Long Term Care

Reducing HAIs and Improving LTC Resident Health

More than 5 million Americans reside in nursing homes, skilled nursing facilities and assisted living facilities. These long-term care facilities (LTCFs) provide a variety of services, both medical and personal care, to people who are unable to manage independently in the community. Data about infections in LTCFs are limited, but the most recent statistics in medical literature estimate:

  • 1 to 3 million serious infections occur every year in LTCFs.
  • Infections include urinary tract infection, diarrheal diseases, antibiotic-resistant staph infections and many others.
  • Infections are a major cause of hospitalization and death; as many as 380,000 people die of infections in LTCFs every year.

Common infections in long-term care settings are becoming more difficult to diagnose. This longer process can lead to multiple issues for residents, including ongoing discomfort, chronic poor health and a higher risk of hospitalization or even death. Unfortunately, one-third of all deaths in seniors result from infectious diseases, according to the American Academy of Family Physicians. Seniors are more susceptible to infection due to a weakened immune system, and seniors with dementia may be at even greater risk.

This life-threatening epidemic demonstrates the need for improved infection control in healthcare facilities. Although significant progress has been made in preventing healthcare-associated infections (HAIs), additional steps need to be taken to control and mitigate this high risk of infection. HAIs are preventable and often caused by poor facility conditions or human error. The Centers for Disease Control and Prevention research shows that when facility staff and vendor employees are aware of infection problems and take specific steps to prevent them, HAI rates can decrease by more than 70 percent. Successfully decreasing HAI rates involves all departments working together toward improving care, protecting patients and saving lives.

Lacking infection control training LTCFs are required to maintain infection control and prevention programs to comply with federal regulations. The expectations for those programs are outlined in the Centers for Medicare and Medicaid Services’ Interpretive Guidance for Infection Control. Unfortunately, most LTCFs lack adequately trained and committed personnel to fulfill all the infection control needs.

A New Hampshire study found that there are 75 percent fewer Infection Preventionists (IPs) in long-term care facilities than in acute care facilities. More commonly, the IPs in LTCFs have multiple responsibilities and can only devote limited time to infection prevention practices. According to the same study, only 10 percent of the assigned Infection Preventionists in LTCFs have any specific Infection Control Prevention training, whereas 95 percent of acute-care IPs have the appropriate training.

A LTCF can implement a facility-wide training model that can be accessed by vendors 24/7 to ensure that the staff is well-educated to make a difference and improve patient care. Address issues that healthcare staff members encounter on a daily basis to eliminate reoccurrence. Every vendor employee that enters the facility should have completed the training courses and learned about their role in HAI prevention.

Reducing HAIs in LTCFs provides multiple benefits to residents, staff and vendors, including healthier residents, happier resident families, less disruption and financial burden for families of residents and stabilized financial benefit for the facility.

Transmitting infections The two most common mechanisms of infection transmission in a long-term care facility involve direct contact via person-to-person or contaminated objects. LTCFs provide an ideal environment for acquisition and spread of infection. LTCF residents are more susceptible to infection when sharing sources of air, touchable surfaces, food and healthcare in a crowded institutional setting.

Many pathogens associated with HAIs survive on various surfaces such as common area furniture, remotes and light switches. As a result, frequently touched surfaces play a key role in transmitting infections between persons. The disinfection of surfaces is vital in infection prevention planning.

Moreover, visitors, staff and residents constantly come and go throughout the facility, increasing the likelihood of bringing in contaminated pathogens from outside sources. Reducing the number of entrances that staff, families and vendor employees use to enter a LTCF will minimize the risk of spreading potential bacteria to residents inside.

In addition, lack of proper use of disinfectants can also mean dangerous fungi and bacteria are not killed. Chemicals designed for disinfecting require different “dwell” times, or the amount of time the chemical agent must remain wet on a surface to be effective in eliminating the pathogens. Proper application requires training and then additional reinforcement of training to assure an effective kill-rate.

Prolonged lengths of stay, limited capacities for diagnosis and ineffectual infection-control programs often allow outbreaks to propagate and persist for many months. The transfer of infected or colonized residents, which is a common occurrence, may export outbreaks to other facilities, including hospitals and medical centers.

Improving facility profits In addition to providing quality needs to the residents, long-term care facilities must thrive financially. A healthy bottom line for care providers means adequate staffing, healthy facilities and effective programs for the residents. Unfortunately, reimbursement programs have been cut so drastically that financial survival has to be the first focus for LTCFs.

Financial stability of a LTCF can mean the difference between an improved lifestyle for residents versus a questionable environment and negative outcomes. There are not credible statistics supporting the difference between profit versus loss and how residents benefit from a well-managed and profitable facility. Even non-profits that are financially healthy mean improved facilities, happy residents and a positive workforce.

The most common areas where LTCFs spend money that is beneficial to the residents are:

  • Hiring and maintaining additional staff members
  • Education programs for staff improvement
  • Repairs to facilities for safety and comfort
  • Environmental issues

One loosely defined study makes the case for non-profit long-term care facilities providing more hours of attendant focus per resident versus for-profit facilities. The report also attempts to make the case for improved outcomes and fewer deaths. However, when closely reviewed, the infection rate in for-profit facilities was less, even though the age of the resident was older when compared to a non-profit facility.

Based on my personal experience in all types of nursing home facilities, I have found the financially stable non-profits and for-profit are basically the same. Both have visibly cleaner, healthier facilities, along with staff members that follow a plan for patient care.

Facilities in financial trouble due to older buildings, a high percentage of resident dependency on government reimbursements and high employee turnover rates suffer when it comes to offering quality care.

Conclusion Combating HAIs requires concentrated efforts by all LTCF personnel and its outside vendors. Taking a multidisciplinary approach to manage HAIs can mitigate the risk of spreading life-threatening infections. Proactive risk management can decrease HAI rates, improve patient satisfaction scores–and most importantly–save patient lives.

Author: Thom Wellington. Article used with permission. Thom is the co-founder of Infection Control University.


About E-Mist E-Mist helps healthcare organizations prevent and reduce HAIs. Founded on a legacy of electrostatic science and technology, the E-Mist Infection Control System and Process eliminates traditional disinfectant methods. The EM360 System is mobile, touchless, safer, cordless, and more cost-effective approach to environmental surface disinfection. E-Mist makes disinfection better, easier and more cost effective.

E-Mist Selected: Top Innovation of the Year

E-Mist's Technology, used in the control and prevention of the 1.7 million healthcare-acquired infections in U.S. hospitals, receives Top Innovation of the Year Award. E-Mist announced today that InfectionControl.tips (ICT), an internationally recognized Pan-Access collective, has selected the company as a Top Innovation of the Year. ICT is dedicated to infection control and prevention and actively publishes peer-reviewed research articles and perspective pieces focused on the topics of infection control and prevention.

ICT selected E-Mist on the basis of exceptional innovation. The highly sought after awards, which are given out annually, are based on innovation and breakthrough technology.

“We are very proud of our organization and our ability to save lives, improve outcomes, and reduce costs through effective environmental surface disinfection,” stated Joshua Robertson, President of E-Mist. “Those involved in the prevention and control of preventable infections require a balanced approach of cost and quality to improve outcomes. Existing healthcare disinfection methods including wipes, spray and wipe, fogging, misting, and UV lighting are ineffective or expensive. As environmental surface contamination and healthcare-acquired infections have become more defined, the E-Mist electrostatic disinfection application system presents an effective, approved, and cost effective alternative to health care facility disinfection procedures.”

According to George Robertson, Chairman of E-Mist, “Studies have shown that less than 50% of environmental surfaces in patient care rooms are properly cleaned and disinfected. Evidence strongly suggests that cross contamination of microorganisms from environmental surfaces is directly related to patient infections. High-touch surfaces such as bed rails, bed surfaces, tables, fluid poles, doorknobs, and supply carts have all been identified as having the greatest potential for transmission of pathogens. Current cleaning/disinfecting methods and procedures are critical, yet, 100,000 people will die this year directly attributable to HAIs. Housekeeping is allocated insufficient time for cleaning/disinfecting resulting in inadequate chemical disinfection contact time as specified on disinfectant product labels. E-Mist helps healthcare organizations prevent and reduce HAIs. Founded on a legacy of electrostatic science and technology, the E-Mist Infection Control System eliminates traditional disinfectant methods by providing a mobile, touchless, safer, and more cost-effective approach to environmental surface disinfection. E-Mist helps hospitals and other healthcare institutions break the chain of pathogen mobility.”

“Electrostatics has been around and used for decades in the automotive, agriculture, inkjet and photocopier industries,” said Brandi Whitely, Infection Control Specialist of E-Mist. “Electrostatics is easily understood: opposite charges attract and like charges repel. Two positively charged things ( + and + ) will repel each other. Two negatively charged things ( – and – ) will repel each other. Using this natural electrostatic phenomenon, E-Mist developed and patented a breakthrough disinfectant application technology and system. The E-Mist Electrostatic Systems place a positive ( + ) charge on the liquid droplets as they leave the spray nozzle. The dispersed droplets spread out more evenly and seek out a negative ( – ) or neutrally charged surface. The end result is that the disinfectant is more targeted, provides more uniform coverage with less waste, and like a magnet, attracted to a surface with remarkable force.”

Healthcare-Acquired Infections (HAIs) Environmental surface disinfection can impact both HAI and patient perceptions. With more than 700,000 HAI events and nearly 100,000 HAI deaths in the U.S. each year, E-Mist is dedicated to mitigating risk and reducing the number of preventable HAIs that unnecessarily endanger patients.

Key HAI Facts (World Health Organization)

  • Health care-associated infections, or infections acquired in health-care settings are the most frequent adverse event in health-care delivery worldwide.
  • Hundreds of millions of patients are affected by health care-associated infections worldwide each year, leading to significant mortality and financial losses for health systems.
  • Of every 100 hospitalized patients at any given time, 7 in developed and 10 in developing countries will acquire at least one health care-associated infection.
  • The endemic burden of health care-associated infection is also significantly higher in low- and middle-income than in high-income countries, in particular in patients admitted to intensive care units and in neonates.
  • While urinary tract infection is the most frequent health care-associated infection in high-income countries, surgical site infection is the leading infection in settings with limited resources, affecting up to one-third of operated patients; this is up to nine times higher than in developed countries. In high-income countries, approximately 30% of patients in intensive care units (ICU) are affected by at least one health care-associated infection.
  • In low- and middle-income countries the frequency of ICU-acquired infection is at least 2─3 fold higher than in high-income countries; device-associated infection densities are up to 13 times higher than in the USA.
  • Newborns are at higher risk of acquiring health care-associated infection in developing countries, with infection rates three to 20 times higher than in high-income countries.

The Impact of Healthcare-Acquired Infections (World Health Organization) As is the case for many other patient safety issues, health care-associated infections create additional suffering and come at a high cost for patients and their families. Infections prolong hospital stays, create long-term disability, increase resistance to antimicrobials, represent a massive additional financial burden for health systems, generate high costs for patients and their family, and cause unnecessary deaths. Such infections annually account for 37,000 attributable deaths in Europe and potentially many more that could be related, and they account for 99,000 deaths in the USA. Annual financial losses due to health care-associated infections are also significant: they are estimated at approximately €7 billion in Europe, including direct costs only and reflecting 16 million extra days of hospital stay, and at about US$ 6.5 billion in the USA.

About E-Mist Innovations E-Mist’s patented electrostatic disinfectant application systems improve outcomes, save lives, and reduce costs through effective environmental surface disinfection. Using the E-Mist System and Process, users can kill up to 99.999 percent of pathogens, reduce labor costs up to 45 percent, and reduce chemical costs as much as 50 percent. Headquartered in Fort Worth, Texas, E-Mist is focused on improving the ability of professionals to stop the unnecessary spread of sickness and infection.

Creative Solutions In Healthcare Selects E-Mist Innovations To Achieve SanoTech 360™ Certifications

[et_pb_section bb_built="1" admin_label="section" fullwidth="on"][et_pb_fullwidth_post_title admin_label="Fullwidth Post Title" title="on" meta="on" author="off" date="off" categories="on" comments="off" featured_image="on" featured_placement="below" parallax_effect="on" parallax_method="on" text_orientation="left" text_color="dark" text_background="off" text_bg_color="rgba(255,255,255,0.9)" module_bg_color="rgba(255,255,255,0)" title_all_caps="off" use_border_color="off" border_color="#ffffff" border_style="solid" /][/et_pb_section][et_pb_section bb_built="1" admin_label="Section" fullwidth="off" specialty="off"][et_pb_row admin_label="Row"][et_pb_column type="4_4"][et_pb_text admin_label="Text" background_layout="light" text_orientation="left" use_border_color="off" border_color="#ffffff" border_style="solid"] New standard in surface management and infection prevention achieved for the first time in the aging-adult services industry. Traditional cleaning and disinfecting processes have been found to introduce unnecessary cost and spread the risk of infection.

Creative Solutions In Healthcare, a top 50 US skilled nursing facility company, has fully adopted and incorporated the E-Mist SanoTech 360 certification program. Based on the E-Mist FACTS™ proper surface disinfection protocol and the integration of the patented E-Mist SanoTech 360 Surface Management System™, Creative Solutions In Healthcare certifies the health of surface touch points in its facilities on a daily basis.

The SanoTech 360 certification program is tailored by E-Mist Innovations to meet the unique surface touch point environment of each facility. The key to proper surface disinfection is to address each surface based upon the volume of touches where pathogens can be found or transferred. Creative Solutions In Healthcare is now able to better utilize its existing choice of disinfectants, apply them more comprehensively, quickly, and as frequently as the environment dictates without additional staff or unique infection control skill sets.

“Facility managers and staff are now empowered to be aggressive and more effective in the fight against the spread of sickness and infection from unhealthy touch point surfaces. With the right protocol and the integration of agile and affordable technologies, it becomes a fair fight,” George Robertson, CEO. “Creative Solutions In Healthcare is a leader in quality of life standards for residents and the ability to reach SanoTech 360 certification across the company is something we are very proud to support.”

About E-Mist Innovations E-Mist Innovations, Inc. is a Fort Worth, Texas headquartered industry leading developer and designer of innovative infection prevention and surface management systems and protocols. Winner of the recent Tech Fort Worth IMPACT award, E-Mist offers the SanoTech 360 Surface Management System and facility certification program to satisfy the FACTS™ surface disinfection protocol for both simple and complex environments alike.

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