Columbus, OH - Results of a statewide study conducted in Minnesota nursing homes revealed that most institutions fulfilled state infection-control (IC) requirements such as documentation of employee illness and tuberculosis skin testing. However, state statutes define only a few relevant policies, most dealing with public health issues or sanitation practices such as water temperatures. In the of standards similar to those are available in acute-care hospior even relevant studies of the issue, it is difficult to assess nursing IC practices.
Crossley et al mailed IC questionnaires to 440 Minnesota nursing homes and received responses from 378 (85.9%), most of them completed by the director of nursing. Mean number of beds in the sample was 107, with a range from 9 to 406. Most of the homes were licensed as both skilled and intermediate care facilities.
Unlike acute care institutions, nearly one third of the respondents reported that health histories were not a prerequisite of employment. While mandated written protocols for managing employee illness or accidents were in effect in most of the nursing homes, the content tended to be inconsistent with current practices (eg, employees with diarrheal illness working with residents). Likewise, management of indwelling urinary catheters tended to be at variance with recommendations of the Centers for Disease Control. Another deviance from current practice was the importance respondents attached to surveillance, rather than the teaching of IC policies and procedures.
In recommending that more nursing home IC studies be undertaken, the authors conclude that the development of IC policies and practices will reduce the occurrence of these infections and the associated costs.
Underlining the need for studies on IC in nursing homes, Smith makes the following suggestions in the absence of these much needed data:
* Vaccinate for influenza and pneumonia.
* Treat tuberculosis skin-test reactors with isoniazid.
* Provide a comprehensive employee health program that includes annual tuberculosis screening, immunization, and work restrictions for sick employees.
* Ensure adequate handwashing facilities.
* Isolate patients with communicable diseases.