Elements of a good infection control program

Elements of a good infection control program – includes related article on staff inservice implementation guidelines

Diane K. Monda

Infection control practice and containment i a hot specialty of the ’90s for long-term care. In the recent past, medical authorities believed antibiotics would be the cure-all for infectious diseases. As a result, important infection control practices faced extinction. But as studies show, microorganisms mutate and are coming back stronger at an alarming rate, and good infection control programs are needed now more than ever.

Yet many long-term care centers do not utilize good infection control (IC) programs.

There are steps to developing such programs. First, “it is necessary to get full support from your administration, including the medical director,” says Louise Lobotsky, RN, CIC, infection control officer at Transitional Living Centers, Brunswick, OH. She suggests the following methods to help achieve this:

* Emphasize that state and Federal regulations require IC programs. The Occupational Safety and Health Administration (OSHA), for example, levies severe fines for demonstrably inadequate IC programs or practices. Fines can include a minimum of $5,000 per violation, with penalties of up to for each willful violation or repeat offense.

* Recruit an enthusiastic staff nurse to do the job. Traditionally, IC is delegated to the busy Director of Nursing (DON) or the assistant DON.

* Realize that little money is required to set up an effective program. Once policies and procedures are in place, a good IC program can be directed by a part-time nurse.

* Consider including quality assurance (QA) and employee health monitoring in the IC nurse’s job description. Since QA and IC focus on improvement, employee health tracking is one statistic that can show improvement or a need for changes.

After a nurse has been designated to enhance and expand the facility’s program, she/he should examine what is already in place. This includes a tour of the center and a review of existing records and minutes from meetings. The nurse should talk to the medical director, nursing staff and residents. Contact and networking with the local hospital IC person can augment the nurse’s support and knowledge of resources.

To assess your staff’s knowledge of IC procedures, casually ask them some questions. For example, How do you clean up a blood spill?” You have some educating to do if the employee’s response is “I’d wipe it up with paper towels and flush it down the toilet!”

Hands are the chief culprits for transmission of pathogens. Therefore, “When you wash your hands, how long should you scrub?” If the answer is “two minutes,” you know employees are not going to wash their hands as frequently as recommended. A ten@ to fifteen-second scrub with antibacterial soap is usually adequate for handwashing, unless the hands are extremely soiled.

Four key components of a good infection control program are:

Policy and procedure. State and Federal regulations for nursing facilities, Centers for Disease Control (CDC) guidelines, and OSHA regulations dictate policies. Formulate your policies from the regulations and accepted standards for nursing practice, which are specific for any kind of nursing task. To illustrate, one policy can outline medication-passing procedures: “You must wash your hands or use dry antiseptic hand wash before and between administering to residents; never touch medications with your hands; medication cups must be inverted on the medication cart or other storage place; the med cart must be locked when not in use.”

Staff Education. Topics that should be covered in orientation include@ definitions of IC terminology; how microorganisms are spread and the prevention of spread; handwashing procedures; regulations on bloodborne pathogens, universal precautions, OSHA requirements; CDC guidelines; Hepatitis B and HIV, linen handling (clean and soiled); identifying signs of infection; and cleaning/disinfecting techniques. Lecture material should be geared to the employee’s position and level of education. (See “Imaginative Inservices.”)

At least four hours per year of IC training for staff is recommended. OSHA regulations require bloodborne pathogen and TB inservices annually. Hold quarterly meetings with department supervisors to communicate and reinforce IC awareness.

Surveillance. Keep statistics on separate forms for employees and residents. Define on the forms what constitutes an infection, i.e., temperature, sore throat, earache. Report these statistics in the quarterly IC meeting, and encourage ideas for improvements from other members. Determine “rates” of infections — the type of infection and occurrences — to see if there is a pattern. A regular surveillance system not only allows early detection, but requires continual vigilance for maximum protection.

Quality Assurance. Feedback from employees and records show how programs are working. If infection rates are up, it may be due to a general outbreak in the area, or a breakdown in IC technique among staff and for residents. Ongoing discussions with staff can reveal weaknesses, which can be corrected by rewriting procedures or adding steps to existing ones. Always inform staff of the reason a task is done a certain way, such as to avoid contamination or cross-infection.

Remember, sound infection control policies and practices protect and promote wellness for everyone: residents, staff and visitors.


Alvaran, M Butz A, Larson E. Opinions, knowledge and self-reported practices related to infection control among nursing personnel in long-term care settings. American Journal of Infection Control Infection Control Update ’94. Nursing, ’94 1994; October:52-54.

Lee Y, Cesario T, Lee R, et al. Colonization by Staphylococcus species resistant to methicillin or quinolone on hands of medical personnel in a skilled nursing facility. American journal of Infection Control 1994, 22(6):346-351.

Leinbach R, English AJ. Training needs of infection control professionals in long-term care facilities in Virginia. American Journal of Infection Control 1995; 23(2):73-77.

Monto A, Ohmit S, Margulies J, Talsma A. Medical practice-based influenza surveillance: Viral prevalence and assessment of morbidity. American Journal of Epidemiology 1995; 141(6):502-506.

Imaginative Inservices

Some ideas to jumpstart your imagination

for successful staff inservices:

Universal Precautions

The day before the inservice (so you can rehearse), recruit four nursing staff volunteers (A, B, C, D) to be actors. A and B are residents in your facility; C and D are nursing staff. A is the neatly dressed, clean resident, while B is disheveled and looks “diseased.”

Simulate a blood draw from Resident A by Nurse C. C does not use gloves since C is new to the facility and A “looks so clean.” Drops of blood (red food coloring) spill on Nurse C’s hand, near a cut on C’s thumb. C finds out, from another staff member, that Resident A is a Hepatitis B carrier.

Nursing Assistant D, that Resident B has no diseases despite B’s appearance. D acknowledges this remark by stating that she is just following universal precaution directives.

(Point: appearances can be deceiving, so always practice universal precautions, and review them during inservices.)


Props needed are “Glo Germ[R]” lotion (available from health education supply catalogs), sink, antibacterial soap, black light, and a dark room. Apply the “Glo Germ [R] lotion to the hands of all in attendance, then instruct them to wash their hands well. Darken the room and turn on the black light. Have staff hold their hands near the black light. Bacteria on hands will glow orange, emphasizing the need for frequent, adequate handwashing.

Environmental Sanitation

Items needed are a spray bottle of disinfectant, gloves, clean damp and dry cloths, and a table. Demonstrate disinfection of the table top: spray disinfectant on the table and use the damp cloth to wipe well. Ask the audience if you should dry the table withe the dry cloth. (Correct answer: no; let the table “airy dry” to avoid recontamination.)

Remember, in any training situation, audience participation is one of the most effective educational methods. And, the truth is, many staff like to be actors in skits and can very realistically portray situations encountered in the day-to-day life of a long-term care facility.

COPYRIGHT 1996 Medquest Communications, LLC

COPYRIGHT 2004 Gale Group