Infection Control in Nursing Homes

The Chain of Infection

Six conditions contribute to the spread of infection. Removing one link in the chain of infection can halt transmission and potentially save lives.

  • Infectious agents are germs that cause disease.
  • Reservoirs are places in the environment where the germs live, including people, medical equipment, and even soil or water.
  • Portal of exit is the way the microbes leave the reservoir, including coughing or sneezing, open wounds, and body fluids.
  •  Means of transmission is how germs transfer from one person to another, like direct contact or respiratory droplets.
  • Portal of entry is the way the germ can enter a new host. These open doors for bacteria or viruses include broken skin, medical devices such as IV lines or urinary catheters, and through the respiratory tract or mucous membranes. 
  • The host is someone who has an infection, is at risk for disease, or is an asymptomatic carrier.  

Viruses, bacteria, fungi, protozoa, and worms are the five types of pathogens that make us sick. More information is available by visiting the  National Center for Biotechnology Information website.

Infection Prevention and Control in Nursing Homes

Infection Prevention and Control in Nursing Homes

The Centers for Medicare & Medicaid Services (CMS) Compliance Group's rules and regulations state that the facility Infection Preventionist (IP) must have primary professional training in the following: 

  • nursing
  • epidemiology
  • microbiology
  • medical technology
  • or a related field 

Additionally, the IP must be qualified for this role through education, training, certification, or experience, and must have completed specialized training in Infection Prevention and Control. This person also needs to work at least part-time at the facility.

Viral Infections and Outbreaks in Nursing Homes

Bacterial infections are more prevalent in nursing homes than are viral infections--which is not to say that they do not occur: Influenza is common, even with yearly vaccinations. Shingles, or Herpes-Zoster virus, is another viral infection; however, its reach is limited under ordinary circumstances. Viral pneumonia and the common cold are other viral infections that we see in nursing homes. 

Generally, viruses get transmitted through droplets that enter the body through the respiratory tract (nose, lungs) or mucous membranes (eyes, mouth). Some viruses, bloodborne pathogens, are transmitted through the direct exchange of body fluids, for example, infected blood can enter a healthy body through broken skin. 

We can ordinarily treat bacterial infections treated with antibiotics. Bacterial infections that are not affected by available medications are called MDROs--Multi-Drug Resistant Organisms. Many people have heard of MDROs like MRSA, VRE, or C-Diff. These bacteria are complicated to treat and have a high potential to cause illness or death. Often with these strains, antibiotics have to be administered intravenously, and the cost of those drugs is usually expensive. 

Bacterial pneumonia is preventable with vaccines such as Prevnar-13 and Pneumovax-23. Together, these vaccines for high-risk individuals will help the body fight off 36 different bacteria that can cause pneumonia. Unfortunately, pneumonia is a leading cause of illness, hospitalization, and death in older people. 

Some common bacterial infections seen in nursing homes are urinary tract infections, skin or soft tissue infections, and respiratory infections. 

How Do Nursing Homes Prevent Infections? - What should visitors to nursing homes know about their role in infection control?

We are all involved in the prevention, whether we are healthcare workers, consumers, or families. Standard Precautions refers to the practice of treating all patients safely with the use of effective hand washing and consistent use of single-use gloves. 

If your loved one has a sign posted outside the room, read it, and follow the instructions. Address the charge nurse with any questions. If your loved one is on "precautions," it is because they can infect other people. Nursing homes typically enact "Contact Precautions" in addition to "Standard Precautions." Personal Protective Equipment (PPE) should be available to any visitors who wish to enter an isolation room, and gel sanitizers for hands should be available as well. 

Nursing home skilled nursing staff should receive ongoing education about prevention and competency evaluations by the IP in the facility. 

  • Before performing patient care, staff should be washing hands. 
  • Employees must clean their hands before and after using gloves. 
  • Gloves should be used only once for one patient, as should gowns. 
  • Trashcans and linen hampers should be located inside the room to prevent PPE from moving into the rest of the unit. 
  • Most importantly, anyone who is sick, even a little bit, should refrain from entering a nursing home. Staff and visitors who are ill are risking everyone else's lives and must stay home. 

Families and visitors are vital to our residents' well-being, and we would never seek to discourage visits; however, keeping your loved one and everyone else safe is a senior care facility's main priority. By only visiting while you're well and using PPE as directed, visitors can keep their family members safe and everyone in their community. 

Visit the following links for more information about infection prevention in nursing homes: