Preventing and Managing the Spread of Disease in Long Term Care Facilities
The typical declining age, existing health conditions, and poor mobility of most long-term care facility patients, in addition to the close proximity they share, makes preventing the spread of viral or bacterial infections particularly important for preserving the health of residents and staff alike. Certified nursing assistants, registered nurses, and other health care professionals in frequent and close contact with long term care residents are part of both the problem and solution to this challenge; they pose a unique ability to unknowingly spread illnesses from patient to patient and also to slow or stop the spread of diseases through good hygiene practices and precautions as they go about their work day.
What Is COVID-19?
In early 2020, a new strain of the coronavirus has captured the world’s attention. While the coronavirus itself is not new, the strain causing present concern is believed to have jumped from animal hosts to humans. This is uncommon and can be concerning as this means its effects are not well studied in humans. After this initial transfer to human hosts, the virus then spread quickly from person to person in its country of origin, China, and began appearing in sporadic numbers in other countries as well.
The symptoms have been reported to range from very mild cold symptoms to more severe respiratory complications and, in some cases, death. In general, the most severely ill patients, and those who have died, have been elderly people with other existing medical conditions that made them more susceptible to complications. While the number of infected has continued to grow since December 2019 when the disease first appeared, the overall number of infected is dwarfed by other viral respiratory infections such as influenza.
Due to the novelty of the coronavirus, there has been quite a bit of media coverage and resulting fear of serious pandemic in the general population. While the situation is still evolving and warrants close observation, most healthcare professionals and scientists watching the virus agree that fear and panic are not necessary, and that the overall risk for the general population seems to be no more than that of the many thousands of other respiratory viruses that circulate each year.
How to Prevent the Spread of Coronavirus
Those most at risk include the elderly, immunocompromised, and those with existing medical conditions that predispose them to complications from respiratory viruses. So what does this mean for residents of long term care facilities who typically meet all of these risk factors? For the most part, it doesn’t mean anything different than the standard hygiene and infection precautions already in place.
The recent spread of coronavirus at a Seattle nursing home does spark concern and demonstrates just how quickly communicable illnesses of any kind can be spread among this type of population. Though infection control procedures are always relevant, the emergence of a novel virus is a prime opportunity for facility administrators and their staff to review disease outbreak protocols and make changes where necessary in order to keep residents and workers safe and healthy as well as be able to provide family members with up to date and factual information when they, understandably, have questions and concerns.
In general, recommendations for preventing the spread of coronavirus are the same as for other illnesses:
Healthcare Practices Regarding Disease Transmission
Best practices for containing disease outbreaks are divided into several categories and should be routinely practiced by CNAs, RNs, and any other workers of long term care facilities that come in direct contact with patients.
The most basic level of hygiene and safety is Standard Precautions which involves any direct care or contact of all residents, regardless of if they have a current infection or not, and should be practiced by anyone visiting or caring for a nursing home resident. Standard precautions are created around the assumption that blood and bodily fluids may contain pathogens of communicable diseases at any given time and should not be directly touched. Gloves should be worn when performing any task that comes in direct contact with bodily fluids, including bathing, changing soiled linens, trach care, dressing changes, giving injections, catheter care, and many others. Proper hand washing should be performed after any patient contact. Surfaces and equipment, such as medication cart surfaces, stethoscopes, and blood pressure cuffs, should be sanitized in between patient uses. Personal protective equipment such as eye protection, masks, and gowns should be considered for patient care activities where splashing or spraying of blood or bodily fluids may occur.
Additional precautions may be indicated for patients with possible or confirmed infections that would not be completely contained with standard precautions alone. Contact Precautions should be implemented for any pathogens that can survive on surfaces or clothing and can be contracted by touching infected objects. These types of infections include bacterial infections such as MRSA and VRE, diarrheal illnesses, and some respiratory pathogens like RSV. With contact precautions, a gown and gloves must be worn with each entry into the patient’s room and patients should have their own reusable supplies, such as stethoscope and blood pressure cuff, that remain in their room and are not shared with other patients.
Adding further protection, Droplet Precautions help prevent the transmission of pathogens that may come from your nose or mouth when you speak, cough, or sneeze and rest on surfaces or come in contact with other people. In addition to the personal protective equipment used with contact precautions, staff must wear a mask any time they enter the patient’s room and the patient themselves must wear a mask if they are transferred anywhere outside of their own private room. Coronavirus is believed to be spread by droplets and this is the level of precaution is being used to care for infected patients at this time.
Finally, Airborne Precautions are utilized for the most highly transmissible of disease that can suspend in the air for a period of time and be contracted that way; this includes illnesses like measles and tuberculosis. These patients are typically kept in isolated negative pressure rooms and a specially fitted respiratory mask that prevents inhalation of contaminated droplets is required. Most standard nursing homes are not equipped to care for residents requiring airborne precautions and typically these patients are transferred to a hospital.
Take Caution When Visiting Nursing Facilities
As a friend or family member visiting someone in a nursing home under any kind of transmission precaution, you may be asked to wear a gown, gloves, or mask depending on the transmissibility of the patient’s illness. Patients themselves may be restricted to their own room or asked to wear a mask if leaving their room for community areas.
For any nursing home worker, visitor, or resident, frequent and proper hand washing and sneezing or coughing into the inside of your elbow rather than onto your hands should be followed. Employees or visitors who are sick or have a fever should not enter a long term care facility and risk exposing vulnerable residents to communicable diseases.
Disease Prevention: Further Reading
There are many resources available with more specific information on how to properly wash your hands, wear personal protective equipment, and prevent the spread of illness in general. The following resources may be useful to medical professionals and family members of long term care residents alike.