replacing, in addition to cleaning and disinfecting processes. Your community will be able to elaborate further on what those processes are.
- Protocols for Exposure Incidents - Exposure incidents are when a specific eye, mouth, or other mucus membranes, non-intact skin, or injection come in contact with blood or other potentially infectious materials. Knowing your community's protocol for exposure incidents ahead of time is incredibly important so that in the event this may occur, you will know the appropriate steps to take in a timely manner.
Staying safe at work and at home
Staying safe at work and home not only protects residents and clients in the community, but you, your coworkers, and others in your life that may be susceptible. Quickly identifying when an individual is symptomatic and promptly following community-based policies and procedures, including standard precautions, can help limit the exposure in a community. Be transparent about any changes, such as symptoms, infections, and vaccinations, with other individuals in the community, other staff, and yourself. Practice social distancing and continue to follow safe practices at home by having a plan in place in your household. While some of these practices may seem small, they can significantly impact those around us and ourselves.
Software that can help
As a leading healthcare software provider for assisted living communities and other long-term care providers, ECP incorporates various tools to help communities implement their policies and procedures while practicing standard precautions.
Symptoms and infections can be documented right as they are detected and can easily be tracked to view progress and resolutions. Tasks can be customized to reflect standard precautions, ensuring staff follows proper procedures. Resident statuses are a great visual to show who may be in isolation or quarantine so that your entire team is aware. Vaccinations can also be logged, making it clear when a new dose is required. This information can then display on important documents such as Face Sheets and Physician Order Sheets. PPE inventory can also be monitored efficiently, so that reorders can be made when supplies are running low. This technology makes it easier than ever to ensure staff follow proper procedures and play their part in breaking the chain of infection.
Contributor to Article
Standard Precautions Trainer
University of Wisconsin