Nurse aides touch residents more than almost any other staff, so hand hygiene, protective equipment and standard precautions are part of nearly every task. Nursing homes must run an infection prevention program (42 CFR 483.80), and CDC sets out the practices behind it.
What the facility program must include
Every nursing facility must maintain an infection prevention and control program to help prevent communicable diseases and infections (42 CFR 483.80). Its written policies must cover surveillance, when and to whom possible infections are reported, standard and transmission-based precautions, and the hand hygiene procedures staff follow in direct resident contact (42 CFR 483.80(a)(2)).
Two rules reach aides directly. The facility must prohibit employees with a communicable disease or infected skin lesions from direct contact with residents or their food if that contact would spread the disease (42 CFR 483.80(a)(2)(v)). And personnel must handle, store, process and transport linens so as to prevent the spread of infection (42 CFR 483.80(e)). Isolation, when used, should be the least restrictive possible for the resident (42 CFR 483.80(a)(2)(iv)).
Standard precautions
Standard precautions apply to all patient care, whatever the diagnosis, and are based on a risk assessment (CDC, Standard Precautions for All Patient Care). They include hand hygiene, personal protective equipment when exposure to infectious material is possible, respiratory hygiene and cough etiquette, safe handling of needles and sharps, cleaning and disinfecting equipment and the environment, and careful handling of textiles and laundry (CDC, Standard Precautions for All Patient Care).
Hand hygiene
CDC recommends alcohol-based hand rub in most clinical situations unless hands are visibly soiled. Use soap and water when hands are visibly soiled, before eating, after using the restroom, and during C. difficile or norovirus outbreaks (CDC, Hand Hygiene in Healthcare Settings). Alcohol-based rub should contain at least 60 percent alcohol. Cover all hand surfaces and rub until dry, about 20 seconds, paying attention to thumbs, fingertips and between fingers. With soap and water, rub vigorously for at least 15 seconds (CDC, Hand Hygiene in Healthcare Settings).
Clean your hands:
- immediately before touching a resident;
- before an aseptic task, such as handling an invasive device;
- before moving from a soiled body site to a clean one on the same resident;
- after touching a resident or the resident's surroundings;
- after contact with blood, body fluids or contaminated surfaces;
- immediately after removing gloves (CDC, Hand Hygiene in Healthcare Settings).
Gloves and other PPE
Use PPE whenever there is an expectation of possible exposure to infectious material (CDC, Standard Precautions for All Patient Care). Gloves are not a substitute for hand hygiene: clean your hands before putting gloves on and after taking them off (CDC, Hand Hygiene in Healthcare Settings). Remove gloves carefully so you do not contaminate your hands.
Change gloves if they are damaged or soiled with blood or body fluids, when moving between residents, when moving from a soiled to a clean body site on the same resident, and before leaving the room (CDC, Hand Hygiene in Healthcare Settings).
Transmission-based precautions
When standard precautions are not enough, the resident is placed on additional precautions based on how the germ spreads (CDC, Transmission-Based Precautions):
- Contact: gown and gloves for any interaction with the resident or the resident's environment, put on at room entry and discarded before leaving.
- Droplet: a mask for staff on entering the room; the resident also wears a mask.
- Airborne: a fit-tested NIOSH-approved N95 or higher respirator for staff, with the resident in an airborne infection isolation room where one is available. Tuberculosis, measles and chickenpox are examples.
In long-term care, room placement is decided case by case, weighing the risks to other residents (CDC, Transmission-Based Precautions). Follow the precaution sign on the door and your nurse's instructions.
Immunizations and what to report
Facilities must offer each resident an influenza immunization from October 1 through March 31 each year unless it is medically contraindicated or already given, and residents or their representatives may refuse (42 CFR 483.80(d)(1)). Facilities must also offer a pneumococcal immunization (42 CFR 483.80(d)(2)). If you notice new coughing, fever, diarrhea, skin changes or several residents with similar symptoms, tell the nurse promptly; facility policy sets when and to whom infections are reported (42 CFR 483.80(a)(2)(ii)).
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