Infection Control in Long-Term Care

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Infectious diseases have become a more prominent area of concern in long-term care facilities in recent years. Clostridium difficile, norovirus, multi-drug resistant organisms (MDROs), and influenza have all presented difficulties for LTC facility staff. The consultant pharmacist has an increasingly important role to play in assisting facilities with oversight of trends relating to infectious diseases, use of antibiotics, and immunization practices. This Practice Resource Center is designed to assist consultant pharmacists in locating resources to enable them to fulfill their important responsibilities related to infection control in long-term care facilities.


Below are links to resources on infection control in long-term care. ASCP welcomes feedback or suggestions to improve this resource. Send comments to ClinAff@ascp.com.


September 2013

Antibiotic Resistance a Growing Threat to Nursing Facility Residents

A recent report released by the Centers for Disease Control and Prevention (CDC) indicates that antibiotic resistance continues to be a growing threat to public health, particularly in health care settings, including skilled nursing and assisted living communities. The report notes that patients in acute or long-term care are particularly vulnerable to antibiotic-resistant bacteria, and are more susceptible to complications from infection and the second- or third-line treatments used for antibiotic-resistant infections. As a result, most deaths from infections occur in hospitals and long-term care facilities.

The CDC recommends a cooperative interprofessional approach to combat the rising infection threat, particularly from bacteria such as C. difficile. The report notes that this combined effort can help to both improve the prescribing and utilization practices that exacerbate antibiotic resistance and slow or halt the spread of antibiotic-resistant infections in health care settings.

February 2013 -- Latest Vaccination Resources

January 2013 -- Latest Flu / Vaccination Resources

ASCP has compiled the most up-to-date information on the 2012-2013 influenza outbreak to help pharmacists treat their most at-risk patients.

FDA approves new seasonal influenza vaccine made using novel technology

The U.S. Food and Drug Administration announced that it has approved Flublok, the first trivalent influenza vaccine made using an insect virus (baculovirus) expression system and recombinant DNA technology. Flublok is approved for the prevention of seasonal influenza in people 18 through 49 years of age.

Unlike current flu vaccines, Flublok does not use the influenza virus or eggs in its production. Flublok’s novel manufacturing technology allows for production of large quantities of the influenza virus protein, hemagglutinin (HA) – the active ingredient in all inactivated influenza vaccines that is essential for entry of the virus into cells in the body. The majority of antibodies that prevent influenza virus infection are directed against HA. While the technology is new to flu vaccine production, it is used to make vaccines that have been approved by the FDA to prevent other infectious diseases.

Read the FDA's news release about Flublok.

23-Valent Pneumococcal Polysaccaride Vaccine for Adults with Immunocompromising Conditions
"PPSV23 contains 12 of the serotypes included in PCV13, plus 11 additional serotypes. PPSV23 is recommended for prevention of IPD among all adults aged ≥65 years, and for adults at high risk aged 19–64 years (1,3). Although conflicting evidence regarding PPSV23 efficacy in HIV-infected adults has been published (15,16), the GRADE evaluation reviewed by ACIP concluded that potential benefits from PPSV23 use in this population outweigh any potential harms. Given the high burden of IPD caused by serotypes in PPSV23 but not in PCV13, broader protection might be provided through use of both pneumococcal vaccines."

December 2012 -- National Influenza Vaccination Week: December 2-8, 2012

National Influenza Vaccination Week (NIVW) is a national observance that was established to highlight the importance of continuing influenza vaccination, as well as fostering greater use of flu vaccine after the holiday season into January and beyond. NIVW will be held December 2-8, 2012.

November 2012 -- Weekly Flu Review

This is a weekly influenza surveillance report prepared by CDC Influenza Division. All data are preliminary and may change as CDC receives more reports. Learn more here.

September 2012 -- Shingles and Vaccination Resources

The FDA has recently approved Zostavax for use in individuals 50 years of age and older. According to the Zostavax Efficacy and Safety Trial (ZEST), the administration of Zostavax decreased the risk of developing shingles by 69.8% for patients 50-59 years of age. Due to a previous history of vaccine supply shortages, the Advisory Committee on Immunization Practices (ACIP), part of CDC, has not changed vaccination recommendations to include patients between the ages of 50-59 at this time.

Shingles

Herpes Zoster Vaccination

References

  1. Zostavax [package insert]. Whitehouse Station, NJ: Merck and Co.; 2011
  2. Schmader KE, Levin MJ, Gnann JW, et al. Efficacy, safety, and tolerability of herpes zoster vaccine in personas aged 50 – 59 years. Clin Infect Dis. 2012;54(7):922-8
  3. Vaccine and Preventable Diseases: Herpes Zoster Vaccination for Health Care Professionals. Centers for Disease Control and Prevention. June 28, 2012. Accessed September 11, 2012.

August 2012 -- Influenza and Immunization Resources

February 2012 -- CDC Releases Interim Guidance for Influenza Outbreak Management in Long-Term Care Facilities

This guidance document consolidates and provides currently recommended strategies for management of influenza outbreaks in LTC facilities.

January 2012 -- North Carolina Offers State Approved Infection Control Course for Adult Care Homes

The state of North Carolina has released a state approved course in infection control for use in adult care homes. The three hour course is mandatory for medication aides in North Carolina. The materials are complimentary and may be useful for other states as well. Instructor materials are being developed and will be posted later. Access the site here.

February 2010 -- New Emphasis on Glucometer Cleaning / Disinfection During Nursing Facility Surveys

Long-term care facilities have been cited for inadequately cleaning or disinfecting glucometers used by multiple residents. In addition to outlining how/where glucometers are mentioned in the infection control guidelines at F-Tag 441 of the CMS State Operations Manual, ASCP has also researched individual glucometer manufacturers' cleaning recommendations, along with the Centers for Disease Control and Prevention (CDC), Environmental Protection Agency (EPA) and American Diabetes Association (ADA) guidelines on this matter. This information should be helpful when developing or assuring the adequacy of your facility’s or facilities’ policies and procedures. Download the ASCP's glucometer cleaning summary document (PDF) here.

Be familiar with which glucometer manufacturer(s) your facility(ies) use(s) and the cleaning procedures recommended by that manufacturer(s). If the manufacturer does not provide specific cleaning recommendations or as a conservative approach to infection control for glucometers with minimal cleaning requirements, facilities might want to consider cleaning glucometers with high-level disinfectants. Be familiar with the amount of time the disinfectant solution is supposed to contact the equipment or how long active cleaning should be performed to ensure complete disinfection. For example, simply wiping equipment with a disinfectant-soaked swab may not be adequate. Wiping for a specific length of time or ensuring the equipment is “wet” or saturated for a specific length of time may be required. Cleaning time frames may be dictated by CDC guidelines or by the disinfectant manufacturer in their “instructions for use.”

CMS State Operations Manual for Nursing Facilities

On July 20, 2009, the Centers for Medicare & Medicaid Services updated the State Operations Manual to strengthen provisions relating to infection control. Download the CMS memorandum (PDF) here. Included in this memorandum is this paragraph:

"Because of increases in MDROs, review of the use of antibiotics (including comparing prescribed antibiotics with available susceptibility reports) is a vital aspect of the infection prevention and control program. It is the physician’s (or other appropriate authorized practitioner’s) responsibility to prescribe appropriate antibiotics and to establish the indication for use of specific medications. As part of the medication regimen review, the consultant pharmacist can assist with the oversight by identifying antibiotics prescribed for resistant organisms or for situations with questionable indications, and reporting such findings to the director of nursing and the attending physician."

The consultant pharmacist has an important role in assisting nursing facilities with infection control issues, and a variety of resources and links are provided below to assist in this responsibility.

Centers for Disease Control and Prevention (CDC)

Association for Professionals in Infection Control and Epidemiology (APIC)

The Society for Healthcare Epidemiology of America

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