PREVENTING AND MANAGING INFECTIONS IN LONG-TERM CARE FACILITIES AND NURSING HOMES
The demand for long-term care (LTC) in Canada is on the increase. According to The Conference Board of Canada, an additional 200,000 LTC beds will be needed by 2035, which is close to double that of the current capacity as was determined in 2017(1).
Census data collected in 2011 suggests that of the 65 million Canadian adults aged 65 years and older, approximately 7% of them reside in institutions that provide care. Of these, around 4.5% are in nursing homes, chronic care facilities or LTC hospitals. In the category of 85 year olds and older, this number rises to almost 30% (2).
The elderly are considered to be a vulnerable population group, with those 85 years and older displaying the most significant vulnerabilities.
With increasing age comes the risk of chronic disease. In fact, it has been suggested that for many, the last 10 years of their life are spent in a state of illness. In these age groups, particularly with those who have underlying health conditions such as heart disease, diabetes, cancer, Alzheimer’s Disease etc., the risk of contracting communicable diseases is high.
In addition, not only does increasing age and decline in health reduce the capacity of the body to fight off infections, the risk of cross contamination of infection is higher in these populations as a result of behavioural factors in these homes, the high use of shared spaces and facilities, the high possibility of transfer between and from other healthcare facilities.
It is of the utmost important to consider the impact of these risks and how it may affect morbidity and quality of life in these populations.
During the ongoing COVID-19 pandemic, more than 80% of deaths in Canada were recorded in LTC facilities; an average of other countries in this category was at 42% (3). This significantly high number of deaths in these settings is highly suggestive that the demand for prevention and management of infectious diseases is on the increase.
For this reason, it is essential to consider whether current practices of prevention and management of infections in these LTC facilities may need further investigation and upgrade.
CURRENT PRACTICES IN INFECTION CONTROL AND PREVENTION
The current guiding principles (4) for infection control and prevention in LTC facilities and nursing homes are set in order to:
• Protect clients, residents, healthcare workers and the entire community of these facilities from the risk and consequences of infection
• Prevent the occurrence of healthcare associated infections, of which 30% haven been determined as being preventable5
• Encourage each healthcare provider to play their role in infection prevention and control
• Promote critical thinking and problem solving practices in healthcare providers for the prevention and management of infections
Basic infection prevention measures currently take into consideration the way that infections may be acquired through the spread of microorganisms, namely:
• The type of contact, where direct contact results in physical transfer of infective agents between persons through touching, indirect contact occurs through physical contact with an object that may contain infectious agents, such as surfaces, inanimate objects or medical equipment and devices, or through droplet transmission, which are typically spread through loud talking, singing, coughing, or sneezing.
• The mode of transmission, where the risks of cross contamination may involve airborne particles, those carried by a vehicle, such as water, food or medications, or those that are vectorborne, and transmitted via contact with a non-human source, such as mosquitoes, flies or rats, for example.
Routine practices that are currently in place to limit the infection rate as well as its spread, include:
Proper hand hygiene, where frequent washing of hands has been suggested as being one of the most effective prevention measures.
Assessing the risk of each individual in the LTC and nursing home environment and taking action with regards to their care and service delivery depending on their current infections by assessing symptoms such as diarrhea, hives or a rash, excretions and secretions, fever or respiratory symptoms, and wound care.
Utilizing appropriate PPE during the care of the individual, implementing frequent cleaning, disinfection and sanitization of the environment, doing laundry in such a way that reduces infection risk, managing waste and sharps, as well as maintaining appropriate hygiene and sanitization protocols in the use of medical equipment.
Maintaining a high level of education and continuous training on infection safety for healthcare providers, as well as providing education for the residents of these facilities as well as their families and other visitors.
The breakdown of these infection control and prevention practices is one of the most significant reasons for high risk of cross transmission in these populations. Studies show that compliance in healthcare providers when it comes to hand hygiene is low and they perform appropriate hand hygiene practices less than half of the time that they should.
Statistics on the transmission of infections as a result of poor hand hygiene show that (6):
• 80% of healthcare workers who are responsible for dressing wounds carry methicillin-resistant Staphylococcus aureus (MRSA) on their hands for up to three hours.
• 60% of hospital staff who have been in contact with a patient infected by Clostridium difficile remained contaminated for 30 minutes following the interaction.
• 40% of interactions between a healthcare provider and a patient with Klebsiella pneumoniae resulted in cross transmission.
Additional considerations of current cleaning and sanitization practices are important in these facilities as a result of the vulnerability of the residents. For example, daily cleaning with chemical solutions may be effective and fairly inexpensive for everyday use, however, they may release volatile organic compounds into the environment, which may affect some of the residents of these facilities, particularly those with respiratory illnesses or infections. Other options such as bleach, may require drying to be effective, and they may have disinfection properties, but no cleaning properties. The need for both cleaning and disinfection solutions are thus necessary, which places additional burden on staff who are tasked with maintaining a clean and safe environment.
Removal of these demands, and automating cleaning and disinfection may be a solution LTC facilities and nursing homes may be looking for (7).
HIGHLY ADVANCED TECHNOLOGIES TO PREVENT AND MANAGE INFECTION IN LONG TERM CARE FACILITIES AND NURSING HOMES
CONTINUOUS ENVIRONMENTAL DISINFECTION
Advances in technology have allowed for the development of a true ‘no-touch’, continuous air filtration and disinfection system that has revolutionized the industry involved in providing clinically proven clean and safe air.
Traditionally, recycling of air through the HVAC and using portable air purification systems have been in place for improving air quality in LTC facilities. UVC light disinfection has also been used to provide targeted strategies for disinfection.
The remainder of the cleaning and disinfection protocols rely on physical cleaning and disinfection of common touch areas.
Additionally, physical isolation tactics have been employed to block off areas of the facilities with residents who are infected. In this COVID-19 era, airborne infection isolation (AII) rooms have made an attempt to reduce the spread of the virus in these facilities, however, there are few true AII rooms available, which makes containing an outbreak difficult. Often, filtration devices such as HEPA and ULPA are not effective against containing the spread of airborne microorganisms. The need is to utilize filters that contain antimicrobial properties in order to kill airborne microbes on contact.
It has also been shown that ionization is effective in significantly reducing the spread of airborne infections. Ions released into the air attract and latch on to contaminants, which includes microorganism particles, dust, smoke, volatile organic compounds, allergens and other common air pollutants. Not only do these ionized particles then cause the light airborne particles to be heavy enough to drop to the floor, they work to deactivate the microorganisms both while airborne and on surfaces.
UVC light has been used for decades as an effective disinfection technology in the healthcare setting. Microorganisms exposed to UV light are deactivated, often within 10 seconds. The trouble with current UV technology is that UVC lamps are required to be moved to targeted areas, and ineffective placement of the device may result in ineffective decontamination. Human exposure to UV radiation is another concern, and these devices may only be used in unoccupied spaces.
This device is installed directly into the current HVAC system and provides an all-in-one solution to these current disinfection challenges in LTC facilities and nursing homes.
This is a filtration device that is certified to be highly effective against microorganisms and other organic matter, that releases ionized particles through a photocatalytic converter into the air and that contains a UV light, provides for continuous air filtration and disinfection even in occupied spaces as long as the HVAC system remains on.
Testing of the CASPR device provides evidence to show that surface disinfection is significant and ranges from 91% to over 99.99% reduction in microbial burden.
In the hospital setting, the CASPR technology was effective in eliminating MRSA upon contact, as well as being highly effective against a variety of other pathogenic microorganisms commonly found in the healthcare setting such as Enterococcus faecalis, Pseudomonas aeruginosa, Feline Calicivirus, Trichophyton interdigitale, Influenza A (H1N1), and MS2 Bacteriophage (MS2).
This device requires no additional resources, does not require evacuation of a room, it provides facility-wide coverage, eliminates human error in cleaning and disinfection protocols, addresses ignored and hard-to-reach areas, and takes up no additional space in the facility.
SURFACE, AIR, HAND AND WOUND DISINFECTION
Additional infection prevention and control comes in the form of a truly unique solution. For decades, scientists have hoped to harness the power of one of the most advanced compounds produced by the human body as part of the immune reaction against a foreign invader. Hypochlorous acid (HOCl), often referred to as nature’s oldest disinfectant, has thus far failed to be created into a compound that is safe to use in the prevention and spread of infections. Instead, all attempts at creating a synthetic version of this highly effective germ killer has resulted in a toxic substance; until now.
Having revolutionized the production of HOCl, Briotech has captured the essence of nature’s disinfectant providing a multi surface sanitizer that is not only safe to use in even critical healthcare settings, but it is gentle enough to use directly on sensitive body tissues such as wounds and mucus membranes.
Testing has revealed that the risk of irritation to the skin or eyes, respiratory system and even ingestion poses little threat to humans, and is completely safe to use in many settings.
Briotech can be used as a highly effective surface cleaner that deactivates a wide array of microorganisms on contact and reduces into water and salt compounds within 30 minutes, having no effect on the structure or integrity of the surface, and requiring no wiping or cleaning after use.
Misting of the environmental air has also been proposed as being a target of Briotech, where rapid disinfection of pathogenic airborne particles may be required.
Research shows that due to its highly non-toxic properties, the application of Briotech as a direct wound disinfectant offers a significant amount of potential for its use in the healthcare setting. Not only may healthcare providers use the solution to disinfect their hands prior to interacting with a LTC facility or nursing home resident, this solution may be used to mist the environment in which the interaction takes place, and to disinfect surface that either provider or resident may come into contact with or to disinfect a wound that may require cleaning or dressing changes.
With the steady rise in demand for LTC facilities and nursing homes with an increasing aged population, and the recent challenges in infection prevention and control being critically highlighted throughout the recent coronavirus pandemic, the need for re-thinking of the current disinfection protocols in these environments has become necessary.
Technological advances provided by both CASPR and Briotech offer effective solu- tions to the current challenges faced in protecting residents, visitors and healthcare providers in LTC facilities and nursing homes, not only from COVID-19 but multiple other pathogenic microorganisms that continue to plague these vulnerable environ- ments.
1. The Conference Board of Canada. Sizing up the challenger: Meeting the demand for long-term care in Canada. 2017.
2. Statistics Canada. 2011 Census of Population: Families, households, marital status, structural type of dwelling, collectives.
3. COHO Snapshot June 2020. Pandemic Experience in the long-term care sector. How does Canada compare with other countries? 2020.
4. Ontario Ministry of Health and Long Term Care Infection Prevention and Control Core Competencies Program, 2005.
5. Canadian Committee on Antibiotic Resistance. Infection prevention and control best practices for long term care, home and community care including health care offices and ambulatory clinics. 2007.
6. Canadian Patient Safety Institute. Hand Hygiene. 2020.
7. Practical Steps to Improve Air Flow in Long-Term Care Resident Rooms to Reduce COVID-19 Infection Risk. Journal of the American Medical Directors Association. Volume 21, Issue 7, July 2020, Pages 893-894
8. Block MS, Rowan BG. Hypochlorous Acid: A Review [published online ahead of print, 2020 Jun 25]. J Oral Maxillofac Surg. 2020;S0278-2391(20)30672-8.