Long Term Care Facilities (LTCFs) which include nursing homes, skilled nursing facilities, and assisted living facilities, provide medical and personal care services to people who are unable to manage independently in the community. Over 5 million Americans are admitted to or reside in LTCFs each year.
Data about infections in LTCFs are limited, but it has been estimated in the medical literature that:
- 1 to 3 million serious infections occur every year in these facilities.
- Infections include urinary tract infection, diarrheal diseases, antibiotic-resistant staph infections and others.
- Infections are a major cause of hospitalization and death; as many as 380,000 people die of the infections in LTCFs every year.
If faced with admitting a family member or loved one into an LTCF, it is essential to ask the right questions first. Below is a list of 10 questions advised by the Center for Disease Control to obtain answers to before admittance to an LTCF:
1. What infections commonly occur among residents in this facility?
Nursing home residents can have a higher chance of getting an infection due to frailty from getting older, needing more help from caregivers who may not have clean hands, and open wounds or medical devices like IV tubes going into their body that break the skin providing a path for germs to enter the body. A nursing home should be tracking the common infections in its residents so they can be sure that actions are taken (i.e. infection prevention practices) to reduce the spread of germs to residents.
2. When was the last outbreak in this facility? What was the cause?
Shared living spaces and lots of visitors can make it easier for a contagious germ (like flu or diarrhea from norovirus) to spread quickly through a nursing home. While many facilities experience outbreaks, early detection and quickly alerting public health authorities can help limit the spread of the infection to more residents, staff and visitors.
3. How does the facility communicate with residents, family and visitors when an outbreak occurs?
Outbreaks of infections do occur in nursing homes. It is important the facility staff have a process for notifying residents, family members and visitors so everyone can take steps to decrease the chance of spreading the infection or getting ill.
4. Is the flu vaccine mandatory for all staff working in this nursing home?
A growing number of healthcare facilities are making flu shots a requirement for staff as a measure to protect patients and staff from flu. In nursing homes, giving a flu vaccine to staff can help reduce the spread of flu in residents.
5. If a staff member is sick, is he/she allowed to stay at home without losing pay or time off?
Coming to work sick is never a good idea, but it can be really dangerous if a person is working with frail or older people who are at increased risk for getting severe infections.
6. How are facility staff trained to respond to questions about hand hygiene from residents and family?
Cleaning hands before and after care for a resident is an important way to prevent the spread of infections.
7. Are residents with new diarrhea given separate toilet facilities until the cause of their diarrhea is determined and/or the diarrhea is resolved?
When a person has new diarrhea it’s important to rule out contagious germs like C. difficile, as the cause. Diarrhea can contain large numbers of the germs causing it. Some of these germs, like C. difficile, are very tough and difficult to clean from the environment.
8. How is shared equipment managed to prevent the spread of germs?
People can carry germs on their skin or other parts of the body for long periods of time without being sick. Having a process to clean and disinfect shared equipment before the next resident uses it is a way to ensure these germs are not spread to others.
9. Does the facility have private rooms for residents who develop signs or symptoms of a potentially contagious infection like new cough and fever or new vomiting and abdominal pain?
When a resident develops signs and symptoms which could be due to a contagious germ, like flu or norovirus, one way to protect the resident and others in the facility is to provide the ill resident with a private room until the cause of their symptoms is known.
10. Does the facility provide educational materials for residents and families on the following topics?
- Hand hygiene
- Use of gowns/gloves and other equipment to prevent the spread of germs
- Antibiotic use policies/practices in this facility
Residents and families are important partners in preventing the spread of infections and reducing misuse of antibiotics. Nursing homes should have materials to educate their residents, families and visitors on the facility’s infection prevention and antibiotic stewardship policies, and steps they can take to support a safe environment.