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Editor’s note: The Caregiving Chronicles blog has partnered with Century Health Systems to bring additional expert information and advice to the MetroWest caregivers we strive to serve at CaregivingMetroWest.org.

Century Health Systems, the parent corporation of Distinguished Care Options and the Natick Visiting Nurse Association, has allowed Caregiving Chronicles to get some valuable insight from its staff for our ongoing series of Q&A sessions with caregiving experts. In this entry, we cover what caregivers should know about infection control in the home. Providing insight is Judith Boyko, MBA, MS, RN, who has served as the CEO of Century Health Systems since it was established in 2001, and Jean Sniffin, RN.

Boyko holds a Bachelor of Science degree in Nursing from the University of Pittsburgh, a Master of Science in Public Health from the University of Massachusetts, Amherst and a Master of Business Administration from Clark University. She has been recognized by the Home & Health Care Association of Massachusetts as Manager of the Year in 1997 and received the Deborah Blumer Community Health Leader Award from the MetroWest Community Health Care Foundation in 2007.

Sniffin is a Public Health Nurse for Century Health Systems and Natick Visiting Nurse Association. Jean regularly teaches on the topic of infection control.

The kitchen. The bathroom. The bedroom. Germs are lurking everywhere. So how do we minimize infections from them?

Caregiving MetroWest: What is infection control and why is it important?

Boyko: Infection control, as defined by the World Health Organization, aims to “ensure the protection of those who might be vulnerable to acquiring an infection both in the general community and while receiving care due to health problems, in a range of settings.”

In the home care setting, the biggest issue when it comes to infection control is preventing caregivers from catching an infection that affects the patient and, conversely, protecting the patient from an infection a caregiver may have. If patients have any illness that compromises their immune systems (patients who are post-operative are more susceptible), they are at risk of infection.

CGMW: What are some of the common infections to guard against and the best ways to do that?

Boyko: In elders, the most common are respiratory and GI infections. Respiratory infections include pneumonia, colds, the flu and bronchitis and can be limited by:

•    Covering coughs and sneezes with the inside of an elbow rather than a hand;
•    Handwashing! Handwashing! Handwashing!; and
•    Not sharing towels or cups in the bathroom and not sharing utensils at meal time.
Gastrointestinal (GI) infections, which include food-borne illnesses like salmonella, e-coli and Hepatitis A, are also very common and can be avoided by taking the proper precautions:

•    Careful food prep
•    Proper food storage
•    A clean environment
•    Sanitized surfaces

Other ways to guard against common infections include the following measures, which are especially pertinent to home care workers who see many patients over the course of their day as well as family caregivers.

•    When working with a patient, keep linens and clothes at an arm’s length; this minimizes the chance of getting infectious matter on your own clothing.
•    Put on an old, large shirt over your clothes that you can then take off easily and put in washer; it creates a barrier between caregiver and patient.
•    Long hair should be pulled back so it’s not touching a patient with an infection.
•    If possible, leave outside shoes at the front door or outside the patient’s room to keep the outside germs where they belong: outside. Alternatively, disposable booties also prevent outdoor germs from contaminating the home.
•    Handwashing, again. We can’t stress this enough. Use regular pump soap (bar soap holds germs) that’s either regular or anti-microbial. Skip the anti-bacterial, since most of what makes us sick is viral, rendering anti-bacterial soap useless.
•    Surface cleaning:
– Use a diluted bleach solution after you’ve washed any surface with soap and water.
– If you use a commercial product like Lysol or Clorox, be sure to read the label on proper usage, and DO NOT mix solutions. For example, if you mix bleach with Windex, the result is a mixture of very noxious fumes that can cause you to pass out.
– Finally, be sure to read all labels before use to make sure you’re using the right cleaning solution for the particular germs you are trying to eradicate.

•    Finally, a few other steps to take to protect the caregiver and the patient:
– Wash hands and wear protective gloves.
– Wear personal preventive equipment like a face mask (which can be purchased at hardware or drug stores) or gloves. Use double-lined trash baskets to prevent contents like wound dressings or clothes that have blood on them from spreading germs.

CGMW: Are there specific issues or concerns for older adults when it comes to infections?

Boyko: The elderly are particularly vulnerable to infection because of their weakened, aged immune systems. Here are some of the most common infections they experience:

•    GI infections, as we mentioned earlier, can cause a variety of symptoms, including nausea, abdominal pain or diarrhea.
•    UTIs, or urinary tract infections, are also very common. Several factors, like catheter use and diabetes, contribute to UTIs in older adults. Antibiotics can be used to clear the infection, but with symptoms like confusion, increased dementia or urinary incontinence, it’s best to prevent them from happening in the first place.
•    Another type of infection common in older adults is the infection of the skin and other soft tissue. Because older adults’ skin heals more slowly than that of their younger counterparts, and because disease can creep into a wound, older adults are susceptible to skin infections. Here, again, is where proper handwashing comes in, as well as good overall hygiene.

•    Finally, bacterial pneumonia is another common infection seen in older adults, According to the American Lung Association, “Streptococcus pneumoniae or pneumococcal pneumonia is the most common cause of bacterial pneumonia acquired outside of hospitals.  The bacteria can multiply and cause serious damage to healthy individual lungs, bloodstream (bacteremia), brain (meningitis) and other parts of the body, especially when the body’s defenses are weakened.”

In fact, in the “Older Adults” section of its website, the New York Times indicates that between 350,000 and 620,000 elderly are hospitalized each year because of pneumonia that’s acquired within the community setting. “Older adults have lower survival rates than younger people. Even when older individuals recover from CAP, they have higher-than-normal death rates over the next several years. Elderly people who live in nursing homes or who are already sick are at particular risk,” the website says.

CGMW: What should a caregiver know about infection control when caring for an older adult?
 When caregivers follow appropriate precautions like collecting, storing and disposing of waste and other medical supplies properly; disinfection and sterilization of equipment; practicing proper hygiene; and using protective equipment like disposable gloves and face masks when necessary, the chance of getting or spreading infection is very low.

CGMW: What are the different risks of infection and ways to fight them for someone living in a long-term care facility vs. someone living at home?
 All infection control measures at home must be more rigorous in long-term care facilities, simply because of the quantities of people. Additionally, older residents who have other existing health conditions combined with an overuse of anti-microbial products create a unique environment in which to control infection. The U.S. National Library of Medicine’s National Institutes of Health says that overuse of antimicrobial products can have significantly negative outcomes for patients, including “ drug interactions, adverse drug events, development of antimicrobial resistance and excessive preventable costs,” according to the website.

The most appropriate measures that minimize infection among long-term care facility residents include ensuring that their immunizations are current; practicing good hygiene and washing hands; and allowing for optimal ventilation. Why? Because germs thrive on warm, still air. With good ventilation – open windows, for example – bacteria have less of a chance to multiply and create new or worsen infections.

CGMW: What are some of the strategies for controlling infections in different parts of the home, such as the bathroom and the kitchen?
 In the kitchen:
•    Faucet handles are the dirtiest place in the kitchen and bathroom – dirty hands turn the faucet on. Wipe down your faucets often.
•    Cutting boards are #2 on the dirty list. The tiny cracks on wood or plastic boards can harbor germs. Wash in dishwasher or microwave after every use. Consider using a glass cutting board to avoid making cracks with knives.
•    If you use a sponge, wash it at least twice per day in the dishwasher or microwave.
•    NEVER let meat juices contaminate surfaces or other foods. Use a plate under the meat- and even on top of a cutting board – and either use disposable gloves, or vigorously wash your hands after handling.
•    Use only antimicrobial soap, as many disease-causing germs are not bacteria.
•    When shopping, buy meat last, and put in plastic – away from other foods. AVOID THE DRIP!
•    Grocery shop just before you go home to avoid prolonged time away from refrigeration.
•    Sanitize all surfaces with sudsy water and a few drops of chlorine bleach. Don’t forget to also wash handles and knobs.
•    Clean sweep the refrigerator once a week. Discard cooked food after four days and raw poultry and ground meat after two days.
•    Use a food thermometer to check the internal temperature of meat being cooked. It should be a minimum of 145 degrees.
•    RINSE ALL fruits and vegetables before cutting so you don’t transfer surface germs to the inside while cutting into the food.

In the bathroom:
The bathroom can be a breeding ground for infection. Believe it or not, the toilet isn’t the only culprit. The floor, the shower and the sink also contain germs. Unfortunately, many of these germs can cause infection:
•    Food contaminants like e-coli and salmonella (which are present in feces) are spread by contaminated foods and can cause severe diarrhea.
•    Staph bacteria, which live on the skin, can be carried by an individual without knowing it. Staph can also live on clothing, bedding and towels, making it very easy to spread the infection. Symptoms of staph, according to Mayo Clinic, can include skin infections, food poisoning, bacteremia (blood poisoning), toxic shock syndrome and septic arthritis.
•    Different types of fungus live on bathroom floors. One common cause of this fungus is athlete’s foot. Other fungus that lives on shower walls can make allergy and asthma symptoms more severe.

The following tips will help you minimize the chance of infection from bathroom germs:
•    Flush the toilet with the lid down. Did you know that flushing the water creates particles that can then spread all over the bathroom?
•    Don’t share toothbrushes. Why? Because germs from your mouth – like saliva, plaque and even blood – can contaminate a toothbrush and be passed to another user.
•    Clean surfaces with a solution that is meant for the type of germs that lurk in the bathroom. It’s always a good idea to wipe down all surfaces, including the toilet, the sink, faucet and door handles, the floor, the shower/tub and countertops.
•    Wash your hands! This rule applies to everyone in every room!
•    Finally, Safety.com recommends the following to minimize infection:
– Never share razors
– Don’t walk barefoot on the bathroom floor; athlete’s foot is caused by germs on the floor.
– If there’s water on the floor, clean it up with tissues or paper towels.
– Since bacteria thrive in moist environments, keep the bathroom as dry as possible.

CGMW: Is there anything else about infections and infection control that you want to mention?
 THE most important for a home-based caregiver is to take care of themselves. They get run down, and everything else comes down with them.

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