Medical care of older persons in residential facilities

Infection control

The RACF environment can potentially facilitate infection between residents, staff, visitors and health care providers. To reduce risks, national best practice guidelines¹⁹⁹ for infection control in the health care setting should be considered in association with the relevant state or territory legislative requirements. Key points for the prevention and management of outbreaks of infection in RACFs are given in the national guidelines:²⁰⁰

Infections in RACFs may be community acquired, health care associated or endemic. Residents are both susceptible to, and a potential source of infection
Infection can be transmitted when transferring residents between different health care settings. Therefore RACFs should have an established infection control relationship with any associated acute care and other health care establishment/providers (eg. for antimicrobial resistant bacteria)
Each RACF must have an infection control program coordinated by a designated infection control practitioner
The home-like atmosphere of RACFs presents some specific issues for infection control, eg. visiting hairdressers, podiatrists and companion animals
Surveillance should be done with data collected by trained personnel using published definitions for case finding and incidence reporting. It may be appropriate to survey infections of skin, respiratory tract, urinary tract and the bloodstream, gastroenteritis and unexplained febrile episodes
Residents may be colonised or infected with multimedication resistant organisms when they are admitted, or through use of antibiotics during their stay. Therefore, the infection control program should include clinical guidelines for empiric antimicrobial prescription (eg. Therapeutic guidelines: antibiotic),²⁰¹ review of antibiotic usage and restricted formulary
Risks of infection can be reduced through patient health programs, including immunisation, tuberculosis screening and prevention and control of each resident's specific infection risks.

Effective infection control programs involve standard procedures for all patients regardless of their perceived infectious risk, and additional precautions for patients known or suspected to be infected with highly transmissible pathogens.

Standard precautions provide adequate protection for blood borne diseases (eg. hepatitis B). Precautions include aseptic technique, hand washing, use of personal protective equipment (eg. gloves, eye protection), appropriate handling of sharps and clinical waste, appropriate reprocessing of instruments and equipment, and implementation of environmental controls and support services. Standard precautions should incorporate safe systems for handling blood (including dried blood), other body fluids, secretions and excretions (excluding sweat), nonintact skin and mucous membranes.

Additional precautions relate to the specific routes of transmission by air (eg. tuberculosis), droplet (eg. influenza, Group A streptococcal pneumonia) or contact with skin or surfaces (eg. resistant bacteria, scabies, pediculosis, and incontinent patients with hepatitis A, gastroenteritis). Precautions are tailored to the particular infectious agent and mode of transmission, and include relative isolation of the patient, use of personal protective equipment, and treatment. See guidelines for details of precautions and treatment for specific conditions.^202,203,204

Immunisation and testing strategies include;²⁰⁵

vaccination of residents for prevention of influenza and pneumococcal pneumonia
vaccination of all health care workers for prevention of hepatitis B, tetanus and influenza
offering tests for HIV, hepatitis C and hepatitis B to health care workers exposed to blood or sharps injuries with potential for blood borne virus infections.