I

n a world permeated with words and images of wellness and healthy aging, we must consider the impact of proper infection control processes for healthcare workers and residents or customers. New methods of hand sanitization have been approved by the Centers for Disease Control and Prevention (CDC) for healthcare environments. Saving time and having effective infection identification and control processes can be very helpful for healthcare workers and their customers.
       So, let's consider the impact of this one recent change in CDC guidelines across the continuum of service delivery to the frail aged population. Frail elders living in independent housing or congregate housing facilities have a great risk if they get an infection. Falls and infections are the two major reasons why elders require acute or post acute skilled care. The change in strength, cognitive ability, and functional status that can result from these events may prohibit the person from returning to independent living. Routine use of hand sanitizers with moisturizers could help prevent the infection. Awareness of the importance of hand sanitization is the first step for people in independent living situations. Having wall dispensers in common areas and dining rooms can significantly decrease the transfer of bacteria. Frequently, elders just forget to wash or sanitize their hands or remind others to do the same.
       Assisted living environments, even though residential in most states, have a staff component that can model and reinforce proper infection control procedures. Here, congregate dining is much the norm, and larger groups use common areas for casual and planned activities. A very expensive part of assisted living operations is the change over of a unit from one person to another. Assisted living providers do not want extra expense with a high frequency of admissions and discharges. Residents want to stay, but if they become ill or get an infection, they might have to move to a more supportive environment. If the staff of the assisted living facility has excellent hand cleaning and sanitization habits, the residents will benefit and infection rates could decrease.
       Having hand sanitizer available in common areas, hallways, rest rooms, and dining rooms will increase use and decrease the microorganisms in the environment. Some products not only sanitize but also moisturize, so tender hands are not at risk. Time savings and increased efficiency for staff can be realized if personal hand sanitization systems are worn by administrators and caregivers. Currently, a system is available that caregivers and staff can wear during the caregiving process and have the ability to sanitize their hands in all locations. Modeling that behavior to residents will have the potential to reduce the spread of infection and improve the wellness of the frail elderly population.
       All facilities should have an active infection-tracking program as well as policies related to staff illness, resident illness, and physician involvement. Chronic infections must be identified and treated aggressively when possible. Policies should be in place to handle flu outbreaks and any other community-based infections. A focus on infection identification, treatment, and control can improve care and facility profitability. This approach does demand educational programs for the staff, residents, and families to be effective and the use of a hand sanitization product with a moisturizing capability.
       The skilled or intermediate care environment must organize their infection control process to not only meet their clinical needs but to function as part of their risk management and quality assurance programs. Tracking infections at the point of admission is very important. The utilization of carefully designed admissions assessment forms that match the Minimum Data Set (MDS) documents to identify infections and treatment as well as the need for isolation or other special needs will assist the clinical and operational staff not only to prepare for the resident but to assess the reimbursement available from the case.
       Clinical staff members must be aware of the early signs and symptoms of infection including subtle temperature changes in the frail elderly. The MDS process introduced the status febrile definition of 2.4 degrees F above the baseline. When baseline body temperature is part of the clinical assessment and changes are monitored early, intervention for infections can be instituted. If an infection is suspected and a urine specimen or other bodily fluids are needed for culture, etc., proper techniques of specimen collection must be established and utilized by the clinical staff. Lab work must be ordered and reported in a timely fashion. The attending physician must be notified and interventions established to treat the problem. Early detection and treatment save many long-term negative outcomes, additional cost, and possible premature death.
       The impact of generalized hand sanitization and proper hand washing can have a significant impact on the spread of infection or the re-infection of a weakened resident. Tracking the type, onset, and location of the infections as well as the location of the resident on the unit can be pivotal to finding the solution. Staff members must be reminded to clean their hands, product needs to be available (personal systems help here), and frequency of use needs to be understood. Nurse aide training and orientation programs must focus on infection control and hand cleansing and sanitization. Professionals must be mentors and models. I have instituted programs in long-term care facilities that require all members of the staff to be skills tested for hand washing and hand sanitization every quarter as part of their job performance reviews--a few minutes every three months to reinforce the importance of technique and practice.
       As we work with a frail aging population, we know the risk of infection is high, and protecting our residents and staff is important. Hand sanitization and proper hand washing when necessary is pivotal to the overall health of our clients, patients, and staff.