ABSTRACT

In one's lifetime, the potential for entering a long-term care facility (LTCF) continues to increase along with its risk. It is estimated that more than 40% of persons aged 65 and older will require an LTCF, such as a skilled nursing facility, sometime during their lifetime. Because of their multiple underlying risk factors, the possibility of infection increases, but chronic illness, dementia, overuse of antibi0tics' and lack of diagnostic resources all contribute to the delay or inability to promptly recognize and treat infection (1). It is no surprise, therefore, that infection control practices in LTCFs are being recognized as a critical component in the prevention and control of infections. This chapter provides practical guidelines for establishing and maintaining an effective infection control program in the LTCF, including useful practices and resources for the beginning infection control professional (ICP). A resource that provided much of the focus for this chapter was previously published (2) (see also Chapters 8 and 10.)

II. THE CASE FOR ESTABLISHING AND MAINTAINING AN EFFECTIVE INFECTION CONTROL PROGRAM

A. Increased Infection Risk in the Elderly

The increasing numbers of frail older persons requires that more care be provided in LTCFs such as nursing homes, especially skilled nursing facilities. Many of these residents are immunocompromised because of comorbidities, medications, and functional disabilities. These residents require comprehensive infection control programs targeted toward the high risks of infection imposed by the special conditions of the LTCF and the residents' own susceptibilities. High employee turnover rates and multiple facility priorities continually thwart effective infection control programs. Such challenges undermine even the best, most organized infection control effort. The nature of the LTCF resident's immune suppressed state, combined with the challenges of day-to-day facility operations require constant vigilance toward infection control and prevention.