UK Nursing Home Infection Control Practices

This coursework contains the full 6,000-word summative essay on the Literature review on the infection control practices in the Nursing Homes most particularly in the United Kingdom. It is well known that the elderly population has a substantially increased incidence and severity of many infectious diseases (Hampton, 2003). The student will focus on the infection control and prevention issues most specifically to person- to-person transmission and a little regarding food –borne transmission. In fact, the Centres for Disease Control and Prevention (CDC) estimates that 1.5 million nosocomial infections occur in long-term care residents per year, which translates to an average of one infection per resident per year (Williams, 2008). Between February and May 2006 infection control staff across the United Kingdom and Ireland completed the third national survey into health care associated infection. A prevalence rate of 7.6% broadly supports the results that were reported in the first and second national surveys (Cole, 2007).

According to Knoll and Lautenschlaeger (2010), the rate of healthcare-associated infections (HCAIs) is listed for the United Kingdom at approximately 50 thousand cases in every year. Among these are the elderly people, which are the most vulnerable hosts (Aitkenhead, 2009). According to Nazarko (2007b), infection control in UK care homes does not yet receive the same level of scrutiny as in hospitals. People requiring care in nursing homes may have infections, or may be at risk of picking up infection from other people. Staff and visitors may also be at risk since they are the ones who are in direct contact with the clients. As being observed by the student, infections spread rapidly between the residents in the Nursing homes. Standard precautions aim to eliminate sources of infection whenever possible and to prevent the spread of infection (Nazarko, 2007). Controlling the spread of the infection may be difficult for some workers due to lack of education on infection control and prevention. This is the main reason why the student came up with several sources that may sum up the problems and makes solutions that may be helpful to health personnel.

The number of people in care homes will continue to expand as the population ages. Today, according to Hampton (2003), residents in care homes have more complicated medical conditions than they did 5 years ago, as they become even more elderly and the trend continues towards shorter and shorter hospital stays in acute care facilities.

This literature review was made by the student to emphasize the importance of compliance of infection control procedures in the care home. The student’s experiences and knowledge gained from work based studies and broad sources of reading materials greatly contribute in making the substance of this paper. This paper may help readers to gain knowledge on the ideal infection control procedures that applies mainly in the healthcare setting.

Common mode of transmission in a nursing home facility

Infection control is described by the National Health Service Executive as a managed environment, which minimises the risk of infection to patients, staff and visitors (Health Protection Agency, 2006). Standard precautions are directed towards breaking the chain of infection by preventing the transmission of infection (Cole, 2010). According to El-Kadiki and Sutton (2005), compliance of infection control may provide high quality and safe services among individuals. It may also prevent cross contamination among staff member and may lower the costs of health care services since prevention is more economical than treatment (Eriksen et al, 2007).

From the article by Nazarko (2005), the spread of infection within health care requires three elements: 1. a source of infecting organism (bacteria, viruses, and fungi), 2. a susceptible host and, 3.a route of transmission of the organism from one person or site to another. In relation to the nursing home environment, the source may be a resident, a staff member or a visitor. That certain individual may have signs of infection, or may be colonized and does not show any symptoms (Knoll, 2010). The source may also be inanimate objects within the environment that have become contaminated such as equipments. The host is the resident or client that is on the nursing home facility. According to Williams (2008), resistance to pathogenic microorganisms may vary greatly from each individual. Microorganisms can be transmitted by variety of routes and the same organism can be transmitted by more than one routes. According to Cole and Lai (2009), there are common modes of transmission of infection in the nursing homes that every staff can prevent by just executing correct infection control procedures. However, the student has chosen the most common types that were being noticed in the workplace. These are 1. Person-to person, 2. Food-borne, and 3. Hospital Acquired Infections (HAIs).

Cole and Lain (2009) briefly describe person-to person spread as a conveyance of a certain disease condition to another individual. Person-to-person spread of infections may be airborne, faecal-oral, blood-blood or skin-to-skin. The most common infectious diseases the student noticed over the past few months were colds and flu. The spread of the infection to each person was so massive despite flu vaccination several months before the onset. The residents that were affected with the viral infection were treated with several courses of antiviral medications and antibiotics. Aitkenhead (2009) indicated that anti-viral medication is currently under-used for older people in care homes in the UK. Isolation was also done to severely affected residents. According to Cole and Lai (2009), isolation may be done to residents if they acquired infectious or communicable disease; they may also be place on isolation if a certain individual has been suspected of any infectious disease. Despite doing procedure, flu virus was able to spread on few of the residents and staff. False handing or poor infection control procedures must have caused the break in isolating the resident with infection.

Food borne infection had also been very common among care homes. With this, according to Ashurst (2007a) on her article, nursing homes and hospitals in the United Kingdom are now subject to strict environmental health inspections to monitor the premises, and making sure that foods that are served are safe for consumption. As being observed by the student in the workplace, all kitchen staffs are handlers of basic food hygiene certificate as part of their induction programme. Kitchen staffs were taught about the principles of food hygiene with emphasis being placed on high standards of personal hygiene, including hand washing.

As stated in Ashurst (2007b) in her second article, food safety should never be taken for granted, as people may lost their lives as direct result of the staff failure to follow agreed policies and procedures. This matter is to protect both the residents and staffs from potential harm. Food poisoning, according to Ashurst (2007a), is caused by poor hygiene and, in particular, is caused by the contamination of ready-to-eat food with food poisoning bacteria. From the student’s basic knowledge, poor temperature control of ready-to-eat food may also cause of bacteria to multiply in large numbers. The best environment for most bacteria to grow and increase in number is a moist environment between 5°C and 60°C. This range of temperatures is known as the ‘growth’ or ‘danger’ zone (Fisher and Hartshorn, 2005). Undercooking may also cause poisoning since this enables food poisoning bacteria to survive.

Hospital acquired infections, according to Gaspard et al (2008), is an infection acquired during hospital care which was not present or incubating prior to admission. Among reported case of nosocomial infections on the student’s work place, MRSA or Methicillin-resistant Staphylococcus Aureus is the most common.

Common types of person to person infection in Nursing Homes in the UK

There have been a number of outbreaks on infection in the Nursing Homes in the UK, according to Nararco (2005). Few of these infective diseases are Flu, gastrointestinal conditions, pneumonia, urinary tract infection, and scabies. Wound infections had also been very common in residents, especially those who developed decubitus ulcers or bed sores. Each of these infectious conditions will be discussed by the students.

Influenza is defined by Daniell (2004) in his journal article as an acute viral, respiratory infection causing the temperature to rise quickly, with profound malaise, headache, myalgia, congested nose, cough and breathing difficulties. For otherwise healthy individuals, influenza is an unpleasant but usually self-limiting disease; this normally resolves in 7–14 days. Flu continues to cause outbreaks in care homes and in the community (Benison, 2006). The student was able to observe that influenza outbreaks occur readily in elderly care homes. They strike rapidly and are frequently associated with widespread severe illness and deaths. Eleven years ago, According to Nguyen-Van-Tam (2000), in Britain, outbreaks are frequently detected too late in their course when the options for effective intervention are few. Flu vaccinations are being given to staffs and clients during outbreaks. Vaccination against flu must also be given to staffs considering they are exposed in both setting – inside and outside the care home. Whilst this cannot be applied to all situations it is advisable in some circumstances. It should always be combined with other infection control efforts however to ensure complete protection. In conjunction with vaccination is post exposure prophylaxis, this is used where vaccines do not exist after contact with infection has occurred (Booker, 2004). Staff spend a lot often time with residents, and can infect vulnerable residents inadvertently. If staff have flu vaccinations they are very unlikely to bring the flu virus into the home, therefore reducing the risk of older people getting flu (Daniell, 2004). The flu immunization season, which is the beginning of winter season, is a busy time for the nurses but its preventive value cannot be overestimated. If an outbreak of flu does occur, anti-viral medication can be used (Eriksen et al 2007). According to Benison (2006), the combined use of immunization and targeted treatment with antiviral agents can effectively control the serious impact of seasonal influenza on vulnerable communities of residents in care. Scottish researchers found that giving flu vaccinations to nursing staff working in nursing homes reduced death rates (Booker, 2004). Flu Vaccination can highly reduce death rates and prevents vulnerable older people who develop flu from becoming increasingly disabled.

Second condition that had been known to be very common is gastroenteritis or diarrhoeal problems. According to Ashurst (2007a), this condition is very common and extremely infectious and affects approximately 1 in 5 people are affected by the condition in En